Content area
Full Text
ABSTRACT The significant gains in health insurance coverage and improvements in health care access and affordability that followed the implementation of the key coverage provisions of the Affordable Care Act in 2014 have persisted into 2017. Adults in all parts of the country, of all ages, and across all income groups have benefited from a large and sustained increase in the percentage of the US population that has health insurance. The gains have been particularly striking among low- and moderate-income Americans living in states that expanded Medicaid. Our latest survey data from the Urban Institute's 2017 Health Reform Monitoring Survey shows that only 10.2 percent of nonelderly adults are now uninsured-a decline of almost 41 percent from the period before implementation of the ACA. Nonetheless, repealing and replacing the ACA remained under consideration during the summer of 2017, along with more systematic changes to the financing of the Medicaid program. Many people will be at substantial risk if key components of the law are repealed or otherwise changed without carefully considering the health and financial consequences for those projected to lose coverage. Though the politics of health reform are challenging, opportunities exist to create a more equitable and efficient health care system.
Although the Affordable Care Act (ACA) has its problems,1'2 there was a sustained decline in uninsurance following the 2014 implementation of its key coverage provisions, benefiting adults across the country.3-10 These declines have been accompanied by improvements in access to and affordability of health care.5'6'8'11 Efforts to repeal and replace the ACA, which remained under consideration during the summer of 2017, could roll back these gains. While the details of the different repealand-replace proposals vary,12 many would eliminate the ACA's Medicaid expansion and make significant changes to the Marketplace and to insurance regulations that would likely disadvantage older adults and adults with preexisting health conditions.13-15 Under many of the repealand-replace scenarios, which often include fundamental changes to the financing of the Medicaid program, millions of Americans would be at risk of losing their health insurance coverage, wiping out the coverage gains made since the ACA was enacted.14-16 But even if the ACA remains in place, the coverage gains for many low- and moderate-income adults are at risk if the administration pursues strategies...