ACA Delivery System

The ACA and the Health Care Delivery System a

Critics have claimed that the ACA overlooked the need to reform the delivery system in our nation so as to constrain its costs and improve its quality. A careful examination of the law, however, shows that it constitutes one of the most aggressive efforts in the history of the nation to address the problems of the delivery system. Just over 5 years ago, on March 23, 2010, President Barack Obama signed the Affordable Care Act (ACA) into law. Its enactment may constitute the most important event of the Obama presidency and could fundamentally affect the future of health care in the United States. From a historical perspective, 5 years is a very short time, far too short to assess definitively the

First, the ACA has brought about considerable improvements in access to affordable health insurance in the United States. On the basis of their own reports, newly insured Americans are also able to see physicians within reasonable periods of time, and anecdotal reports about restricted access to out-of-network providers, although a concern, have not yet caused a major backlash. Second, the implementation of the ACA has coincided with another important development — a slowdown in the rate of increase in national health care spending. From 2010 through 2013, per capita U.S. health care expenditures increased at the historically low rate of 3.2% annually, as compared with 5.6% annually over the previous 10 years. As a percentage of the gross domestic product, health spending has stabilized at approximately 17%. Third, if it is premature to draw conclusions about the cost effects of the ACA, it is doubly so for the quality effects of the law. The reductions in hospital-acquired conditions and Medicare readmissions since the enactment of the ACA are unprecedented and encouraging, but here again, the causes of these favorable trends are uncertain. It may be some time before we can assess the quality effects of this major new legislation.

In conclusion, Health care access and insurance coverage are major factors that contributed to racial and ethnic disparities before the ACA implementation (Chen, Vargas-Bustamante, Mortensen, & Ortega, 2016). Our results demonstrate that racial and ethnic disparities in access have been reduced significantly during the initial years of the ACA implementation that expanded access and mandated that individuals obtain health