Quadagno Jill
Florida State University.
J Health Polit Policy Law. 2014 Feb;39(1):35-56. doi: 10.1215/03616878-2395172. Epub 2013 Nov 5.
On March 23, 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act (ACA). Did the ACA signify a government takeover of the health care system, a first step on the road to socialism, as conservative critics charged? Or was it, rather, a sellout to the right wing, as liberal single-payer advocates proclaimed? The ACA's key provisions, the employer mandate and the individual mandate, were Republican policy ideas, and its fundamental principles were nearly identical to the Health Equity and Access Reform Today Act of 1993 (HEART), a bill promoted by Republican senators to deflect support for President Bill Clinton's Health Security plan. Yet the ACA was also a policy legacy of the Clinton administration in important ways that rarely are acknowledged, notably Medicaid expansion and insurance company regulation. Although the ACA departed from the liberal vision of a single-payer plan and adhered closely to the objectives of those who believed that the health care system should encourage the free market, it included provisions that will make coverage more affordable, reliable, and accessible.
2010年3月23日，巴拉克·奥巴马总统签署了《患者保护与平价医疗法案》（简称ACA）使其成为法律。正如保守派批评人士所指责的那样，ACA是否意味着政府对医疗保健系统的接管，是迈向社会主义道路的第一步？或者，正如自由派单一支付者倡导者所宣称的那样，它是否是向右翼势力的妥协？ACA的关键条款，即雇主强制保险和个人强制保险，是共和党的政策理念，其基本原则与1993年的《今日健康公平与准入改革法案》（HEART）几乎相同，该法案由共和党参议员推动，旨在转移对比尔·克林顿总统的《健康保障计划》的支持。然而，ACA在重要方面也是克林顿政府的一项政策遗产，而这些方面很少被提及，特别是医疗补助扩大和保险公司监管。尽管ACA背离了单一支付者计划的自由派愿景，紧密遵循了那些认为医疗保健系统应鼓励自由市场的人的目标，但它包含了一些条款，将使医保覆盖更实惠、可靠且可及。
