Sharon K. Long (
Lea Bart is a research assistant at the Health Policy Center, Urban Institute.
Health Aff (Millwood). 2017 Sep 1;36(9):1656-1662. doi: 10.1377/hlthaff.2017.0798.
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 Many people will be at substantial risk if key components of the law are repealed or otherwise changed without carefully considering the health and financial consequences for those projected to lose coverage.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.
自 2014 年平价医疗法案的主要覆盖条款实施以来，美国的医疗保险覆盖范围显著扩大，医疗保健的可及性和可负担性也得到了改善，这一趋势在 2017 年得以持续。全国各地、各个年龄段和各个收入群体的成年人都从美国拥有医疗保险的人口比例大幅持续增长中受益。在扩大医疗补助的州，中低收入的美国人受益尤为显著。我们从城市研究所 2017 年健康改革监测调查中获得的最新调查数据显示，现在只有 10.2%的非老年成年人没有医疗保险——这一比例比平价医疗法案实施前下降了近 41%。尽管如此，在 2017 年夏天，仍在考虑废除和取代平价医疗法案，同时对医疗补助计划的融资进行更系统的改革。如果没有仔细考虑那些预计将失去保险的人的健康和经济后果，而草率地废除或修改该法案的关键内容，许多人将面临巨大的风险。尽管医疗改革的政治存在挑战，但仍有机会创建一个更公平、更高效的医疗保健系统。
