The Affordable Care Act (ACA) created a hybrid with many moving parts: incorporating employer mandates, individual responsibility and refundable tax credits (shared responsibility), and a Medicaid expansion. It is unclear which parts over time will give way to others. Some predict the demise of employment-based coverage; there is no evidence that is happening. Others predict death spirals in the individual market where only the very ill participate; there is no evidence of that either. So far there appears to be a steady equilibrium between employment-based coverage, the Medicaid expansion, and the individual market Exchanges; employment-based coverage is holding steady while the Exchanges and Medi-Cal grow to cover the uninsured. Both the young and middle aged are participating in the Exchanges.
The ACA shifts the delivery system away from the hospital emergency room towards primary care and prevention. It builds incentives for plans and providers to improve quality and outcomes. It creates important incentives to restrain the growth in health spending. In the following report, we highlight where we should be going with health reform implementation and where we are at in the present.
Download the full report here: Where Should We Be Going?