U.S. Health Care Policy
The U.S. health care system is in flux. The Patient Protection and Affordable Care Act (ACA), enacted in 2010, remains in force. But from its inception, the law has faced strong opposition.
Congress must decide whether to eliminate the ACA and replace it with a different system, or change the ACA to meet different political goals. Extensive RAND research offers insights about the likely impact of repealing or revising the ACA along key dimensions, including Medicaid, the individual mandate, effects on employers, tax subsidies, changing rate regulations, and essential health benefits. We have also explored effects of alternatives to the ACA, including a single payer system.
In a recent analysis, a health policy expert steps back to consider what the basic ingredients are for health care reform.
Browse RAND Analyses of Health Care Legislation, Policies, and Proposals
Jun 1, 2017
Policy discussions of single-payer health system proposals need to account for the substantial variation in how they would change the financing, pooling, purchasing and delivery of health care.
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Christine Eibner, a senior economist who has led influential work on how to improve the nation's health care system, has been appointed to the RAND Corporation's Paul O'Neill Alcoa Chair in Policy Analysis.
RAND researchers used the RAND Health Care Payment and Delivery Simulation Model (PADSIM) to estimate how sensitive physician behavior is to the design of alternative payment models under the Medicare Access and CHIP Reauthorization Act (MACRA).
The American Health Care Act would have reduced insurance enrollment by an estimated 14.2 million people in 2020 and by 19.7 million people by 2026. The uninsured would have been older, sicker, and poorer than those currently uninsured. Also, the AHCA would have increased the deficit by $38 billion in 2020 while reducing it by $5 billion in 2026.
The Affordable Care Act authorized short-term, enhanced payments for qualifying primary care providers participating in Medicaid. Challenges with implementation, short timelines, and the need for new or adapted payment systems limited the policy's impact.