United States Health Care Reform Progress to Date and Next Steps EDITORIAL COMMENT

The economy, federal budgets, and the financial well-being of American families are all impacted by health care costs. To combat the issues of the rapid rise in health care costs as well as to address the issue of a significant proportion of the population being uninsured, the Affordable Care Act (ACA) was the most important health care legislation enacted in the United States since the creation of Medicare and Medicaid in 1965. These comprehensive reforms were designed to improve the accessibility, affordability, and quality of health care. This study reviewed the factors influencing the decision to pursue health reform, presents evidence on the impact of the law to date, provides recommendations to improve the health care system, and finally identified general lessons for public policy from the ACA. All the data used for this study were collected through the analysis of data (1) that were publicly available, (2) from government agencies, and (3) from research publications covering the period between 1963 and early 2016. It is evident that the ACA has made significant progress toward solving long-standing challenges facing the US health care system related to access, affordability, and quality of care. After the implementation of the ACA, the uninsured rate has decreased by 43% from 16.0% in 2010 to 9.1% in 2015. Despite concomitant improvements in the economy, it appears that the predominant reasons for this trend are due to the law's reforms. There has also been accompanying improvements in access to care (eg, an estimated reduction in the share of nonelderly adults unable to afford care of 5.5 percentage points), financial security (eg, an estimated reduction in debts sent to collection of $ 600-$ 1000 per person gainingMedicaid coverage), and health (eg, an estimated reduction in the share of nonelderly adults reporting fair or poor health of 3.4 percentage points). In addition, the ACA has helped transform health care payment systems, with an estimated 30% of traditional Medicare payments now flowing through alternative payment models such as bundled payments or accountable care organizations. It has also contributed to a sustained period of slow growth in per-enrollee health care spending and improvements in health care quality. However, there are many major opportunities to improve the health care system that remain unexplored. Findings of the study reveal that policy makers should build on progress initiated by the ACA by continuing to implement Health Insurance-Marketplaces and delivery system reform, increasing federal financial assistance for Marketplace enrollees, introducing a public plan option in areas lacking individual market competition, and taking actions to reduce prescription drug costs. The ACA demonstrates that positive change is achievable on some of the nation's most complex challenges, despite the partisanship and special-interest opposition that remain.