Implementing the Affordable Care Act in North Carolina: the rubber hits the road.

The health insurance mandate, perhaps the best-known provision of the Patient Protection and Affordable Care Act of 2010 (ACA), is slated to go into effect on January 1, 2014. Yet most people do not know how the ACA will affect them. More than one-third of people in a recent national poll were unaware that new health insurance marketplaces will make it easier to purchase coverage or that some people will qualify for subsidies to help them purchase coverage. The ACA includes many other provisions that will have a profound impact on our health care delivery system. Some changes are already helping to break down silos in the delivery of care. Groups of health care professionals are working together to manage the health of populations. The ACA places a much greater emphasis on measuring quality and on paying health professionals and health care institutions based on the value of the services they provide. In addition, the ACA makes greater investments in prevention and in population health management. This issue brief highlights some of the health system changes that have taken place over the past 3 years, as well as some of the potential changes that are yet to come relating to insurance coverage, access to care, quality of care, rising health care costs, and overall population health.