Affordable Care Act

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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

  • Mother and son at a medical reception desk

    Report

    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 boost costs for consumers as much as 43 percent and cause more than 11 million Americans to lose their health insurance.

    Oct 21, 2014

  • A man looks over the ACA signup page on HealthCare.gov, October 2, 2013

    Commentary

    Happy Birthday, Healthcare.Gov

    This month marks the one-year anniversary of the health insurance Marketplaces—the online exchanges for buying and selling insurance created by the Affordable Care Act. Last year, after a near-disastrous start that included massive website failures, the Marketplaces rebounded to a surprising success.

    Oct 16, 2014

  • Hospital sign in front of hospital building

    Report

    Barriers to Enrollment in Health Coverage in Colorado

    Explores why eligible individuals are not enrolled in health insurance coverage in Colorado and makes recommendations on how Colorado can strengthen its future outreach and enrollment efforts.

    Oct 6, 2014

  • News Release

    News Release

    Federal Drug Discount Program Faces Challenges as It Expands Under Health Reform

    A federal program that provides billions in drug discounts to safety net hospitals and other health care providers is expanding under health care reform, but divergent views on the purpose and future scope of the program create uncertainty for safety net providers and drug manufacturers.

    Aug 12, 2014

  • U.S. Capitol building with summer flowers

    Blog

    Summer Reading for Congress

    No matter how policymakers spend their break—meeting with home-state constituents, traveling abroad with congressional delegations, or spending time with family—this summer reading list contains policy ideas that can help them hit the ground running when they return.

    Jul 31, 2014

  • A pregnant woman in an exam room with a gynecologist and nurse

    Commentary

    RAND Helps to Develop From Coverage to Care, a New CMS Initiative

    Health coverage is a means to an end: the aim is to help more Americans use their coverage to access routine primary care and preventive services. For many of the newly insured, however, the leap between obtaining insurance and establishing a regular source of care is substantial.

    Jul 29, 2014

  • Doctor talking to her male patient in her office

    Commentary

    The ACA's Opportunity to Improve Care for Substance Use Disorders

    The Affordable Care Act (ACA) will significantly increase coverage for the publicly funded treatment of substance use disorders. But in order to maximize the benefit to patients, families, and society, it's critical to invest in the development, validation, and use of performance measures.

    Jul 28, 2014

  • A prescription bottle labeled Affordable Care Act and prescription pad

    Report

    Federal Drug Discount Program Faces Challenges as It Expands Under Health Reform

    A federal program that provides billions in drug discounts to safety net hospitals and other health care providers is expanding under health care reform, but divergent views on the purpose and future scope of the program create uncertainty for safety net providers and drug manufacturers.

    Jul 21, 2014

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    Research Brief

    Will Heath Care Reform Affect Disability Insurance Claiming?

    By enabling access to affordable private health insurance and expanding access to subsidized public health insurance, the Affordable Care Act alters the calculus of disability claiming decisions. Research offers empirical evidence that, on net, disability applications are likely to decrease.

    Jul 10, 2014

  • Events @ RAND Audio Podcast

    Multimedia

    The Affordable Care Act: Change Is the Only Constant

    Listen as Leonard D. Schaeffer, founding chairman and CEO of WellPoint and RAND’s 2014 Williams Laureate, discusses the effects of the Affordable Care Act.

    Jun 12, 2014

  • Journal Article

    Journal Article

    Disproportionate-share Hospital Payment Reductions May Threaten the Financial Stability of Safety-Net Hospitals

    We examined the impact of the ACA's Medicaid DSH reductions on California public hospitals' financial stability by estimating how total DSH costs (uncompensated care costs and Medicaid shortfalls) will change as a result of insurance expansion and the offsetting DSH reductions.

    Jun 1, 2014

  • Arkansas state quarter

    Infographic

    Infographic: How Arkansas May Fare Under the Affordable Care Act

    This infographic presents findings from a RAND analysis of the economic and other effects of the Affordable Care Act on the state of Arkansas.

    May 21, 2014

  • Pennsylvania capitol building

    Infographic

    Infographic: How Pennsylvania May Fare Under the ACA

    This infographic presents findings from a RAND analysis of the economic and other effects of Medicaid expansion on the commonwealth of Pennsylvania.

    May 21, 2014

  • Social secruity card

    Journal Article

    Disability Insurance and Health Insurance Reform: Evidence from Massachusetts

    We study the 2006 Massachusetts health insurance reform to estimate the potential effects of the ACA on SSDI and SSI applications.

    May 1, 2014

  • measuring blood pressure

    Commentary

    Tracking the ACA with the RAND Health Reform Opinion Study

    The HROS uses panel data to track changes in public opinion regarding the Affordable Care Act and insurance coverage. By surveying the same respondents each month, the HROS observes not only aggregate changes, but also individual changes in opinion or insurance coverage over time.

    Apr 22, 2014

  • a doctor discussing a patient's chart on a tablet

    Blog

    RAND Health Reform Opinion Study: Few Changes After Open Enrollment

    At the close of the ACA's open enrollment period, no significant changes in opinion were observed in the RAND Health Reform Opinion Study. This may be because open enrollment has no bearing on the health insurance of many people.

    Apr 16, 2014

  • News Release

    News Release

    Affordable Care Act Could Change Costs for Auto, Malpractice, Other Liability Insurance

    As more Americans become newly covered under the ACA, the cost of providing automobile insurance, workers compensation, and homeowners insurance may decline. But an increase in the number of people using the health care system may trigger an increase in the number of medical malpractice claims.

    Apr 9, 2014

  • Research Brief

    Research Brief

    The Impact of the Affordable Care Act on Liability Insurance

    Summarizes a report that identifies potential mechanisms through which health care reform might affect claim costs for several major types of liability coverage, especially auto insurance, workers’ compensation coverage, and medical malpractice.

    Apr 9, 2014

  • emergency medical services at the scene of an auto accident

    Report

    ACA Could Change Costs of Auto, Malpractice, and Other Liability Insurance

    As more Americans become newly covered under the Affordable Care Act, the cost of providing automobile insurance, workers compensation, and homeowners insurance may decline. Meanwhile, an increase in the number of people using the health care system may trigger a corresponding increase in the number of medical malpractice claims.

    Apr 9, 2014

  • doctor with senior patient

    Commentary

    Survey Estimates Net Gain of 9.3 Million American Adults with Health Insurance

    Early survey evidence indicates that the Affordable Care Act has already led to a substantial increase in insurance coverage. Consistent with the ACA's design, this gain in insurance has come not only from new enrollment in the marketplaces, but also from new enrollment in employer coverage and Medicaid.

    Apr 8, 2014

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