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affordable care act (Obamacare)

signed it into law in 2010 upheld by Supreme Court in June 2012 open enrollment on October 1, 2013 enacted Jan 2014 Notes: Provisions that affect care of the elderly include: - $10 billion for establishment of the Center for Medicare & Medicaid Innovation - elimination of the 'doughnut hole' coverage gap, by reducing co-insurance rates from 100% to 25% for patients affected by the gap - creation of Accountable Care Organizations, in which physicians share in the cost savings to Medicare by attaining specified quality measures - a 10% increase in fee for service reimbursement rates for geriatricians delivering primary care services Funding for Medicare Advantage Programs is decreased because the alleged increase overall costs [3] health insurance exchanges & Medicaid expansion enacted in 2014 - expanding Medcaid under the Affordable Care Act reduces number of uninsured 14% [6] & improves healthcare access [8] - Medicaid expansion associated with better coverage & access [11] - California & New York expanded Medicaid whereas Texas & Florida did not; uninsured rates among young adults in those states is 8%, 10%, 30% & 27%, respectively [11] - % of patients with newly diagnosed cancer without health insurance declined by 1/3 after ACA enacted [12] - with its incentives & financial readmission penalties the the Affordable Care Act has reduced hospital readmissions [7] repeal of the ACA would worsen the opioid epidemic [10]

References

  1. Health Affairs Blog, November 7th, 2012 Election 2012: A Win For Health Reform, But Much Work Remains http://healthaffairs.org/blog/2012/11/07/election-2012-a-win-for-health-reform-but-much-work-remains/
  2. Washington Post. Wokblog. November 7th, 2012 Obamacare stands. Now states need to make it work. http://www.washingtonpost.com/blogs/ezra-klein/wp/2012/11/07/obamacare-stands-now-states-need-to-make-it-work/
  3. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
  4. Blumenthal D and Collins SR Health Care Coverage under the Affordable Care Act - A Progress Report. N Engl J Med. July 2, 2014 PMID: 24988300 http://www.nejm.org/doi/full/10.1056/NEJMhpr1405667
  5. Orciari Herman A, Fairchild DG Affordable Care Act to Face Supreme Court Physician's First Watch, March 4, 2015 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
  6. Sommers BD, Blendon RJ, Orav EJ Both The 'Private Option' And Traditional Medicaid Expansions Improved Access To Care For Low-Income Adults. Health Affairs. 2016 Jan 35(1):96-105 PMID: 26733706 http://content.healthaffairs.org/content/35/1/96.abstract
  7. Zuckerman RB et al. Readmissions, observation, and the Hospital Readmissions Reduction Program. N Engl J Med 2016 Feb 24 PMID: 26910198 Free Article
  8. Wherry LR, Miller S Early Coverage, Access, Utilization, and Health Effects Associated With the Affordable Care Act Medicaid Expansions: A Quasi-experimental Study. Ann Intern Med. Published online 19 April 2016 PMID: 27088438 - Kullgren JT Injecting Facts Into the Heated Debates Over Medicaid Expansion. Ann Intern Med. Published online 19 April 2016 PMID: 27088778 http://annals.org/article.aspx?articleid=2515051
  9. Obama B United States Health Care Reform. Progress to Date and Next Steps. JAMA. Published online July 11, 2016 PMID: 27400401 http://jama.jamanetwork.com/article.aspx?articleid=2533698
  10. Friedmann PD, Andrews CM, Humphreys K How ACA Repeal Would Worsen the Opioid Epidemic. N Engl J Med 2017; 376:e16. March 9, 2017 PMID: 28273016 http://www.nejm.org/doi/full/10.1056/NEJMp1700834
  11. The Commonwealth Fund. Insurance Coverage, Access to Care, and Medical Debt Since the ACA: A Look at California, Florida, New York, and Texas. http://www.commonwealthfund.org/publications/issue-briefs/2017/mar/coverage-access-medical-debt-aca-california-florida-new-york-texas
  12. Soni A, Sabik LM, Simon K et al Changes in Insurance Coverage Among Cancer Patients Under the Affordable Care Act. JAMA Oncol. Published online October 19, 2017. PMID: 29049486 https://jamanetwork.com/journals/jamaoncology/article-abstract/2657670
  13. Bagley N Perspective. Is Obamacare Really Unconstitutional? N Engl J Med. Jan 2, 2020 PMID: 31893512 https://www.nejm.org/doi/full/10.1056/NEJMp1917063
  14. The Affordable Care Act. Read the Law. http://www.hhs.gov/healthcare/about-the-law/read-the-law/
  15. Center for Medicare & Medicaid Innovation http://innovations.cms.gov