Affordable Care Act

Featured

Through a number of provisions—such as individual and employer mandates, health insurance exchanges, and the expansion of Medicaid—the Patient Protection and Affordable Care Act (ACA) aims to expand access to health care for uninsured Americans. RAND has examined implementation challenges, cost and coverage implications, Medicaid expansion, state health insurance exchanges, and reforms to both care delivery and payment.

  • Patient at a medical clinic filling out paperwork, photo by Dimensions/Getty Images

    Report

    How to Prevent Health Insurance Loss During Future Recessions

    Nov 12, 2021

    The pandemic–related recession and job loss raised concerns that millions of Americans would lose their health insurance. But temporary aid to protect coverage prevented that from happening. Making the enhanced marketplace tax credits in the American Rescue Plan permanent could keep coverage stable in future recessions.

  • A woman using an inhaler and holding her chest, photo by PeopleImages/Getty Images

    Commentary

    The Importance of Getting the Affordable Part of the Affordable Care Act Right

    Jun 17, 2022

    The ACA's expansion of Medicaid and the marketplaces that sell subsidized policies have helped decrease the uninsured rate. Research on being underinsured shows that affordability at the point of care is central to keeping people healthy. For example, a new study found a significant relationship between having health insurance and better asthma control.

Explore Affordable Care Act

  • Doctor explaining diagnosis to her female patient

    Commentary

    Exchange Tax Credits or Employer Coverage: What's Better for Low-Income Americans?

    As the King v. Burwell case approaches, there's likely to be more discussion about potential modifications to the ACA's tax credit structure. Policymakers might consider whether there are opportunities to level the playing field for low-income workers, regardless of whether their employers offer insurance.

    Feb 12, 2015

  • A reporter reads a summary of the performance and usage of the Massachusetts ACA health insurance exchange, Boston, November 17, 2014

    Commentary

    Open Enrollment, Take 2: What Matters for the ACA Marketplace?

    As the Affordable Care Act's second open-enrollment period draws to its February 15 close, relatively few of the millions of Americans eligible to switch plans have revisited their options. What actions can be taken to ensure that people know they have the right to a new choice each year?

    Feb 11, 2015

  • Friends taking a selfie

    Research Brief

    How Does Enrollment of Young Invincibles Affect Premiums in the ACA Individual Market?

    Using the COMPARE microsimulation model, researchers estimated the effects of reduced enrollment of young adults (invincibles) in the individual health insurance market. Results indicate that reduced enrollment of invincibles is associated with only modest premium increases.

    Feb 5, 2015

  • Congressional Briefing Podcast

    Multimedia

    Premium Tax Credits and the Affordable Care Act: The Potential Ramifications of King v. Burwell

    In this February 2015 Congressional Briefing, Christine Eibner discusses the role of premium tax credits in ensuring stability in the individual health insurance marketplace and the ramifications of King v. Burwell on the Affordable Care Act.

    Feb 3, 2015

  • A patient and counseling professional shake hands

    Research Brief

    Improving Outcomes for Substance Use Patients: Quality Measures May Be Necessary

    The Affordable Care Act significantly increases coverage for substance use treatment, but it does not define quality measures—which are essential to monitoring and improving treatment. Thus, increased coverage may not translate into better outcomes unless existing measures are refined and new measures are developed and tested.

    Jan 16, 2015

  • Supreme Court pillars

    Research Brief

    What If King v. Burwell Had Turned Out Differently?

    The Supreme Court has ruled that the Affordable Care Act's subsidies can continue in all states. According to RAND research cited in the court's majority opinion, a different outcome could've resulted in higher premiums and about 8 million uninsured Americans.

    Jan 16, 2015

  • News Release

    News Release

    Who Pays for Health Care in Vermont Under the Current System

    If Vermont considers further health care reform proposals, legislators might look for opportunities to better align the degree of subsidization available for individuals with similar incomes, regardless of whether they are enrolled on the exchange or in employer coverage.

    Jan 14, 2015

  • A person browsing the HealthCare.gov website on an iPad

    Journal Article

    Consumers Who Buy Subsidized Health Plans May Face Higher Costs in Competitive Markets

    For people who buy subsidized coverage through marketplaces created under the ACA, those who live in areas with more plan offerings may have to pay a higher premium to receive the same deductible when compared to consumers in regions with fewer options.

    Jan 9, 2015

  • News Release

    News Release

    Eliminating Health Insurance Subsidies Will Boost Costs, Cause Millions to Drop Coverage

    Eliminating government subsidies for low- and moderate-income people who purchase coverage through federally run health insurance marketplaces would sharply boost costs and reduce enrollment in the individual market by more than 9.6 million.

    Jan 8, 2015

  • A stethoscope rests on a credit card.

    Report

    A Look at Health Care Spending in Vermont As It Weighs Reform

    Most Vermont residents receive more in health benefits than they pay for directly or through taxes. Those with lower incomes pay less for health care than those with higher-incomes but there is much variation, something legislators may wish to review as they consider implementing universal health coverage.

    Jan 8, 2015

  • Journal Article

    Journal Article

    The Invisible Homebound: Setting Quality-of-Care Standards for Home-Based Primary and Palliative Care

    This article describes the current status of home-based medical care in the United States and offers a brief narrative of a fictional homebound patient and the health events and fragmented care she faces.

    Jan 8, 2015

  • A consumer signs up for health insurance online

    Report

    Eliminating Health Insurance Subsidies Will Boost Costs, Cause Millions to Drop Coverage

    Eliminating government subsidies for low- and moderate-income people who purchase coverage through federally run health insurance marketplaces would sharply boost costs and reduce enrollment in the individual market by more than 9.6 million.

    Jan 8, 2015

  • News Release

    News Release

    Consumers Who Buy Subsidized Health Plans May Face Higher Costs When More Choices Are Available

    For people who buy subsidized coverage through marketplaces created under the ACA, those who live in areas with more plan offerings may have to pay a higher premium to receive the same deductible when compared to consumers in regions with fewer options.

    Jan 6, 2015

  • Affordable Care Act highlighted in the act itself

    Content

    Affordable Care Act

    The Patient Protection and Affordable Care Act (ACA) represents one of the most sweeping reforms of the U.S. health care system ever enacted. RAND’s work on the ACA has focused on four key policy areas: costs and coverage, individual and small business marketplaces, Medicaid expansion, and payment reform and new models of care.

    Jan 2, 2015

  • A doctor consults with his patient

    Journal Article

    The ACA Expands Coverage for Substance Use Treatment, but Will It Improve Quality of Care?

    With increased coverage for treating substance use disorders, the Affordable Care Act presents an opportunity to improve quality of care. However, meaningful quality measures must be developed before patients, their families, and society can benefit from improved treatment.

    Dec 8, 2014

  • Susan Dentzer, Leonard Schaeffer, Sue Siegel, David Goldhill, and Bob Kocher at RAND's Politics Aside 2014

    Blog

    Innovations in Health Care: New Treatments, Changing Systems

    From the Affordable Care Act and new advances in medical technology to the impact of the aging population, panelists at RAND's Politics Aside discussed a wide-range of topics affecting America's health care system today and into the future.

    Nov 18, 2014

  • Doctor with a clipboard and patients in a waiting room

    Commentary

    The ACA's Tax Credits Keep Premiums Low for Everyone

    The ACA's tax credits currently contain several properties that stabilize premiums while providing assistance to low- and moderate-income people. As policymakers contemplate modifications to the ACA that would affect the tax credits, it will be important to consider not only how they affect those who are eligible, but also how they affect premiums for everyone else.

    Nov 10, 2014

  • Doctor and patient shaking hands

    Commentary

    A Case for Exchange-Based, Long-Term Health Insurance Policies

    Multi-year health plans have the potential to finally align the interests of health plan enrollees and insurers by reaping long-term benefits of patient health management.

    Nov 10, 2014

  • News Release

    News Release

    Eliminating Subsidies for People to Buy Health Coverage Would Increase Premiums and Number of Uninsured

    Eliminating subsidies that help low- and moderate-income people purchase coverage through government-run health insurance marketplaces would sharply boost costs for consumers as much as 43 percent and cause more than 11 million Americans to lose their health insurance.

    Oct 21, 2014

  • Close up of young woman using laptop

    Research Brief

    Young Adult Enrollment and the Affordable Care Act

    Reduced young-adult enrollment in the individual health insurance market created under the Affordable Care Act would lead to modest premium increases; however, eliminating tax credits would substantially increase premiums and reduce enrollment.

    Oct 21, 2014

Research conducted by