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On March 23, 2010, President Obama signed into law the first U.S. comprehensive health care reform bill, the Patient Protection and Affordable Care Act (PPACA). After almost a century of failed attempts, the U.S. now has a national health care system which promises to increase access to care, increase consumer choice, and ban insurance discrimination for individuals with preexisting medical conditions. The PPACA is expected to expand insurance coverage to 32 million individuals by 2019 through a variety of measures. At a cost of $938 billion over 10 years, the PPACA is projected to reduce the deficit by $143 billion in the first decade and $1.2 trillion over the second. Almost everyone will be required to purchase health insurance by 2014, with certain exceptions, or face a penalty. The mandate is coupled with sliding scale subsidies to make the purchase more affordable, and it limits annual and out of pocket spending. If the penalty is strong enough, the mandate will be effective in expanding the pool of insured people, spreading the health risk, and eventually decreasing premiums. Key coverage expansions, such as expanding Medicaid benefits to individuals and families with incomes up to 133% of the federal poverty line (FPL), are critical, but access to providers must also be ensured. By 2014, states must set up exchanges where consumers can shop for health insurance at competitive rates. Subsidies will be provided to individuals and families under 400% of the FPL and not eligible under Medicaid to help purchase insurance in the exchange. Additionally, small businesses with fewer than 100 employees will receive tax credits for offering insurance. The PPACA reverses common industry practices that have, in the past, created barriers to coverage. It prohibits insurers from denying coverage to those with preexisting conditions and allows young adults to remain on their parents’ plans up to age 26. For Medicare patients, the Part D coverage gap is closed and cost sharing for preventative care is eliminated, while the amount of out-of-pocket costs paid per year is limited. This historic legislation takes great strides towards providing everyone with medical care, irrespective of income or health status. It will improve public health, and place more emphasis on primary and preventive care. However, issues still remain surrounding difficult choices on how to reduce increasing costs, improve quality, and ensure appropriate payment reimbursement for providers.

Publication Citation

303 JAMA 2521-2522 (2010)