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The Past, Present and Future of U.S. Health Care Reform


  • Jonathan Gruber


The beginning of the most important elements of the Patient Protection and Affordable Care Act of 2010 (ACA) is an opportune time to review the history of health care reform in the United States, the issues involved in the development of the ACA and its prospects. Efforts for reform trace back to President Teddy Roosevelt and have moved forward since then. The ACA is the culmination of years of debate and discussion at the federal level, but the Massachusetts Health Care Reform Plan adopted in 2006, Romneycare, was the most tangible forerunner and experiment confirming the design, possibilities and success of the ACA. Obamacare is Romneycare. Based on the success of Romneycare, Obamacare will be successful. This paper develops the fundamental challenges of reform and the approaches taken by the ACA to solve those potential problems, especially improving access to health care, improving affordability and avoiding increased federal budget deficits. It also outlines steps developed in the ACA to achieve significant future cost control in health care without sacrificing the trend productivity gains in health care observed in the past and that can further improve access and affordability. This paper is based on a presentation at the Networks Financial Institute’s forum on health care reform, \The Big Bang for the Affordable care Act

Suggested Citation

  • Jonathan Gruber, 2013. "The Past, Present and Future of U.S. Health Care Reform," NFI Policy Briefs 2013-PB-07, Indiana State University, Scott College of Business, Networks Financial Institute.
  • Handle: RePEc:nfi:nfipbs:2013-pb-07

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    Affordable Care Act; Health Care Insurance; Obamacare;

    JEL classification:

    • H20 - Public Economics - - Taxation, Subsidies, and Revenue - - - General
    • H11 - Public Economics - - Structure and Scope of Government - - - Structure and Scope of Government
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private

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