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

  • Report

    Tax-Based Health Care Subsidies: Three Approaches

    Jul 13, 2017

    When comparing different approaches to tax-based health insurance subsidies, there are unavoidable trade-offs. But any tax-based subsidy that increases health insurance enrollment is likely to increase health systems costs.

  • Announcement

    Health Care Economist Christine Eibner Appointed to Endowed Chair at RAND Corporation

    May 4, 2017

    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.

  • Report

    The Effects of the American Health Care Act

    May 3, 2017

    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.

  • Report

    Examining the Implementation of the Medicaid Primary Care Payment Increase

    Apr 4, 2017

    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.

  • Report

    Oregon's Options for Financing Health Care

    Jan 19, 2017

    Federal health care reform had just begun in 2013 when Oregon authorized a study to improve how the state pays for health care. A comparison of the projected impacts and feasibility of four options can help Oregon's stakeholders choose the option that best suits their needs.

  • Report

    Effects of the ACA's Medicaid Expansion on Health Insurance Enrollment

    Dec 29, 2016

    Increases in insurance coverage were larger in states that expanded Medicaid, but take-up was lower among men, Hispanics, and adults under 36.

  • Journal Article

    Effect of ACA Lactation Support on Breastfeeding

    Nov 28, 2016

    The likelihood that mothers with private health insurance would start breastfeeding increased by 2.5 percentage points after the Affordable Care Act mandated the coverage of lactation support services.

  • Journal Article

    Knowledge About Health Insurance and Finance Linked to Higher Rates of Health Coverage

    Nov 17, 2016

    Uninsured individuals who knew more about health insurance and finance were more likely to gain coverage under the ACA. Policies and programs aiming to reduce the numbers of uninsured should consider the financial literacy and health insurance knowledge of the groups they are trying to reach.

Browse All RAND Research on the Affordable Care Act