American College of Physicians, Washington, DC (R.A.C.).
Texas Medical Home Initiative, Dallas, Texas (S.S.B.).
Ann Intern Med. 2019 May 7;170(9):651-653. doi: 10.7326/M18-3401. Epub 2019 Apr 16.
The coverage reforms of the Patient Protection and Affordable Care Act have fundamentally changed the U.S. health care system. The law's health insurance regulations, which include protections for persons with preexisting conditions, have made health insurance more accessible. The premium tax credit and cost-sharing subsidies have made nongroup coverage more affordable. The essential health benefit package and coverage for preventive services without cost sharing have made insurance more comprehensive. Perhaps most important, the Medicaid expansion extended coverage to millions of low-income adults. Despite these gains, more needs to be done to bring the United States closer to achieving universal coverage. In this position paper, the American College of Physicians recommends action to enhance and expand eligibility for health insurance financial subsidies; stabilize health insurance marketplaces; provide sustained funding for outreach, education, and enrollment assistance activities; test and implement a mechanism to encourage enrollment; expand Medicaid in all states; and establish a public insurance option to increase competition.
《平价医疗法案》的覆盖范围改革从根本上改变了美国的医疗保健体系。该法案的医疗保险规定包括对有既往疾病的人的保护,使医疗保险更容易获得。保费税收抵免和费用分担补贴使非团体保险更加负担得起。基本健康福利套餐和无费用分担的预防服务覆盖范围使保险更加全面。也许最重要的是,医疗补助计划的扩大将覆盖范围扩大到了数以百万计的低收入成年人。尽管取得了这些进展,但仍需要采取更多措施,使美国更接近实现全民覆盖。在这份立场文件中,美国医师学院建议采取行动,扩大医疗保险财政补贴的资格;稳定医疗保险市场;为外展、教育和注册援助活动提供持续资金;测试并实施鼓励注册的机制;在所有州扩大医疗补助计划;并建立公共保险选择以增加竞争。