Health care reform

Abstract

With the passage of The Patient Protection and Affordable Care Act (PPACA), dramatic changes are coming in health care delivery in the United States. Supporters of the new law say that it will improve quality of care and outcomes, provide more accountability in health care, and even reduce costs. This issue of cost is important. Estimates from 2009 suggest that the United States spent $2.6 trillion (17.3% of gross domestic product) on health care while the average spending in the rest of the world equals just 9% gross domestic product.1 The numbers can be debated, but the rising cost of health care cannot be sustained. Supporters argued that the law was essential to containing costs. Will PPACA contain cost? The Congressional Budget Office (CBO) expressed concern that health care costs will remain high even after reform, even as it determined that the PPACA will reduce the federal budget deficit by more than $100 billion over the first decade and by more than $1 trillion between 2020 and 2030.2 CBO also estimated that the cost of covering the bill would be more than offset by Medicare savings through fraud and abuse efforts, new taxes and fees, tax on high-cost employer-sponsored health plans, and tax on investment incomes of the most affluent Americans.2 Now that the legislation has passed, the regulatory work has begun. This is where the language of the bill is put into details by regulatory agencies such as the Department of Health and Human Resources and the Centers for Medicare and Medicaid Services. Debate exists about what the provisions really mean in PPACA, but some facts are generally accepted.