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The Patient Protection and Affordable Care Act: What Does it Really Do?

In the Affordable Care Act (ACA), Congress assumed that the private insurance sector will continue to underwrite health risks for most of the non-elderly population. But nothing requires private insurers to continue to do so. To the contrary, the burdensome nature of the ACA’s provisions is likely to eventually drive private insurers out of the individual health insurance market altogether. Meanwhile, large employers will chafe under their new obligation to provide health coverage under pain of penalty and will align with private insurers to shed their involvement in health insurance. They will be joined by the numerous individuals who discovered to their dismay that many of the subsidized plans that are marketed as affordable come with high deductibles and co-pays. With private insurers heading for the exits, employers following closely behind, and citizens demanding truly affordable health insurance with no costly hidden surprises, an odd coalition of forces will coalesce supporting change to a single-payer, government health insurance system. The ACA, however, has other, more lasting legacies, including value-based purchasing, comparative effectiveness research, and several related provisions which will dramatically change how new medical technology and new and existing practices are evaluated and delivered.