The Affordable Care Act and the Transformation of US Health Care
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27/10/2016
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| Resumo |
The neoliberal period was accompanied by a momentous transformation within the US health care system. As the result of a number of political and historical dynamics, the healthcare law signed by President Barack Obama in 2010 ‑the Affordable Care Act (ACA)‑ drew less on universal models from abroad than it did on earlier conservative healthcare reform proposals. This was in part the result of the influence of powerful corporate healthcare interests. While the ACA expands healthcare coverage, it does so incompletely and unevenly, with persistent uninsurance and disparities in access based on insurance status. Additionally, the law accommodates an overall shift towards a consumerist model of care characterized by high cost sharing at time of use. Finally, the law encourages the further consolidation of the healthcare sector, for instance into units named “Accountable Care Organizations” that closely resemble the health maintenance organizations favored by managed care advocates. The overall effect has been to maintain a fragmented system that is neither equitable nor efficient. A single payer universal system would, in contrast, help transform healthcare into a social right. El periodo neoliberal ha sido acompañado por una transformación transcendental en el seno del sistema de salud estadounidense. Como resultado de una serie de dinámicas políticas e históricas, la nueva ley de atención a la salud firmada por Barack Obama en el 2010 –La Ley de Cuidado de la Salud Asequible (ACA)‑ se basó menos en modelos universales de otros países que lo que se propuso en reformas conservadoras anteriores del sistema de salud. Esto fue en parte el resultado de la influencia de los intereses de poderosas empresas de salud. Esta ley expande la cobertura sanitaria, pero lo hace de forma incompleta y desigual, con disparidades aseguradoras y vacíos persistentes en el acceso al sistema según el estatus del seguro. Además, la ley incorpora un cambio total hacia un modelo consumista de cuidado caracterizado por costes elevados en el momento de su uso. Finalmente, la ley promociona una mayor consolidación del sector de cuidado de la salud, por ejemplo en unidades llamadas “Organizaciones de cuidado responsables” que se parece mucho a las organizaciones de cuidado de la salud promovidas por abogados de la atención médica administrada. El efecto total ha sido el mantenimiento de un sistema fragmentado que ni es equitativo ni es eficiente. Un sistema universal mediante contribuyente único hubiera podido, en cambio, ayudar a transformar la sanidad en un derecho social. |
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application/pdf |
| Identificador |
http://revistas.ucm.es/index.php/CRLA/article/view/53456 10.5209/CRLA.53456 |
| Publicador |
Ediciones Complutense |
| Relação |
http://revistas.ucm.es/index.php/CRLA/article/view/53456/49016 /*ref*/Abelson, Reed. 2015. Health Care Companies in Merger Frenzy. October 29,. Accessed December 2, 2015. http://www.nytimes.com/2015/10/30/business/dealbook/health-care-companies-in-merger-frenzy.html?_r=0. /*ref*/Bach, P. B. 2008. Cost sharing for health care--whose skin? Which game? The New England journal of medicine 358 (4):411-3. /*ref*/Banthin, J. S., and D. M. Bernard. 2006. Changes in financial burdens for health care: national estimates for the population younger than 65 years, 1996 to 2003. JAMA : the journal of the American Medical Association 296 (22):2712-9. /*ref*/Barua, S., R. Greenwald, J. Grebely, G. J. Dore, T. Swan, and L. E. Taylor. 2015. Restrictions for Medicaid Reimbursement of Sofosbuvir for the Treatment of Hepatitis C Virus Infection in the United States. Annals of internal medicine 163 (3):215-23. /*ref*/Berenson, R. A., and R. Burton. 2011. Accountable Care Organizations in Medicare and the Private Sector: A Status Update Urban Institute. /*ref*/Blumenthal, D., and S. R. Collins. 2014. Health Care Coverage under the Affordable Care Act — A Progress Report. New England Journal of Medicine 371 (3):275-281. /*ref*/Brill, S. 2015. America's bitter pill: money, politics, backroom deals, and the fight to fix our broken healthcare system. New York: Random House. /*ref*/Brook, R. H., J. E. Ware, Jr., W. H. Rogers, E. B. Keeler, A. R. Davies, C. A. Donald, G. A. Goldberg, K. N. Lohr, P. C. Masthay, and J. P. Newhouse. 1983. Does free care improve adults' health? Results from a randomized controlled trial. The New England journal of medicine 309 (23):1426-34. /*ref*/Budowsky, Brent. 2012. RomneyCare=ObamaCare=NixonCare=DoleCare. The Hill. Accessed December 2, 2015. http://thehill.com/blogs/pundits-blog/healthcare/239725-romneycareobamacarenixoncaredolecare. /*ref*/Claxton, G., C. Cox, and M. Rae. 2015. The Costs of Care with Marketplace Coverage. Henry J. Kaiser Family Foundation. /*ref*/Collins, S.R., P.W. Rasmussen, S. Beutel, and M.M. Doty. 2015. The Problem of Underinsurance and How Rising Deductibles Will Make It Worse—Findings from the Commonwealth Fund Biennial Health Insurance Survey. The Commonwealth Fund, . /*ref*/Congressional Budget Office. 2015. Insurance Coverage Provisions of the Affordable Care Act-CBO’s March 2015 Baseline." Available at: https://www.cbo.gov/sites/default/files/cbofiles/attachments/43900-2015-03-ACAtables.pdf [accessed May 2015]. /*ref*/Crowley, R. A., and W. Golden. 2014. Health policy basics: Medicaid expansion. Annals of internal medicine 160 (6):423-5. /*ref*/Cutler, D. M., and F. Scott Morton. 2013. Hospitals, market share, and consolidation. JAMA : the journal of the American Medical Association 310 (18):1964-70. /*ref*/Dafny, L. 2014. Hospital industry consolidation--still more to come? The New England journal of medicine 370 (3):198-9. /*ref*/Derickson, A.. 1994. Health Security for All? Social Unionism and Universal Health Insurance, 1935-1958. The Journal of American History 80 (4):1333-1356. /*ref*/Ellwood, P. M., A. C. Enthoven, and L. Etheredge. 1992. The Jackson Hole initiatives for a twenty-first century American health care system. Health economics 1 (3):149-68. /*ref*/Ellwood, P. M., Jr., N. N. Anderson, J. E. Billings, R. J. Carlson, E. J. Hoagberg, and W. McClure. 1971. Health maintenance strategy. Medical care 9 (3):291-8. /*ref*/Enthoven, A. C. 1978a. Consumer-Choice Health Plan - A National-Health-Insurance Proposal Based on Regulated Competition in the Private Sector. New England Journal of Medicine 298 (13):709-720. /*ref*/Enthoven, A. C. 1978b. Consumer-Choice Health Plan - Inflation and Inequity in Health Care Today: Alternatives for Cost Control and an Analysis of Proposals for National Health Insurance. New England Journal of Medicine 298 (12):650-658. /*ref*/Frakt, A. B., and A. E. Carroll. 2013. Sound policy trumps politics: states should expand Medicaid. Journal of health politics, policy and law 38 (1):165-78. /*ref*/Frakt, A., A. E. Carroll, H. A. Pollack, and U. Reinhardt. 2011. Our flawed but beneficial Medicaid program The New England journal of medicine 364 (16):e31. /*ref*/Funigiello, Philip J. 2005. Chronic politics: health care security from FDR to George W. Bush. Lawrence, Kan.: University Press of Kansas. /*ref*/Gaffney, A. 2015. The neoliberal turn in American health care. International journal of health services: planning, administration, evaluation 45 (1):33-52. /*ref*/Gaffney, A., S. Woolhandler, M. Angell, and D. U. Himmelstein. 2016. Moving Forward From the Affordable Care Act to a Single-Payer System. American journal of public health 106 (6):987-988. /*ref*/Geyman, J. P. 2007. Moral hazard and consumer-driven health care: a fundamentally flawed concept. International journal of health services: planning, administration, evaluation 37 (2):333-51. /*ref*/Gordon, C. 2005. Dead on arrival: the politics of health care in twentieth-century America. Princeton, N.J.: Princeton University Press. Original edition, 2003. /*ref*/Gray, Bradford H. 2006. The Rise and Decline of the HMO: A Chapter in U.S. Health-Policy History. In History and health policy in the United States : putting the past back in, edited by Rosemary Stevens, Charles E. Rosenberg and Lawton R. Burns, 309-339. New Brunswick, N.J.: Rutgers University Press. /*ref*/Gruber, Jonathan. 2010. Health Care Reform Is a 'Three Legged Stool'. In: Center for American Progress. https://cdn.americanprogress.org/wp-content/uploads/issues/2010/08/pdf/repealing_reform.pdf [Accessed November 17, 2015]. /*ref*/Health Policy Brief. 2013.Excise Tax on 'Cadillac' Plans. Health affairs. /*ref*/HealthPocket. 2015a. 2015 Obamacare Deductibles Remain High But Don't Grow Beyond 2014 Levels.. /*ref*/HealthPocket. 2015b. 2016 Affordable Care Act Market Brings Higher Average Premiums for Unsubsidized. . Accessed November 30, 2015. /*ref*/Henry J. Kaiser Family Foundation. 2007a. Kaiser Health Tracking Poll: Election 2008 - March 2007. In. http://kff.org/health-costs/poll-finding/kaiser-health-tracking-poll-election-2008-march/ [Accessed 11-3-15]. /*ref*/Henry J. Kaiser Family Foundation. 2007b. Kaiser Health Tracking Poll: Election 2008 – December 2007. In: Kaiser Family Foundation. http://kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-election-2008-december/ [Accessed 11-3-15]. /*ref*/Henry J. Kaiser Family Foundation. 2007c. Kaiser Health Tracking Poll: Election 2008 — March 2007. In: Kaiser Family Foundation. http://kff.org/health-costs/poll-finding/kaiser-health-tracking-poll-election-2008-march/%5BAccessed 11-3-15]. /*ref*/Henry J. Kaiser Family Foundation. 2012. A Guide to the Supreme Court's Affordable Care Act Decision. Accessed December 2, 2015. https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8332.pdf. /*ref*/Henry J. Kaiser Family Foundation. 2013. Summary of the Affordable Care Act. Accessed December 2, 2015. http://kff.org/health-reform/fact-sheet/summary-of-the-affordable-care-act/. /*ref*/Henry J. Kaiser Family Foundation. 2015a. The 2015 Employer Health Benefits Survey. Accessed September 29, 2015. /*ref*/Henry J. Kaiser Family Foundation. 2015b. Status of State Action on the Medicaid Expansion Decision. http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/ [Accessed November 30, 2015]. /*ref*/Himmelstein, D. U., D. Thorne, E. Warren, and S. Woolhandler. 2009. Medical bankruptcy in the United States, 2007: results of a national study. The American journal of medicine 122 (8):741-6. /*ref*/Himmelstein, D. U., and S. Woolhandler. 2014. Global Amnesia: Embracing Fee-For-Non-Service-Again. Journal of general internal medicine. /*ref*/Hoffman, B. 2001. The Wages of Sickness. Chapel Hill: The University of North Carolina Press. /*ref*/Hoffman, B. R. Health care for some: rights and rationing in the United States since 1930. /*ref*/Hoffman, B R. 2012. Health care for some: rights and rationing in the United States since 1930. Chicago: University of Chicago Press. /*ref*/Jost, T. S. 2007. Health care at risk: a critique of the consumer-driven movement. Durham: Duke University Press. /*ref*/Kaiser Commission on Medicaid and the Uninsured. 2015. The Uninsured: A Primer - Key Facts About Health Insurance and the Uninsured in America. Available at http://kff.org/uninsured/report/the-uninsured-a-primer/ [Accessed 03/05/2015]. /*ref*/Lemieux, S. 2014. "No, Obamacare Wasn't a 'Republican' Proposal." The American Prospect. /*ref*/Lubove, R. 1986. The Struggle for Social Security 1900-1935. Pittsburgh: University of Pittsburgh Press. /*ref*/Maarse, H. 2006. The privatization of health care in Europe: an eight-country analysis. Journal of health politics, policy and law 31 (5):981-1014. /*ref*/Marmor, T. R., and J. Morone. 1977. The Health Programs of the Kennedy-Johnson Years: An Overview. In Toward new human rights : the social policies of the Kennedy and Johnson administrations, xv, 448 p. Austin: Lyndon B. Johnson School of Public Affairs, University of Texas at Austin. /*ref*/McDonough, J. E. 2011. Inside national health reform. Berkeley /*ref*/New York: University of California Press ;Milbank Memorial Fund. /*ref*/Navarro, V. 1995. Why Congress did not enact health care reform. Journal of health politics, policy and law 20 (2):455-62. /*ref*/Navarro, V. 1989. Why Some Countries Have National Health Insurance, others Have National Health Services, and the United States Has Neither. International Journal of Health Services 19 (3):383-404. /*ref*/Numbers, Ronald L. 1978. Almost persuaded: American physicians and compulsory health insurance, 1912-1920, The Henry E Sigerist supplements to the Bulletin of the history of medicine. Baltimore: Johns Hopkins University Press. /*ref*/Obama, B. 2015. Remarks by the President on the Supreme Court's Ruling of the Affordable Care Act. https://www.whitehouse.gov/the-press-office/2015/06/25/remarks-president-supreme-courts-ruling-affordable-care-act [Accessed Novembe 23, 2015]. /*ref*/Oberlander, J. 2007. Presidential politics and the resurgence of health care reform. The New England journal of medicine 357 (21):2101-4. /*ref*/Oberlander, J., and M. J. Laugesen. 2015. Leap of Faith — Medicare's New Physician Payment System. New England Journal of Medicine 373 (13):1185-1187. /*ref*/Pham, Hoangmai H., J. Pilotte, R. Rajkumar, E. Richter, S. Cavanaugh, and Patrick H. Conway. 2015. Medicare's Vision for Delivery-System Reform — The Role of ACOs. New England Journal of Medicine 373 (11):987-990. /*ref*/Poen, Monte M. 1979. Harry S. Truman Versus the Medical Lobby: The Genesis of Medicare. Columbia: University of Missouri Press. /*ref*/Pollock, A. M., and P. Roderick. 2015. Why the Queen's Speech on 19 May should include a bill to reinstate the NHS in England. Bmj 350:h2257. /*ref*/Quadagno, J. S. 2005. One nation, uninsured: why the U.S. has no national health insurance. New York: Oxford University Press. /*ref*/Reeves, A., M. McKee, and D. Stuckler. 2015. The attack on universal health coverage in Europe: recession, austerity and unmet needs. European journal of public health 25 (3):364-5. /*ref*/Schoen, C., S. R. Collins, J. L. Kriss, and M. M. Doty. 2008. How many are underinsured? Trends among U.S. adults, 2003 and 2007. Health affairs 27 (4):w298-309. /*ref*/Schoen, C., M. M. Doty, R. H. Robertson, and S. R. Collins. 2011. Affordable Care Act reforms could reduce the number of underinsured US adults by 70 percent. Health affairs 30 (9):1762-71. /*ref*/Skinner, A. C., and M. L. Mayer. 2007. Effects of insurance status on children's access to specialty care: a systematic review of the literature. BMC health services research 7:194. /*ref*/Sommers, B. D., K. Baicker, and A. M. Epstein. 2012. Mortality and Access to Care among Adults after State Medicaid Expansions. New England Journal of Medicine 367 (11):1025-1034. /*ref*/Starr, P. 1982. The social transformation of American medicine. New York: Basic Books. /*ref*/Starr, P. 2013. Remedy and reaction: the peculiar American struggle over health care reform. Revised edition. ed. New Haven: Yale University Press. /*ref*/Waitzkin, H. 1994. The strange career of managed competition: from military failure to medical success? American journal of public health 84 (3):482-9. /*ref*/Waitzkin, H.. 2010. Selling the Obama Plan: Mistakes, Misunderstandings, and Other Misdemeanors. American journal of public health 100 (3):398-400. /*ref*/Waitzkin, H.. 2011. Medicine and public health at the end of empire. Boulder, CO: Paradigm Publishers. /*ref*/Wilper, A. P., S. Woolhandler, K. E. Lasser, D. McCormick, D. H. Bor, and D. U. Himmelstein. 2008. A national study of chronic disease prevalence and access to care in uninsured U.S. adults. Annals of internal medicine 149 (3):170-6. /*ref*/Wilper, A. P., S. Woolhandler, K. E. Lasser, D. McCormick, D. H. Bor, and D. U. Himmelstein. 2009. Health insurance and mortality in US adults. American journal of public health 99 (12):2289-95. /*ref*/Woolhandler, S., D. U. Himmelstein, M. Angell, Q. D. Young, and Physicians' Working Group for Single-Payer National Health Insurance. 2003. Proposal of the Physicians' Working Group for Single-Payer National Health Insurance. JAMA : the journal of the American Medical Association 290 (6):798-805. |
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| Fonte |
Cuadernos de Relaciones Laborales; Vol 34, No 2 (2016): La cuestión social de la sanidad; 239-261 |
| Palavras-Chave | #the Affordable Care Act; universal models; US health care system; consumerist model of care #La Ley de Cuidado de la Salud Asequible; modelos universales; el sistema sanitario estadounidense; modelo consumista de cuidados |
| Tipo |
info:eu-repo/semantics/article Artículo revisado por pares info:eu-repo/semantics/publishedVersion |
