Running head: ADVANTAGES AND DISADVANTAGES OF THE ACA 1

Advantages and Disadvantages of the Affordable Care Act

Overview of the Affordable Care Act

The Patient Protection and Affordable Care Act (ACA) of 2010 remains the most

significant healthcare legislation in the United States since the Social Security Act was passed in

1935. The Affordable Care Act was designed to address the major weaknesses of the U.S.

healthcare system (Bartens, Gill, & Naslund, 2015). In fact, it introduced a number of radical

changes to the healthcare system from the expansion of insurance coverage, amendments to the

protections given to consumers, to the active promotion of preventive care (NCLS, 2020).

Overall, the ACA wanted to transform the healthcare system to improve the affordability and

quality of healthcare. In turn, the ACA introduced value-based care into the U.S. healthcare

service delivery model replacing the fee-for-service model of the past (NEJM Catalyst, 2017). Its

various provisions were created to respond to various shortcomings and failures of the healthcare

system, thus opening a new era of healthcare reform in U.S. healthcare.

Problems with the U.S. Health Care System

Before 2010, the U.S. healthcare system was ranked for access and affordability last

among developed nations (Coghlan, 2017, Hellman, 2014). Primarily, healthcare in the United

States was unaffordable. Data from the World Health Organization identified 72 key

performance indicators across five domains to measure the quality of healthcare systems in

OECD nations (Schneider, Sarnak, Squires, Shah, & Doty, 2017). In contrast to other OECD

nations, the United States was at the bottom of the list for access to care, efficiency, equity, and

several important public health outcomes (Schneider et al., 2017). Conversely, the United States

also spent $235 trillion in 2017, making it the costliest healthcare system among OECD nations

or 16.6 percent of U.S. gross domestic product (GDP) (OECD, 2020). The per capita spending of
2
ADVANTAGES AND DISADVANTAGES OF THE ACA
the United States in 2019 was $11,072 about 30 percent higher than Switzerland that ranked

second in the list (OECD, 2020). Nevertheless, the U.S. ranked fifth in the quality of care

processes after the Netherlands and New Zealand (OECD, 2020). The report suggests that the

U.S. healthcare system had serious cost and efficiencies issues. As a result, these issues have

serious detrimental effects on patient healthcare outcomes and public health.

The most significant problem in U.S. healthcare is accessibility. An estimated 30 to 35

million Americans remain without healthcare insurance and these individuals do not have any

form of healthcare coverage from the state or federal government (DeVoe, 2018). The United

States remains the only developed nation that uses a completely private healthcare insurance

model with the majority of health insurance coverage provided by employers (Millman, 2015).

While American healthcare is one of the most advanced, limited access has created systemic

barriers for improving public health and achieving system efficiency in care delivery.

Aside from access, the U.S. healthcare system suffers from inefficiencies and

misallocation of resources. The WHO report revealed that the United States is the only OECD

nation that overspends on healthcare while simultaneously failing to meet its public health

targets and goals (OECD, 2020). In fact, the United States has the same life expectancy as

Slovenia and Chile in spite of spending 700 percent more than the two countries (Schneider et

al., 2017). This can be attributed to inefficiencies in the system. From a macro perspective, the

U.S. healthcare system is grossly inefficient (Fuchs, 2018, Glied & Sacarny, 2018). Compared to

the U.K. and Switzerland, U.S. health care providers often use interventions that are more costly

(Fuchs, 2018). American physicians are 44 percent more likely to call for an MRI scan as a

routine procedure and are 33 percent more inclined to recommend a cesarean delivery for a non-

complicated pregnancy than doctors in other developed nations (Fuchs, 2018). Inefficient
3
ADVANTAGES AND DISADVANTAGES OF THE ACA
prescribing also drives up the cost of healthcare in the country (Fuchs, 2018). On the contrary,

healthcare service delivery in the United States is comparatively better than other countries

ranking fifth out of 12 OECD countries surveyed by the WHO (Schneider et al., 2017). The

problem seems to lie at the industry level as healthcare providers misallocate resources

prescribing procedures, interventions, and medications that have very little marginal benefit

(Fuchs, 2018).

Finally, the healthcare system suffers from fragmentation and a lack of integrative care

delivery. DeVoe (2018) described how gaps in coverage, a lack of continuity in care delivery

often prevent Americans from receiving preventive care, and continuity of care. For many who

do not have uninterrupted coverage, fragmentation of care often increases the risk for

noncompliance and lack of access to primary care (DeVoe, 2018). The lack of care coordination

among healthcare providers providing care to the same patient undermines the quality of care

and lowers the quality of patient outcomes (Stange, 2019). Gaps in communication, coordination,

and monitoring lead to poorer patient outcomes and it also increases the risk of medical errors

(Stange, 2019). Likewise, the overall lack of care continuity also translates to fewer visits per

year to one’s primary care physician, unequal access to non-urgent care, and overutilization of

emergency medical services, all driving up aggregate costs and increasing the level of

inefficiency in the system.

Changes after the ACA

The ACA recognized the challenges and limitations of the healthcare system and

sought to find ways to improve its efficiency and quality through payment reform and expansion

of access to care. The key provisions of the ACA included the expansion of insurance
4
ADVANTAGES AND DISADVANTAGES OF THE ACA
accessibility, protections and guarantees for coverage, promotion of preventive care, payment

reform, and the shift to a value-based care model.

Health Insurance Coverage

One of the provisions of the ACA was the expansion of health insurance

coverage. The ACA has legally expanded Medicaid coverage to households who earn up to 133

percent of the federal poverty limit (NCLS, 2020). It has also expanded coverage to include

young adults in their parents' plan (NCLS, 2020). The ACA also granted tax credits to small

businesses that provide health insurance to their employees (Blumenthal & Abrams, 2020).

Additionally, it also created mandates to increase the competitiveness of insurance providers

using state and multi-state insurance marketplaces that would promote insurance exchanges.

Finally, the individual mandate of the ACA imposed a penalty on individuals who do not have

health insurance coverage.

More importantly, the ACA increased coverage protection for individuals that would help

more Americans obtain and retain insurance coverage. One of the persistent issues of the U.S.

healthcare system was accessibility (DeVoe, 2018, Millman, 2015, Stange, 2019). The ACA

addressed this by guaranteeing that individuals could not be denied coverage because of

preexisting conditions. Moreover, it bans insurance companies from rescinding or canceling

coverage for individuals except in cases involving fraud (Blumenthal & Abrams, 2020). It also

subjects insurance rate hikes and premium increases to state rate reviews to deter insurance

companies from unfairly raising premiums. The ACA has also prevented insurance companies

from excluding children and minors with preexisting conditions from coverage. Above all, the

ACA would eliminate lifetime monetary caps on coverage as well as annual caps (NCLS, 2020).
5
ADVANTAGES AND DISADVANTAGES OF THE ACA
In all, the ACA’s provisions that change health insurance coverage were designed to

eliminate or minimize the impact of systemic barriers to healthcare access. Many of its

provisions were aimed at removing discriminatory practices in the health insurance system that

excluded individuals because of income, preexisting conditions, and the severity of medical

needs. The ACA aimed to achieve nondiscrimination in the way Americans accessed care and

received health care and mental health care services.

Payment Reform

A second key change in healthcare after the ACA is payment reform. The Centers for

Medicare & Medicaid Services (CMS) handles all reimbursements for government-sponsored

healthcare insurance coverage. Both Medicare and Medicaid reimbursements depend on the

guidelines set by the CMS. Healthcare providers who cater to Medicare and Medicaid

beneficiaries have to comply with the revised reimbursement guidelines and standards of the

ACA. The ACA introduced changes to the traditional fee-for-service (FFS) model for

reimbursements revising the payment rules and rates as well as introducing quality criteria

affecting the reimbursements received by providers (Stone et al., 2014).

Healthcare reform has targeted CMS payment rules as a way to influence quality and

efficiency in healthcare. Instead of paying for every service rendered to the patient, the new

payment provisions include setting a standard rate for conditions, value-based payments, as well

as bundled payments for several conditions (Blumenthal & Abrams, 2020). The changes in CMS

reimbursements since the implementation of the ACA were designed to provide incentives for

improving accountability among providers in addition to integrating measures for quality into the

criteria and conditions for provider payments.

6
ADVANTAGES AND DISADVANTAGES OF THE ACA
After the ACA, CMS payments rules now consider patient outcomes as criteria for

reimbursement rather than simply reimbursing providers for the number of services they

provided (Blumenthal & Abrams, 2020). Both the Hospital Readmission Reduction Program and

the Hospital-Acquired Condition Reduction Program now use a value-based reimbursement

system helping providers wean away from the FFS payment model (Blumenthal & Abrams,

2020). Likewise, the ACA’s provisions on preventive care now increase CMS payments for

preventive care services from 2011 (NCSL, 2020). The ACA has also introduced bundled

payments based on standard care costs. Finally, payment reform has paved the way for the

creation of accountable care organizations (ACO) which receive savings payments when quality

targets are met.

Accountable Care Organizations

One of the new innovations introduced by the ACA is the formation of accountable care

organizations. ACOs are healthcare entities that provide comprehensive care to the patient and

take responsibility for patient outcomes for a specific patient population (Abrams et al., 2015).

ACOs are designed to improve the quality of patient outcomes while improving the allocation of

resources as a means of improving the quality of care (Blumenthal & Abrams, 2020). The CMS

reports that there are currently 558 ACOs as of September 2020, an increase of 29 percent since

2015 (CMS, 2020).

The ACA created the Shared Savings Program to encourage healthcare providers to

create ACOs as an innovation designed to address the issue of cost efficiency and quality of care.

One of the goals of the ACA is to improve the quality of healthcare by reducing waste and

improving resource allocation in healthcare. ACOs adopts an entirely new model for delivering
7
ADVANTAGES AND DISADVANTAGES OF THE ACA
health care. Participating providers in the ACO take responsibility and accountability for the

outcomes of care provided to patients (Abrams et al., 2015).

The ACO framework is completely aligned with the goals and aspirations of the ACA.

ACOs take financial and medical responsibility for care outcomes. ACOs allow healthcare

providers to create a collaborative network that delivers care to patients under their care (Abrams

et al., 2015). These networks coordinate care for a particular health condition instead of passing

this responsibility to the patient. Through the ACO's collaborative network, healthcare providers

are expected to communicate better, more frequently, and more openly. In turn, better

communication would reduce wasteful redundancies, overprescribing, and repeated procedures,

further improving the care delivery and creating cost savings. Overall, ACOs are able to

simultaneously improve patient outcomes while improving communication and streamlining

various processes involved in care delivery.

According to the CMS, the Shared Savings Program now have participants from hospital

networks, clinics, and Skilled Nursing Facilities (SNF) (CMS, 2020). Program participation has

increased steadily over the past decade with an estimated 400 ACOs in 2015 expanding to 558

ACOs in 2020 (CMS, 2020). These ACOs now provide care to 12.3 million beneficiaries (CMS,

2020). More importantly, private health care insurance companies are now encouraging

providers to adopt an ACO model of care. This is because ACOs are reimbursed using a value-

based payment model where healthcare providers are given the opportunity to reduce costs while

being awarded a portion of the cost savings if quality standards are met (Abrams et al., 2015).

The sharing saving model uses a value-based, quality benchmark model to determine if ACOs

meet the qualifications for savings sharing reimbursements. In 2015, 52 ACOs received shared

savings bonuses with Montefiore Medical Center in the Bronx receiving the highest rating for
8
ADVANTAGES AND DISADVANTAGES OF THE ACA
quality in 2015 (Abrams et al., 2015). In all, the ACO model could potentially help create a shift

in the care delivery paradigm used in healthcare and help healthcare providers adopt procedures

and models for care that integrate quality and efficiencies in their care delivery processes.

Changes in Healthcare Workforce

The ACA has introduced sweeping changes in nearly every aspect of the health care

system. Title 5 of the ACA has paved the way for changes and improvements in the workforce

addressing issues of competency, burnout, and career pathways (NCLS, 2020). Title 5 is pushing

for improvements in the competencies of various healthcare professionals. The provisions affect

access to education, required qualifications for nurses, physicians, and other professionals in the

allied medical fields (NCLS, 2020). The provisions in Title 5 of the ACA have introduced

reforms to both education and training. The ACA has expanded scholarships for healthcare

professionals and student loans for students in the field of healthcare (NCLS, 2020). It has also

paved the way for better support for training, education, and career pathways for nurses and

other healthcare professionals (NCLS, 2020). Provisions of the ACA also promote improvements

in qualifications for all healthcare professionals including standards that promote the completion

of bachelor’s degrees and post-graduate degrees to improve competency and improve career

pathways for healthcare professionals (NCLS, 2020).

Advantages and Achievements of the ACA

Expansion of Coverage

After a decade, the effects of the Affordable Care Act are now evident. While American

healthcare is still the most expensive in the world, the ACA has had several clear achievements

in terms of reform, innovation, and change. Before the ACA, there were an estimated 44 million

Americans without health insurance and after implementation, the uninsured rate fell to 26.7
9
ADVANTAGES AND DISADVANTAGES OF THE ACA
million by 2016 (Garfield & Orgera, 2019). Moreover, the various provisions of the ACA have

allowed for the expansion of Medicaid providing coverage to millions of households that did not

qualify for government-sponsored or employer-sponsored health insurance in the past (Garfield

& Orgera, 2019). Moreover, health insurance marketplaces have given Americans the option to

purchase or exchange their existing health insurance plans with ACA compliant plans (Garfield

& Orgera, 2019). In turn, these ACA compliant plans ensure that their beneficiaries are not

denied insurance coverage for preexisting conditions, receive the care they need without the

restriction for annual caps and monetary caps for healthcare services (Rafogel, Gee, & Calsyn,

2020).

After the first set of provisions were implemented, coverage for the neediest

segment of the population expanded with Medicaid enrollment growing by 13 million over a

five-year period (Goodnough, Abelson, Sanger-Katz, & Kliff, 2020). Adults aged 18 to 64 years

old who earned between 101 to 133 percent above the federal poverty rate were now eligible for

Medicaid after the ACA was passed. Incidentally, the greatest gains in health insurance coverage

were among ethnic minorities (Goodnough et al., 2020). Asians, Latinos, and African-Americans

had seen a drop in the number of uninsured adults without children since 2013 (Goodnough et

al., 2020). Similarly, more children, adolescents, and young adults now have coverage from their

parents’ insurance plans after the ACA was passed (Garfield, Orgera, & Damico, 2019). The law

has allowed states to create local and state initiatives that would allow states to set-up their own

healthcare exchange marketplaces and create opportunities for special enrollment periods for

insurance during times of need (Goodnough et al., 2020). Although the White House has blocked

the individual mandate from taking effect, the greatest contribution of the ACA is the expansion

of coverage for all.

10
ADVANTAGES AND DISADVANTAGES OF THE ACA
Adoption of Value-Based Care

Additionally, the U.S. healthcare system is steadily adopting value-based care and

this has created the opportunity for healthcare providers to improve the quality of care they

provide to patients, adjust to new CMS payment requirements, and adjust to the demands of a

changing healthcare landscape after the ACA (Rafogel et al., 2020). Payment reform has led to

lower government spending on healthcare. Shifting away from the FFS payment model, the CMS

has influenced the way healthcare providers deliver care by making efforts to improve the quality

of care provided to patients, reduce costs, and improve accountability for patient outcomes. The

impact of the ACA on the adoption of value-based care is evident with the creation of new ACOs

across the country. ACOs exemplify the service delivery model that the ACA hopes to achieve

with healthcare reform. There are now 558 new ACOs after the ACA was passed. These new

networks now provide comprehensive, coordinated care to over 12 million Americans. Over the

years, the ACA’s payment reform provisions have forced all healthcare providers servicing

Medicare and Medicaid beneficiaries to improve the delivery of care and ensure positive patient

outcomes or risk non-reimbursements. As a result, this has created a cascading effect among

healthcare providers and greater adoption of the value-based care framework in all segments of

the healthcare system.

Cost, Redundancies, and the Financial Impact of the ACA

One of the important contributions of the ACA is the reduction in total healthcare

spending since the provisions of the ACA were implemented. Payment reform has led to lower

CMS reimbursements owing to the shift to value-based payments. Medicare costs have dropped

by over 20 percent while the quality of care remained the same overall (Blumenthal & Abrams,

2020). The ACA allowed the CMS to penalize providers that abused certain provisions of the
11
ADVANTAGES AND DISADVANTAGES OF THE ACA
FFS program and reward providers that reach quality benchmarks standards in care delivery and

patient outcomes (Blumenthal & Abrams, 2020).

The Shared Savings Program has paved the way for incentivizing improvements in

accountability among healthcare providers and changes in service delivery processes that

promote better-coordinated care. Another source of efficiency improvement is the expanded use

of bundled payments for certain surgical interventions and medical conditions (Blumenthal &

Abrams, 2020). Bundled payments prompt healthcare providers to reduce their costs by

eliminating redundancies, reducing the use of unnecessary services and care, and adopting

innovation (Blumenthal & Abrams, 2020). Finally, the ACA’s heavy promotion for primary care

and expansion of coverage for uninsured Americans has lowered costs associated with

overutilization of the emergency department Blumenthal & Abrams, 2020). With better access to

primary care, individuals no longer need to visit the emergency department to receive medical

attention and this lowers the costs of emergency care for hospitals, further lowering healthcare

costs.

Overall, the national spending on healthcare has risen more slowly than projections made

before the ACA was passed (Emanuel, 2019). Between 2010 and 2017, the ACA has had a total

cost savings of $2.3 trillion cumulatively (Emanuel, 2019). Spending forecasts estimated that by

2017, the U.S. healthcare spending would reach $4.14 trillion (Emanuel, 2019). On the contrary,

U.S. healthcare spending in that year was $3.5 trillion, a 16 percent increase from 2010 and this

suggests that the provisions of the ACA have indeed, slowed down the burgeoning costs of the

U.S. healthcare system in the long run (Emanuel, 2019).

Disadvantages and Shortcomings of the ACA

12
ADVANTAGES AND DISADVANTAGES OF THE ACA
The ACA is the most comprehensive and detailed healthcare bill in the history of the

United States. Over the past decade, the ACA has proven to have far-reaching and significant

effects on all of its stakeholders. By changing the healthcare landscape, the ACA has created

new challenges within the healthcare system that may or may not have adverse effects on its

various stakeholders.

First, the ACA’s various provisions on health insurance have led to higher risks and costs

for healthcare insurance companies. Consequently, the coverage guarantees, and protections of

the ACA has increased the costs for healthcare insurance companies. Extending coverage to all

dependent children exponentially raises the potential costs of insurance companies by

multiplying the number of individuals every plan guarantees coverage. The protections and

guarantees for individuals with preexisting conditions also increase the costs of insuring clients

and it lowers insurers’ abilities to manage and offset costs with limitations to coverage. Changes

in annual caps and monetary caps not only compound the costs of insurance companies, but it

also makes them increasingly financially responsible for a larger portion of the healthcare costs

(NCLS, 2020).

It is true that the ACA has a significantly positive impact on expanding coverage and

access to care. However, a decade after the ACA was passed, the premium costs have steadily

increased since 2013 (Hall & McCue, 2016). Premiums for individual plans are significantly

more expensive from private insurance providers. Additionally, a few new insurance companies

have also closed because they are unable to comply with the provisions of the ACA and remain

profitable while still trying to be competitive (Hall & McCue, 2016). The provisions of the ACA

were designed to improve the patient outcomes but the author and advisors of the bill did not

consider the overall costs and economic impact of the ACA on health insurance providers and
13
ADVANTAGES AND DISADVANTAGES OF THE ACA
the private healthcare industry (Hall & McCue, 2016). In fact, one of the major pitfalls of

expanding coverage and imposing more patient protections is the law did not consider the

financial effects of these provisions on the costs and profits of insurance companies. Since 2013,

the average cost for claims has increased by 5.7 percent and because of this, small insurance

companies have been unable to remain competitive in the market, leading to an overall loss of

competitiveness in the health insurance market.

One direct result of this phenomenon is the rising premium and deductible costs of many

privately provided health insurance plans. Expanding coverage to dependent children costs more

for insurance providers. Protections and guarantees for individuals with preexisting conditions

have had a similar economic effect on health insurance companies. Thus, higher payments affect

both individuals and employers. In turn, employers are finding it harder to provide healthcare

coverage to their employees. Employees have to pay higher contributions and pay higher

deductibles for their plans (Abelson, 2019). The average cost of an annual family plan in 2019 is

$20,000 and the average employee contributions were $6,000 (Abelson, 2019). One of the

unintended outcomes of the new healthcare provisions is that deductibles are now an average of

$2,000 (Abelson, 2019). High deductibles are shouldered by employees and deductibles have

risen steadily since the ACA’s was implemented and by 2019, the average deductible has risen

by nearly 180 percent since 2009 while family premiums have risen about 50 percent (Abelson,

2019). Thus, one of the unintended effects of the ACA has become the rising costs of premiums

and deductibles, which affects employers and employees the most.

Likewise, payment reform has changed the way healthcare providers deliver care to

Medicare beneficiaries. While this has paved the way for the creation and widespread adoption

of ACOs and value-based care, it has also reduced reimbursements to providers (NCSL, 2020).
14
ADVANTAGES AND DISADVANTAGES OF THE ACA
Provisions of the ACA have created programs that penalize certain practices among healthcare

providers that used to be commonplace before the ACA was passed and implemented

(Blumenthal & Abrams, 2020). Changes in CMS payments would hurt smaller healthcare

providers and undermine their competitiveness in the short run. Hence, the ACA has become

more difficult for small and medium-sized healthcare providers to survive, especially when

rising costs and shrinking reimbursements.

Evaluations of the ACA

The United States healthcare system is in dire need of an overhaul. Before the ACA,

healthcare was unaffordable, inefficient, and with poor accessibility (Fuchs, 2018). The ACA

created to save the U.S. healthcare system and correct its most significant problems while

preserving its core aspects and fundamental structures. However, the ACA’s many achievements

are overshadowed by its various unintended aftereffects. Because the U.S. healthcare system

combines several different stakeholders to be able to provide healthcare services. The ACA has

reduced aggregate costs and improved coverage for millions of Americans. However, the ACA

has also increased premiums, deductibles, and employee contributions (Abelson, 2019). The

ACA has ensured that individuals have protections and guarantees that allow them to have

coverage regardless of a preexisting condition and the cost of treatment required. The ACA has

also increased the total cost of health insurance coverage. In fact, raising the rate of deductibles

also contributes to the accessibility problem when patients are unable to afford the deductibles to

access care.

At present, the U.S. healthcare system costs $3.5 trillion in 2019 (Emanuel, 2019). This is

higher than the cost of healthcare in 2009. The cost of healthcare is still rising in spite of a

decade of ACA. Aggregate costs for healthcare are still high compared to the other healthcare
15
ADVANTAGES AND DISADVANTAGES OF THE ACA
systems of other developed nations (OECD, 2020). The overall quality-to-cost ratio of the U.S.

healthcare system is significantly lower compared to other high-spending countries like

Switzerland and the U.K. (OECD, 2020). This suggests that inefficiencies still exist in the

current healthcare system even with the ACA. The ACA may improve some aspects of the

healthcare system, especially for patients and individuals. However, the ACA lacked foresight in

terms of predicting and forecasting the effects of its various provisions on other stakeholders in

the healthcare industry. Healthcare providers and health insurance companies are important

stakeholders of the healthcare industry. Without healthcare providers and health insurance

companies, the healthcare industry would collapse. It is important to take care of all of the

stakeholders of the U.S. healthcare system because each of them contributes significantly to

ensuring that the healthcare system continues to function.

Suggestions and Recommendations

Rectifying the shortcomings of the ACA while simultaneously trying to achieve its goals

requires further fundamental changes in the healthcare system. First, shifting to a single-payer

system would help with the shortcomings of the current system and it would help improve the

effects of the ACA. A single-payer system would improve accessibility because it would create a

health care insurance system that would ensure that every American has the option to enroll for

and obtain healthcare insurance coverage. It would also create an economy of scale for the

single-payer provider. A government-sponsored single-payer would eliminate or reduce the cost

effects of expanded protections and guarantees (Weisbart, 2020). If the federal government

introduces an additional payer in the marketplace of healthcare insurance by expanding

Medicare, it would improve accessibility and contribute positively to making healthcare more

affordable (Weisbart, 2020).

16
ADVANTAGES AND DISADVANTAGES OF THE ACA
Aggregate costs are a persistent problem in the U.S. healthcare system. The ACA

provided healthcare reform at half-measure. Going further and passing a law that would allow

state and local governments to provide health care services directly would reduce the costs of

healthcare service delivery. It may even increase competition among healthcare service

providers. With government-run hospitals and clinics, access to care would be expanded and this

would be beneficial for all Medicare and Medicaid beneficiaries. It may eliminate the need for

the CMS or reduce the functions and roles of the CMS. Additionally, government-run health care

could be limited to providing primary care to the public and this would improve the costs of

overall healthcare delivery while contributing to the promotion of preventive care. Overall, by

increasing the participation and role of the government in healthcare service delivery, the U.S.

government could reduce overall healthcare spending while improving quality and reducing

wastefulness and inefficiencies.

17
ADVANTAGES AND DISADVANTAGES OF THE ACA
References

Abelson, R. (2019, September 15). Employer Health Insurance Is Increasingly Unaffordable,

Study Finds. The New York Times. Retrieved from

https://www.nytimes.com/2019/09/25/health/employer-health-insurance-cost.html

Abrams, M.K., Nuzum, R., Zezza, M.A., Ryan, J.M., Kiszla, J., & Guterman, S. (2015, May 7).

The Affordable Care Act's Payment and Delivery System Reforms: A Progress Report at

Five Years. The Commonwealth Fund. Retrieved from

https://www.commonwealthfund.org/publications/issue-briefs/2015/may/affordable-care-

acts-payment-and-delivery-system-reforms

Bartels, S. J., Gill, L., & Naslund, J. A. (2015). The Affordable Care Act, Accountable Care

Organizations, and Mental Health Care for Older Adults: Implications and

Opportunities. Harvard review of psychiatry, 23(5), 304–319.

https://doi.org/10.1097/HRP.0000000000000086

Blumenthal, D. & Abrams, M.K. (2020, February 26). The Affordable Care Act at 10 Years:

What’s Changed in Health Care Delivery and Payment? The Commonwealth Fund.

Retrieved from https://www.commonwealthfund.org/publications/journal-article/2020/

feb/aca-at-10-years-changed-health-care-delivery-payment

Center for Medicare and Medicaid Services. (2020, September 14). ACO Participation and

Performance Data. Retrieved from https://www.cms.gov/Medicare/Medicare-Fee-for-

Service-Payment/sharedsavingsprogram/program-data

Coghlan, A. (2017, July 14). US ranked worst healthcare system, while the NHS is the best. New

Scientists. Retrieved from https://www.newscientist.com/article/2140698-us-ranked-

worst-healthcare-system-while-the-nhs-is-the-best/#ixzz6b1aCqbti
18
ADVANTAGES AND DISADVANTAGES OF THE ACA
DeVoe J. (2018). The unsustainable US health care system: a blueprint for change. Annals of

family medicine, 6(3), 263–266. https://doi.org/10.1370/afm.837

Emanuel, E. J. (2019, March 22). Name the much-criticized federal program that has saved the

U.S. $2.3 trillion. Hint: it starts with Affordable. STAT News. Retrieved from

https://www.statnews.com/2019/03/22/affordable-care-act-controls-costs/

Fuchs, V. R. (2018). Is US medical care inefficient?. Jama, 320(10), 971-972.

doi:10.1001/jama.2018.10779.

Garfield, R. & Orgera, K. (2019, January 25). The Uninsured and the ACA: A Primer - Key

Facts about Health Insurance and the Uninsured amidst Changes to the Affordable Care

Act. KFF. Retrieved from https://www.kff.org/report-section/the-uninsured-and-the-aca-

a-primer-key-facts-about-health-insurance-and-the-uninsured-amidst-changes-to-the-

affordable-care-act-how-many-people-are-uninsured/

Glied, S., & Sacarny, A. (2018). Is the US health care system wasteful and inefficient? A review

of the evidence. Journal of Health Politics, Policy and Law, 43(5), 739-765.

Goodnough, A., Abelson, R., Sanger-Katz, M., & Kliff, S., 2020). Obamacare Turns 10. Here’s

a Look at What Works and Doesn’t. The New York Times. Retrieved from

https://www.nytimes.com/2020/03/23/health/obamacare-aca-coverage-cost-history.html

Hall, M.A., & McCue, M.J., (2016, July 20). How Has the Affordable Care Act Affected Health

Insurers' Financial Performance? The Commonwealth Fund. Retrieved from

https://www.commonwealthfund.org/publications/issue-briefs/2016/jul/how-has-

affordable-care-act-affected-health-insurers-financial

Hellman, M. (2014, June 17). Time Magazine. Retrieved from https://time.com/2888403/u-s-

health-care-ranked-worst-in-the-developed-world/
19
ADVANTAGES AND DISADVANTAGES OF THE ACA
Millman, M. (Ed.). (2015). Access to health care in America. National Academies Press.

National Council of State Legislators. (2020). The Affordable Care Act: A brief summary.

Retrieved from https://www.ncsl.org/research/health/the-affordable-care-act-brief-

summary.aspx#Over

NEJM Catalyst. (2017, January 1). What Is Value-Based Healthcare?. Retrieved from

https://catalyst.nejm.org/doi/full/10.1056/CAT.17.0558

OECD. (2020). Health Spending. Retrieved from https://data.oecd.org/healthres/health-

spending.htm.

Rafogel, N., Gee, E., & Calsyn, M. (2020, March 23). 10 Ways the ACA Has Improved Health

Care in the Past Decade. Center for America Progress.Retrieved from

https://www.americanprogress.org/issues/healthcare/news/2020/03/23/482012/10-ways-

aca-improved-health-care-past-decade/

Schneider, E.C., Sarnak, D.O., Squires, D., Shah, A., & Doty, M.M. (2017, July 14). Mirror,

Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S.

Health Care. The Commonwealth Fund. Retrieved from

https://www.commonwealthfund.org/publications/fund-reports/2017/jul/mirror-mirror-

2017-international-comparison-reflects-flaws-and

Stange K. C. (2019). The problem of fragmentation and the need for integrative solutions.

Annals of family medicine, 7(2), 100–103. https://doi.org/10.1370/afm.971

Stone, P. W., Glied, S. A., McNair, P. D., Matthes, N., Cohen, B., Landers, T. F., & Larson, E.

L. (2014). CMS changes in reimbursement for HAIs: setting a research agenda. Medical

care, 48(5), 433–439. https://doi.org/10.1097/MLR.0b013e3181d5fb3f

20
ADVANTAGES AND DISADVANTAGES OF THE ACA
Weisbart, E. (2020). A Single-Payer System Would Reduce U.S. Health Care Costs. AMA

Journal of Ethics. Retrieved from https://journalofethics.ama-assn.org/article/single-

payer-system-would-reduce-us-health-care-costs/2012-11