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The Impacts of the Affordable Care Act: How Reasonable Are the Projections?

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  • Gruber, Jonathan

Abstract

The Patient Protection and Affordable Care Act (ACA) is the most comprehensive reform of the U.S. medical system in at least 45 years. The ACA transforms the non-group insurance market in the United States, mandates that most residents have health insurance, significantly expands public insurance and subsidizes private insurance coverage, raises revenues from a variety of new taxes, and reduces and reorganizes spending under the nation’s largest health insurance plan, Medicare. Projecting the impacts of such fundamental reform to the health care system is fraught with difficulty. But such projections were required for the legislative process, and were delivered by the Congressional Budget Office (CBO). This paper discusses the projected impact of the ACA in more detail, and describes evidence that sheds light upon the accuracy of the projections. It begins by reviewing in broad detail the structure of the ACA, and then reviews evidence from a key case study that informs our understanding of the ACA’s impacts: a comparable health reform that was carried out in Massachusetts four years earlier. The paper discusses the key results from that earlier reform and what they might imply for the impacts of the ACA. The paper ends with a discussion of the projected impacts of the ACA and offers some observations on those estimates.

Suggested Citation

  • Gruber, Jonathan, 2011. "The Impacts of the Affordable Care Act: How Reasonable Are the Projections?," National Tax Journal, National Tax Association;National Tax Journal, vol. 64(3), pages 893-908, September.
  • Handle: RePEc:ntj:journl:v:64:y:2011:i:3:p:893-908
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    References listed on IDEAS

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    1. Jonathan Gruber, 2008. "Covering the Uninsured in the United States," Journal of Economic Literature, American Economic Association, vol. 46(3), pages 571-606, September.
    2. Gruber, Jonathan & Lettau, Michael, 2004. "How elastic is the firm's demand for health insurance?," Journal of Public Economics, Elsevier, vol. 88(7-8), pages 1273-1293, July.
    3. Jonathan Gruber, 2011. "Massachusetts points the way to successful health care reform," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 30(1), pages 184-192, December.
    4. Miller, Sarah, 2012. "The effect of insurance on emergency room visits: An analysis of the 2006 Massachusetts health reform," Journal of Public Economics, Elsevier, vol. 96(11), pages 893-908.
    5. Gruber, Jonathan, 2011. "The Tax Exclusion for Employer-Sponsored Health Insurance," National Tax Journal, National Tax Association;National Tax Journal, vol. 64(2), pages 511-530, June.
    Full references (including those not matched with items on IDEAS)

    Citations

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    Cited by:

    1. Courtemanche, Charles & Friedson, Andrew I. & Koller, Andrew P. & Rees, Daniel I., 2017. "The Affordable Care Act and Ambulance Response Times," IZA Discussion Papers 10951, Institute for the Study of Labor (IZA).
    2. Richard V. Burkhauser & Sean Lyons & Kosali I. Simon, 2011. "The Importance of the Meaning and Measurement of "Affordable" in the Affordable Care Act," NBER Working Papers 17279, National Bureau of Economic Research, Inc.
    3. Gilad Sorek & David Benjamin, 2016. "Health insurance mandates in a model with consumer bankruptcy," Journal of Regulatory Economics, Springer, vol. 50(2), pages 233-250, October.
    4. Dunn, Abe & Shapiro, Adam Hale, 2015. "Physician payments under health care reform," Journal of Health Economics, Elsevier, vol. 39(C), pages 89-105.
    5. Molly Frean & Jonathan Gruber & Benjamin D. Sommers, 2016. "Premium Subsidies, the Mandate, and Medicaid Expansion: Coverage Effects of the Affordable Care Act," NBER Working Papers 22213, National Bureau of Economic Research, Inc.
    6. Barbaresco, Silvia & Courtemanche, Charles J. & Qi, Yanling, 2015. "Impacts of the Affordable Care Act dependent coverage provision on health-related outcomes of young adults," Journal of Health Economics, Elsevier, vol. 40(C), pages 54-68.
    7. Randy Albelda & Diana Salas Coronado, 2014. "Expanding Women's Healthcare Access in the United States: The Patchwork “Universalism†of the Affordable Care Act," Working Papers 2014_02, University of Massachusetts Boston, Economics Department.
    8. Bhardwaj, Ramesh, 2015. "Restraining High and Rising Cancer Drug Prices: Need for Accelerating R&D Productivity and Aligning Prices with Value," MPRA Paper 63405, University Library of Munich, Germany.
    9. Stavrunova, Olena & Yerokhin, Oleg, 2014. "Tax incentives and the demand for private health insurance," Journal of Health Economics, Elsevier, vol. 34(C), pages 121-130.
    10. repec:lrc:larrss:v:2:y:2017:i:3:p:1-8 is not listed on IDEAS
    11. Shapiro, Adam Hale, 2015. "Did Massachusetts health-care reform affect prices?," FRBSF Economic Letter, Federal Reserve Bank of San Francisco.
    12. repec:eee:jhecon:v:53:y:2017:i:c:p:72-86 is not listed on IDEAS
    13. repec:sip:wpaper:12-028 is not listed on IDEAS

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