The Affordable Care Act as a National Experiment: Health Policy Innovations and Lessons

Preface
Contents
Contributors
Chapter 1: Introduction: An Overview of the ACA as a National Experiment
	References
Chapter 2: A Decade of ACA: The Successes, Unfinished Work, and Impact of the Affordable Care Act
	The ACA’s Successes
		Reforms to Healthcare Delivery Still Stand
		The Expansion of Medicaid in States Across the Country
		Despite the Negative Predictions from Opponents, the Market Embraces and Protects the ACA
		The ACA Is Promoting and Encouraging Innovation in Healthcare Delivery
	The Unfinished Work of the ACA
		Medicaid Expansion Needs to Exist in All States and Without Work Requirements
		Subsidies Should Be Adequate in Every State to Ensure That Everyone Has Access to Healthcare
		State Marketplaces Need More Health Plans at Affordable Prices
		A Public Option Is Now Being Reconsidered as a Part of the ACA
	The Legacy of the ACA
	References
Chapter 3: Patient Protections in the Affordable Care Act
	A History of Patients’ Rights Efforts
	Overview of Patient Protections in the ACA
	Evaluating Whether the ACA’s Patient Protections Have Been Effective and What Areas Need Improvement
	A Path Toward More Comprehensive Protections
	References
Chapter 4: Beyond Coverage and Controversy: The ACA’s Distinctly American Approach to Healthcare Coverage and Reform
	The ACA’s Legislative History
	The ACA Approach to Healthcare Reform
	Looking Forward: US Healthcare Coverage Compared to Other Developed Nations
	Can Policymakers Build on ACA’s Progress?
	References
Chapter 5: Medicaid Expansion and Insurance Reform Under the Affordable Care Act: The New Federalism of Health Policy or the Same Old Same Old?
	A Brief History of Federalism in US Health Policy
	The ACA and Health Insurance Coverage
	The ACA and Health Insurance Regulation
	Federalism in US Health Policy Post-ACA
	References
Chapter 6: Policies Designed to Achieve a Data-Driven Learning Healthcare System: A Decade of Progress and Future Directions
	The Triple Aim and the ACA: From Theory to Strategy
		Early Health IT Experiments: Beacon Communities
		Health IT Legislation After the ACA and Future Implications
	References
Chapter 7: The Healthcare Message Wars
	Healthcare Messaging Pre-ACA
	White House Messaging Falters After Passage of the ACA
	Healthcare Prominent in 2016 Presidential Campaign
	Pelosi Moves to Reclaim Healthcare Messaging
	2020 Presidential Candidates Search for Rhetorical Sweet Spot
	References
Chapter 8: The Role of the Supreme Court in Shaping the Affordable Care Act
	National Federation of Independent Business (NFIB) v. Sebelius
	Other Challenges to the ACA
	References
Chapter 9: The Center for Medicare and Medicaid Innovation – A Decade of Experimentation and Continued Evolution
	A Decade of Models and Results
		Accountable Care Organizations
		Advanced Primary Care
		Bundled Payments
			Health Promotion and System Transformation
	Second Decade of Innovation, Opportunities, and Challenges
		Emphasizing Accountability and Managing Total Cost of Care
		Improving How Models Are Designed and Tested
		Building the Evidence for Expansion and Dissemination
		Moving Private Payers into Value-Based Payment Models
		Continuing to Test and Evaluate Models
	References
Chapter 10: Social Determinants: Working Upstream to Solve Health Problems Before They Start
	Social Determinants: A Primer
	Examples of Social Determinants of Health
		Economic Stability
		Education
		Social and Community Context
		Neighborhood and Built Environment
		Health and Healthcare
	The Difference Between Addressing Social Determinants of Health and Addressing Individual Social Needs
	Social Determinants Programs in the United States
		Health System Programs Addressing Health-Related Social Needs
			Boston Medical Center’s Housing Initiative
			MANNA’s Nutrition Program
			REACH’s Mammograms
		Public Programs Addressing Social Determinants of Health
			SNAP
			Public Housing
			Public Education
	Think Globally, Act Locally
	References
Chapter 11: Stories of the Uninsured
	Coverage Gaps
	Coverage Churn
	Citizenship Status
	Work Requirements
	Being Uninsured Affects All Income Levels
	Being Underinsured
	Preexisiting Conditions Before the ACA
	Twenty-Eight Million Americans Are Uninsured
	References
Chapter 12: Can Fifty-One Laboratories Cure What Ails the Individual Health Insurance Markets?
	Switching to a State-Based Marketplace
	Establishing a State Reinsurance Program
	Restricting the Sale of Individual Health Insurance That Is Non-compliant with the ACA
	Enacting State Individual Mandates
	Expanding Subsidies
	Implementing a Public Option Buy-In Program
	Conclusion
	References
Chapter 13: What’s Next: The Push for Universal Healthcare
	Uncovered: The Remaining Uninsured—Who Are They?
		The Coverage Gap
		Citizenship Status
	Barely Covered: The Underinsured—A Growing Problem
	A Solution: Universal Healthcare
		Medicare for All
		A Public Option
		Expanding the ACA
	Getting There: The Funding
	Getting There: The Politics
	My Observations
	References
Epilogue
Index