Challenges facing the United States of America in implementing universal coverage

• Type of Material: Article
• Authors: Thomas Rice, University of California Los Angeles; Lynn Y Unruh, University of Central Florida; Pauline Rosenau, University of Texas; Andrew J Barnes, Virginia Commonwealth University; Richard Saltman, Emory University; Ewout van Ginneken, Berlin University of Technology
• Language: English
• Date: 2014-12-01
• Publisher: World Health Organization (WHO): Creative Commons Attribution
• Publication Version: Final Published Version
• Copyright Statement: © 2014, World Health Organization, All rights reserved.
• License: Creative Commons Attribution 3.0 IGO License
• Final Published Version (URL): http://dx.doi.org/10.2471/BLT.14.141762
• Title of Journal or Parent Work: Bulletin of the World Health Organization
• ISSN: 0042-9686
• Volume: 92
• Issue: 12
• Start Page: 894
• End Page: 902
• Keywords: Science & Technology; Life Sciences & Biomedicine; Public, Environmental & Occupational Health
• Research Categories: Health Sciences, Occupational Health and Safety; Health Sciences, Public Health

Abstract

In 2010, immediately before the United States of America (USA) implemented key features of the Affordable Care Act (ACA), 18% of its residents younger than 65 years lacked health insurance. In the USA, gaps in health coverage and unhealthy lifestyles contribute to outcomes that often compare unfavourably with those observed in other high-income countries. By March 2014, the ACA had substantially changed health coverage in the USA but most of its main features - health insurance exchanges, Medicaid expansion, development of accountable care organizations and further oversight of insurance companies - remain works in progress. The ACA did not introduce the stringent spending controls found in many European health systems. It also explicitly prohibits the creation of institutes - for the assessment of the cost-effectiveness of pharmaceuticals, health services and technologies - comparable to the National Institute for Health and Care Excellence in the United Kingdom of Great Britain and Northern Ireland, the Haute Autorité de Santé in France or the Pharmaceutical Benefits Advisory Committee in Australia. The ACA was - and remains - weakened by a lack of cross-party political consensus. The ACA’s performance and its resulting acceptability to the general public will be critical to the Act’s future.