The Affordable Care Act

The Patient Protection and Affordable Care Act (ACA)—aka Obamacare—was intended to reduce the number of uninsured, make coverage more affordable, and expand access to care. The Act expanded eligibility for Medicaid and created new market places where people without employer coverage could buy policies direction from insurers.

The ACA also mandated new approaches to reducing costs and improving quality, including reducing payments to hospitals for some Medicare services and experimenting with new payment and delivery models.   To understand the impact of these features and to monitor the overall effects of the ACA, RAND used COMPARE, a microsimulation model that allows us to estimate how proposed changes will affect key outcomes, including health coverage, employer-based insurance, consumer costs, and government spending.

RAND continues to use COMPARE to assess proposed revisions to the ACA. We also use a complementary model—Health Care Payment and Delivery Simulation Model (PADSIM)—to better understand provider responses to changes in payment policy.

The Affordable Care Act in Depth

What's Hot Now

  • Stethoscope on insurance policy with medical insurance, selective focus, photo by sodawhiskey/Adobe Stock


    Effects of Alternative Insurer Responses to Discontinued Federal Cost-Sharing Reduction Payments

    Jun 3, 2019

    Under the Affordable Care Act, insurers are required to offer cost-sharing reductions (CSRs). The federal government is no longer covering these insurer costs, so most states and insurers have increased the costs of silver premiums. What are the potential effects of a policy change that would disallow this practice?

  • West Virginia flag waving in the wind, photo by bkindler/Getty Images

    Journal Article

    The Affordable Care Act in the Heart of the Opioid Crisis: Evidence from West Virginia

    Apr 4, 2019

    The growing use of medication treatment for opioid use disorder in the West Virginia Medicaid expansion population provides an opportunity to reduce overdose deaths.

  • Nurse helping mother patient fill out paperwork in clinic waiting room

    Journal Article

    Expanding Enrollment Without the Individual Mandate

    Dec 27, 2018

    Recent changes to the Affordable Care Act, including the elimination of the individual mandate penalty, may reduce enrollment in the individual market. But even with these changes, options exist for increasing health coverage.

  • Two male doctors talking in a hospital corridor


    Physicians Need Time to Adapt to Changing Payment Models

    Oct 24, 2018

    It is difficult for physicians to keep up with changing payment models, navigate complexity, and invest in data and reporting. Slowing the rate of change and simplifying payment models can help physicians improve patient care and earn financial benefits.

  • Women hugging in a group therapy session

    Journal Article

    Keeping Young Adults Insured Means More Mental Health Care

    Sep 21, 2018

    Lack of insurance has been a barrier to mental health treatment for young adults. The ACA's Dependent Care Expansion, which allows them to stay on their parents' policies until age 26, has increased use of mental health care among this high need group—without affecting quality of care or disparities in access.

  • Nurse introducing a patient to a doctor in hospital waiting room


    Impacts of Eliminating the Individual Mandate Penalty in New York

    Sep 20, 2018

    In 2019, the ACA's individual mandate penalty will be eliminated. How will this affect New York's nongroup insurance market? It could result in an estimated 23 to 25 percent increase in premiums and a 37 percent reduction in enrollment.

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    Journal Article

    Evaluating the CARE Act: Implications of Repealing and Replacing the Affordable Care Act

    Aug 23, 2018

    Policymakers seeking to adopt the CARE Act, or pursue a similar repeal-and-replace policy, may need to maintain some of the ACA's revenue-generating provisions, adopt alternative revenue-generating provisions, or reduce the generosity of tax credits to achieve budget neutrality.

  • Close up of calculator buttons for tax increase or tax decrease with blurred American dollars in the background

    Journal Article

    The Effect of Eliminating the ACA's Individual Mandate

    Jul 12, 2018

    Removing the financial penalties associated with the Affordable Care Act's individual mandate may cause enrollment to fall by 2.8 million to 13 million people. It could also result in a 3 to 13 percent increase in bronze plan premiums.

Browse All RAND Research on the Affordable Care Act