Glied Sherry, Jackson Adlan
Sherry Glied and Adlan Jackson are with the New York University Robert F. Wagner Graduate School of Public Service, New York.
Am J Public Health. 2017 Apr;107(4):538-540. doi: 10.2105/AJPH.2017.303665. Epub 2017 Feb 16.
We describe the patterns of coverage gains associated with the Affordable Care Act (ACA) expansions and use these patterns to assess the potential impact of alternative repeal or repeal and replace strategies because Congress and the president are weighing options to repeal or replace the ACA. We find that specific provisions of the ACA, including the Medicaid expansion and the structure of premium subsidies, have been associated with large and robust gains in insurance coverage. We evaluate the impact of retaining dependent coverage and high-risk pool provisions and show, on the basis of the ACA experience, that these provisions would have little effect on coverage. We find that many replacement proposal components, including flat tax credits and maintaining cost savings provisions, could jeopardize the ability of many of the ACA's primary beneficiaries, as well as other Americans, to access coverage and care. By leading to a deterioration of the safety net, these strategies could also imperil population health activities.
我们描述了与《平价医疗法案》（ACA）扩张相关的医保覆盖范围增加模式，并利用这些模式评估替代废除或废除并取代策略的潜在影响，因为国会和总统正在权衡废除或取代《平价医疗法案》的选项。我们发现，《平价医疗法案》的具体条款，包括医疗补助扩张和保费补贴结构，与保险覆盖范围的大幅稳健增长相关。我们评估了保留受抚养人保险覆盖条款和高风险保险池条款的影响，并基于《平价医疗法案》的经验表明，这些条款对覆盖范围影响甚微。我们发现，许多替代提案的组成部分，包括统一税收抵免和维持成本节约条款，可能会危及《平价医疗法案》许多主要受益人群以及其他美国人获得医保覆盖和医疗服务的能力。这些策略会导致安全网的恶化，也可能危及人群健康活动。
