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.
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Browse RAND Analyses of Health Care Legislation, Policies, and Proposals
Aug 10, 2018
Starting in 2019, the Affordable Care Act's individual mandate penalty will be eliminated, effectively ending the law's requirement that most people have health insurance. While declines in coverage and increases in premiums are likely, the magnitudes of these effects are highly uncertain.
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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.
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.
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.
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.