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The Economists' Voice 2.0The Financial Crisis, Health Care Reform, and More$
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Joseph Stiglitz and Aaron Edlin

Print publication date: 2014

Print ISBN-13: 9780231160155

Published to Columbia Scholarship Online: November 2015

DOI: 10.7312/columbia/9780231160155.001.0001

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Systemic Reform of Health Care Delivery and Payment

Systemic Reform of Health Care Delivery and Payment

(p.39) Chapter 5 Systemic Reform of Health Care Delivery and Payment
The Economists' Voice 2.0

Henry J. Aaron

Columbia University Press

This chapter discusses the four main obstacles faced by the Affordable Health Care Act (ACA). The first hurdle is judicial. Several states are challenging the constitutionality of the individual mandate—the requirement that everyone who is not insured at work or covered by a public program must personally buy health insurance. Second, Republicans have sworn to seek repeal of the ACA. The third challenge is implementation. The technical challenges of implementation are enormous. For example, many observers believe that health insurance subsidies should be based on data that are more current than the tax information currently available to the IRS. Collecting such data, processing the information, paying out subsidies, and recovering overpayments are daunting tasks. The fourth group of obstacles is found in state capitals. The ACA requires each of the fifty states to set up health insurance exchanges. It grants the states wide discretion as to how to organize the exchanges and where to place them in the state governmental structure. How well the states do this job is of critical importance. Insurers will be tempted to try to dump high-cost patients in the exchanges. If they succeed, premiums charged in the exchanges will be very high, rendering insurance through the exchanges burdensome or unaffordable for many people.

Keywords:   Affordable Care Act, ACA, health care policy, health care reform, health insurance exchange

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