HEALTH REFORM ARTICLES    |    FOLLOWING THE ACA BLOG POSTS



Health reform from Obamacare to Trumpcare is covered by Health Affairs in nonpartisan, peer-reviewed journal articles and Health Policy Briefs plus timely Health Affairs Blog posts from multiple points of view. Key health policy questions are explored for the Affordable Care Act (ACA), Medicare, Medicaid and payment reform. Health Affairs has informed health reform for 35 years.

Repeal and Replace or Amend?
Medicaid Block Grants
Premium Support
Private Insurance Regulation





January 03, 2016     LEGISLATION
The Problems With 'Repeal And Delay'
The most likely end result of "repeal and delay" would be less secure insurance for many Americans, procrastination by political leaders, and ultimately no discernible movement toward a real marketplace for either insurance or medical services.
Joseph Antos and James Capretta



Repeal and Replace or Amend?

January 11, 2017     EMPLOYER-SPONSORED INSURANCE
Get Health Insurance Through Your Employer? ACA Repeal Will Affect You, Too
Job-based plans offered to employees and their families cover 150 million people in the United States. If the ACA is repealed, they stand to lose critical consumer protections that many have come to expect of their employer plan.
JoAnn Volk

January 11, 2017     MARKETPLACES
ACA 'Repeal And Delay' Would Leave A Narrow Window To Stabilize Exchanges
This post describes the deadlines facing health plans as they make decisions about whether to continue participating in the Exchanges in 2018. We then offer options that Congress and the executive branch could use to stabilize the Exchanges and encourage continued health plan participation.
Joel Michaels and Jeremy Earl

January 10, 2017     MEDICARE
To Get Dems On Board With ACA Replacement, Republicans Should Take Medicare Off The Table
With two relatively straightforward acknowledgements, Republicans could create a pathway for bipartisan reconsideration of health care coverage in America.
Rodney Whitlock

January 05, 2017     THE HOUSE
The Republican Study Committee's ACA Replacement Proposal
On January 4, 2017, the House Republican Study Committee, a caucus of conservative Republican House members, introduced the American Health Care Reform Act, their replacement proposal.
Timothy Jost

January 05, 2017     HEALTH LAW
The Best-Laid Plans For Health Care
Tremendous uncertainty awaits, though I expect that we will see a slowing down of the repeal and replace process, with even the individual mandate persisting for some time; unmaking the Affordable Care Act without leaving millions stranded will be harder than the campaign may have suggested.
I. Glenn Cohen

January 04, 2017     THE COURTS
Judge Certifies Insurer's Risk Corridor Case As A Class Action
This is one of more than a dozen cases that have been brought by insurers in the Court of Claims challenging the failure of the government to pay marketplace insurers amounts that they claim were due to them under the ACA's risk corridor program.
Timothy Jost

January 04, 2017     MEDICAID
The ACA Transformed Medicaid Enrollment Processes. Rolling Them Back Would Wreak Havoc.
Implementing the ACA's Modified Adjusted Gross Income (MAGI) rules and systems were a heavy lift for states. Reversing them would wreak havoc for states and low-income families who depend on Medicaid.
Tricia Brooks

January 03, 2017     BUDGET RESOLUTION
ACA Repeal Process Begins In Congress
On January 3, 2017, Senator Mike Enzi, Chair of the Senate Budget Committee, introduced a concurrent budget resolution in the Senate to begin the process of repealing the Affordable Care Act.
Tim Jost

January 02, 2017     NONDISCRIMINATION
ACA Pregnancy Termination, Gender Identity Protections Blocked; Wellness Program Incentives Survive (Updated)
A judge has preliminarily enjoined protections regarding pregnancy termination and gender identity in an ACA nondiscrimination rule. Another judge refused to block regulations allowing employers to offer incentives for employees to disclose medical information in connection with wellness programs.
Tim Jost

December 06, 2016     HEALTH REFORM
Health Reform: Where We've Been, Where We're Going
What are the ACA's successes and failures? How might the new administration and Congress proceed with repealing and replacing it? What provisions might be adopted to replace the ACA and how might these provisions improve on, or undermine, the law's accomplishments?
Tim Jost

December 22, 2016     COVERAGE
ACA Round-Up: Robust Marketplace Enrollment, CBO On Defining Health Insurance, And More
As of December 19, the deadline for enrolling in coverage for January 1, 2017, 6,356,488 consumers were covered by plans selected on HealthCare.gov, HHS announced. Other developments included CBO blog posts discussing how that agency would evaluate coverage effects of ACA replacement proposals.
Timothy Jost

December 20, 2016     THE COURTS
Two Recipients Of ACA Cost-Sharing Subsidies Seek Voice In Litigation
Two of the 5.9 million people who benefit from ACA cost-reduction payments have asked to intervene in House v. Burwell to protect their interests in continuing to receive the CSRs.
Timothy Jost

December 15, 2016     COUNCIL OF ECONOMIC ADVISORS
Obama Administration Lays Out Its Case For ACA's Success
A new Obama administration report and accompanying material argue that by many measures the ACA has been an outstanding success in addressing the key issues of our health care system-expanding access, lowering costs, and improving quality.
Timothy Jost

December 12, 2016     DELIVERY SYSTEM REFORM
Building A System That Works: The Future Of Health Care
As the Obama Administration comes to a close, Secretary Burwell lays out a vision for the future of health care.
Sylvia Mathews Burwell

December 08, 2016     HSAs
Trump Plan To Increase Health Savings Accounts Should Ensure That They Do Not Only Benefit The Wealthy And Healthy
New approaches will be needed if HSAs are to be used more widely and improve health outcomes for the broader population.
Kathryn Phillips

December 07, 2016     REPEAL
Five Reasons The ACA Won't Be Repealed
The repeal and replace "two step" is fraught with difficulty, bolder than the ACA itself, and far from certain to succeed.
Billy Wynne

December 01, 2016     PRESIDENTIAL NOMINEES
Previewing Potential HHS Leadership
Tim Jost profiles the records of Rep. Tom Price (R-GA) and Seema Verma, Donald Trump's designated HHS Secretary and CMS Administrator.
Tim Jost

November 09, 2016     DAY ONE AND BEYOND
What Trump's Election Means for the ACA
On the day following the election, Health Affairs Blog regular and legal expert Timothy Jost offered a first pass at what Donald Trump’s election may mean for the ACA, popularly known as Obamacare.
Timothy Jost

August 29, 2016     MEDICAID WAIVERS
Healthy Indiana 2.0 Is Challenging Medicaid Norms
Seema Verma is President-elect Trump's pick to head CMS. Here she describes how Indiana launched the most significant departure from Medicaid to date, achieved with a series of waivers sought by Vice President-elect Mike Pence (then governor of Indiana).
Seema Verma and Brian Neale

December 09, 2015     ACA ALTERNATIVE
An Alternative Framework for Reform
Scott Gottlieb recently joined President-elect Trump's health transition team. In this post, he joins with a group of conservative coauthors to propose a plan to replace the ACA and to enact major reforms to the tax treatment of employer-sponsored health care, Medicaid, Medicare, Health Savings Accounts, and other areas.
Joseph Antos, James Capretta, Lanhee Chen, Scott Gottlieb, Yuval Levin, Thomas Miller, Ramesh Ponnuru, Avik Roy, Gail R. Wilensky, and David Wilson

November 07, 2016     VIEWS ON HEALTH CARE
The 2016 Election: Differences Are Deeper than Ever
John McDonough

June 22, 2016     ACA ALTERNATIVE
The House Republican's Health Plan
Joseph Antos and James Capretta

June 16, 2016     SESSIONS-CASSIDY BILL
The World's Greatest Health Care Plan
John Goodman

June 01, 2016     SESSIONS-CASSIDY BILL
Sessions-Cassidy: An ACA Alternative
Timothy Jost

September 18, 2015     REPUBLICAN PLAN
What Would Republicans Do Instead of the ACA?
John McDonough and Max Fletcher

April 14, 2015     REPEAL AND REPLACE
If the ACA Were Repealed, What Would Replace It?
Timothy Jost

JULY 10, 2015     REFORM ALTERNATIVE
A Health Reform Framework: Breaking Out of the Medicaid Model
Joseph Antos and James Capretta

September 20, 2011     CONTROLLING COSTS
Medicare Is More Efficient Than Private Insurance
Diane Archer

November 2008     Health Reform
The McCain Plan to Restructure Health Insurance
Thomas Buchmueller, Sherry A. Glied, Anne Royalty and Katherine Swartz



Medicaid Block Grants

APRIL 18, 2013     HEALTH POLICY BRIEF
Per Capita Caps in Medicaid
This policy brief examines the issues surrounding per capita caps in Medicaid and explores other policy options for states and the federal government.

January 12, 2012     HEALTH POLICY BRIEF
Medicaid Reform
This policy brief explores some of the major ideas being discussed to restructure Medicaid and outlines the competing arguments.

July 2015     MEDICAID AT 50
Remarkable Growth Fueled by Unexpected Politics
Michael Sparer

JANUARY 2003     HEALTH AFFAIRS THEME ISSUE
Medicaid Comes of Age
This thematic issue of the journal on the growth of Medicaid explores questions about how to finance the program.

JANUARY 2003     MEDICAID FINANCING
The Flexibility Factor: Finding the Right Balance
Cindy Mann

JANUARY 2003     MEDICAID AND STATES
There's Something about Medicaid
Alan Weil



Premium Support

March 22, 2012     PROS AND CONS OF PREMIUM SUPPORT
Premium Support In Medicare
This Health Policy Brief explains the concept of premium support and examines the debate between proponents and critics.

April 06, 2012     DEFINING PREMIUM SUPPORT
Vouchers or Premium Support: What's in a Name?
The term "premium support" was introduced by Henry Aaron and Robert Reischauer in a 1995 Health Affairs article. Aaron and Reischauer's ideas drew heavily on Alain Enthoven's theory of managed competition, which are definitively explained in a 1993 Health Affairs article.
Henry Aaron

JANUARY 2015     MEDICARE COSTS
Variations in Medicare Costs Have Implications for Premium Support
By Brian Biles, Giselle Casillas, and Stuart Guterman

MAY 2012     MEDICARE REFORM
Three Large-Scale Changes to Medicare
Christine Eibner, Dana P. Goldman, Jeffrey Sullivan, and Alan M. Garber

SEPTEMBER 2000     PREMIUM SUPPORT
Is Premium Support the Right Medicine for Medicare?
Jonathan Oberlander



Private Insurance Regulation


High-Risk Pools:


March 15, 2016     COVERAGE
It's All About The Risk Pool
Linda Blumberg and John Holahan

March 2011     ENROLLMENT
The Preexisting Condition Insurance Plan
Joann Kenen

June 2010     ENROLLMENT
Temporary Insurance for High-Risk Individuals
Deborah J. Chollet

May 2007     INSURANCE MARKET
Risk Pooling And Regulation: Policy and Reality
Mark V. Pauly and Bradley Herring

October 2002     INSURANCE MARKET
Competitive Markets for Individual Health Insurance
Scott Harrington and Tom Miller

October 2002     COVERAGE
Expanding Individual Health Insurance Coverage: Are High-Risk Pools the Answer?
Deborah Chollet

October 2002     INSURANCE MARKET
The Nongroup Insurance Market: Short on Facts, Long on Opinions and Policy Disputes
Mark V. Pauly and Len Nichols

October 2002     COVERAGE
Using Tax Credits and State High-Risk Pools to Expand Coverage
Bruce Abbe

Selling Across State Lines:


February 24, 2010     COVERAGE
Should We Be Able to Buy Insurance Across State Lines?
John Goodman

October 27, 2010     INSURANCE SALES
Interstate Insurance Sales: Questioning the 'Race to the Bottom'
John Goodman