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

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  • Jonathan Gruber

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 the evidence that sheds light upon the accuracy of the projections. It begins by reviewing in broad details 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 impact of the ACA and offers some observations on those estimates.

Suggested Citation

  • Jonathan Gruber, 2011. "The Impacts of the Affordable Care Act: How Reasonable Are the Projections?," NBER Working Papers 17168, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:17168
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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. 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.
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    5. James M. Poterba, 2002. "Tax Policy and the Economy, Volume 16," NBER Books, National Bureau of Economic Research, Inc, number pote02-1, January.
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    7. 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.
    8. 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.
    9. Cogan John F & Hubbard R. Glenn & Kessler Daniel, 2010. "The Effect of Massachusetts' Health Reform on Employer-Sponsored Insurance Premiums," Forum for Health Economics & Policy, De Gruyter, vol. 13(2), pages 1-8, June.
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    Cited by:

    1. Courtemanche, Charles & Friedson, Andrew & Koller, Andrew P. & Rees, Daniel I., 2019. "The affordable care act and ambulance response times," Journal of Health Economics, Elsevier, vol. 67(C).
    2. Katerina Sherstyuka & Dolgorsuren Dorjb & Gerard Russo, 2014. "Health Insurance and the Labor Market with Wage Rigidities: Insights from a Laboratory Experiment," Working Papers 201427, University of Hawaii at Manoa, Department of Economics.
    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. Frean, Molly & Gruber, Jonathan & Sommers, Benjamin D., 2017. "Premium subsidies, the mandate, and Medicaid expansion: Coverage effects of the Affordable Care Act," Journal of Health Economics, Elsevier, vol. 53(C), pages 72-86.
    5. Tianxu Chen, 2019. "Health Insurance Coverage and Marriage Behavior: Is There Evidence of Marriage Lock?," Working papers 2019-09, University of Connecticut, Department of Economics.
    6. 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.
    7. 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.
    8. Laura J. Owen, 2017. "Part-time Employment and Health Insurance Reform: What Can Massachusetts Tell Us about the Affordable Care Act?," Review of Social Sciences, LAR Center Press, vol. 2(3), pages 1-8, March.
    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. Dunn, Abe & Shapiro, Adam Hale, 2015. "Physician payments under health care reform," Journal of Health Economics, Elsevier, vol. 39(C), pages 89-105.
    11. Padmaja Ayyagari, 2019. "Health Insurance and Early Retirement Plans: Evidence from the Affordable Care Act," American Journal of Health Economics, University of Chicago Press, vol. 5(4), pages 533-560, Fall.
    12. Patricia Foo & Wichsinee Wibulpolprasert, 2013. "Who bears the burden of the U.S. health reform? An Event Study Incidence Analysis," Discussion Papers 12-035, Stanford Institute for Economic Policy Research.
    13. 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.
    14. Burney, Shaheer & Boehm, Rebecca & Lopez, Rigoberto, 2021. "The impact of the ACA Medicaid expansion on SNAP participation," Food Policy, Elsevier, vol. 101(C).
    15. Burney, Shaheer & Boehm, Rebecca L. & Lopez, Rigoberto A., 2018. "Impact of the 2014 Medicaid Expansion on SNAP Participation," 2018 Annual Meeting, August 5-7, Washington, D.C. 273847, Agricultural and Applied Economics Association.
    16. 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.
    17. Tianxu Chen, 2023. "Health insurance coverage and marriage behavior: Is there evidence of marriage lock?," International Studies of Economics, John Wiley & Sons, vol. 18(2), pages 136-158, June.
    18. Charles Courtemanche & James Marton & Benjamin Ukert & Aaron Yelowitz & Daniela Zapata, 2016. "Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non-Expansion States," NBER Working Papers 22182, National Bureau of Economic Research, Inc.
    19. repec:mab:wpaper:22 is not listed on IDEAS
    20. Adam Hale Shapiro, 2015. "Did Massachusetts health-care reform affect prices?," FRBSF Economic Letter, Federal Reserve Bank of San Francisco.
    21. Ye, Wei & Rodriguez, Javier M., 2021. "Highly vulnerable communities and the Affordable Care Act: Health insurance coverage effects, 2010–2018," Social Science & Medicine, Elsevier, vol. 270(C).

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    More about this item

    JEL classification:

    • H3 - Public Economics - - Fiscal Policies and Behavior of Economic Agents
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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