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

  • Jonathan Gruber

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.

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File URL: http://www.nber.org/papers/w17168.pdf
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Paper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 17168.

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Date of creation: Jun 2011
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Publication status: published as “The Impacts of the Affordable Care Act: How Reasonable Are the Projections?,” National Tax Journal , 64, September 2011, 893 - 908.
Handle: RePEc:nbr:nberwo:17168
Note: HC HE PE
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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. James M. Poterba (ed.), 2002. "Tax Policy and the Economy, Volume 16," MIT Press Books, The MIT Press, edition 1, volume 1, number 0262661292, June.
  3. Gruber, Jonathan, 2011. "The Tax Exclusion For Employer-Sponsored Health Insurance," National Tax Journal, National Tax Association, vol. 64(2), pages 511-30, June.
  4. 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.
  5. 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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