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Foreshadowing Pitfalls for the Affordable Care Act

by Cedric Dark, MD, MPH, FACEP, FAAEM in Affordability & Delivery System

Several countries have implemented healthcare systems that seek to attain universal health insurance through private markets. Germany, the Netherlands, and Switzerland have [...]


Quality of Care

Access to Care

Health care costs

Affordable Care Act

  • Source: Donnie Ray Jones (Flickr/CC)

    Barking up the wrong tree

    Medical liability accounts for only 2.4% of all health care costs, yet medical malpractice reform is often hailed as a critical ingredient to reducing costs. Though capping non-economic damages—those that compensate patients for their pain, suffering, emotional distress, and disfigurement following a negligent medical error—reduces liability payments, it doesn’t accomplish what it’s meant to do. Costs are still sky-high, and patients that have proven in a court of law that they were the [...]
  • Source: Quasifly (Flickr/CC)

    No Good Deed Goes Unpunished

    The cost-reductions built into the Patient Protection and Affordable Care Act (ACA) are based upon the assumption that as the number of uninsured decreases, the need for federal subsidies to hospitals providing uncompensated care will also decrease.  However, 25 states have declined Medicaid expansions, and in total the ACA will cover only an additional 20 million of the estimated 50 million uninsured Americans. As implementation of the ACA progresses, hospitals serving indigent patient [...]
  • Source: Dan Moyle (Flickr/CC)

    It Costs More to be Poor

    Uninsured patients are the most financially vulnerable to hospital charges. Hospitals bill a high charge for medical services, with the expectation that a fraction of that is actually paid by insurance companies. With a large consumer base, commercial and government insurance programs negotiate for substantially lower rates. Meanwhile, the uninsured have little to no bargaining power, and thus are frequently tethered with substantial payments at the gross price. Source: Dan Moyle (Flickr/CC) To [...]
  • Source: Matthew Anderson (Flickr/CC)

    Primary Care 101: Supply and Demand

    The Affordable Care Act (ACA) has helped millions of Americans get insured. The hope is that if an individual is insured, he or she is more likely to gain access to primary care. More access to primary care means fewer expensive emergency room visits and hospitalizations. Source: Matthew Anderson (Flickr/CC) One fear, however, is that the demand for primary care will skyrocket, but the supply of primary care providers (even with mid-level providers taking on some of the workload) will not be [...]
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    Toppling the Ivory Tower of Medicine

    Last summer’s Institute of Medicine report on Graduate Medical Education (GME) raised vociferous concerns from stakeholders ranging from academic medicine (Association of American Medical Colleges), hospitals (American Hospital Association), and organized medicine (American Medical Association). In this Health Policy Report from the NEJM, the details of the IOM report are summarized and the salient issues surrounding the reform of GME are explained. Graduate medical education, the system by [...]
  • Source: Flickr/CC

    Less is More: HIE Prevents Repeat Tests

    Health Information Exchange (HIE) lets doctors see all of their patients’ records online, no matter where patients choose to go for care. If a patient has a doctor they really like in one hospital, but wants their labs drawn and prescriptions filled at a more convenient location in their neighborhood, then winds up in the ER across town after falling at a shopping mall, their ER doctor can see which medicines they are taking, and their bone specialist can see the results of the X-rays done at [...]
  • Source: Kirt Edblom (Flickr/CC)

    Coverage that Doesn’t Cover It

    As a medical student living in Texas, two things are very familiar to me: having uninsured family members and being solicited by said family members for medical advice. Source: Kirt Edblom (Flickr/CC) A few weeks ago, a relative approached me at a family BBQ (also familiar to anyone living in Texas) and showed me a superficial skin infection on her inner thigh. It was red, painful, and had gnarly streaks where the infection was spreading. I advised her to head to a real doctor for antibiotic [...]
  • Source: NIH/NIAID (Flickr/CC)

    The Economic Benefit of Preventing HIV

    In May 2014, the CDC released guidelines for pre-exposure prophylaxis (PrEP) for individuals considered high risk for HIV infection: those in relationships with HIV positive partners, those engaged in high-risk sexual behavior, and those with ongoing intravenous drug use. The recommendations include daily Truvada, an antiretroviral drug, and follow-up visits with STI/HIV testing and lab work every 3 months. These guidelines represent a significant investment estimated at $13,000 annually [...]
  • Source: (CC)

    Happy accident lowers health care costs

    The Affordable Care Act (ACA) increased emphasis on quality reporting for doctors and hospitals in an effort to improve care and, hopefully, improve health outcomes for patients. Whether or not this will be accomplished is yet to be seen. However, Medicare’s Hospital Compare tool, implemented prior to the ACA in 2005 by the Centers for Medicare and Medicaid (CMS), has had another unanticipated effect: lowering costs. Source: (CC) A new study published in Health Affairs by public [...]
  • Source: Flickr/CC

    The kids may not be alright

    As implementation of the Patient Protection and Affordable Care Act continues, an estimated 7 to 12 million children will benefit from Medicaid and CHIP expansions. However, the question of access still remains. Will the number of newly insured children outpace the number of providers accepting public insurance? Will geographic disparities grow as some states opt out of expansion? Now that Medicaid payment parity has expired, what will happen to access for children? Source: Flickr/CC A study [...]

Healthcare Costs

Public Health

Healthcare Delivery System

The Uninsured

  • Source: Dan Moyle (Flickr/CC)

    It Costs More to be Poor

    April 13, 2015 // 0 Comments

    Uninsured patients are the most financially vulnerable to hospital charges. Hospitals bill a high charge for medical services, with the expectation that a fraction of that is [...]
  • Source: U.S. Army Corps of Engineers Europe District (Flickr/CC)

    Give the people what they want

    January 19, 2015 // 0 Comments

    Under the Affordable Care Act, eligibility for Medicaid benefits was expanded to include low-income childless adults. This provision has proven to be immensely controversial, [...]
  • Source: Minnesota Historical Society (Flickr / CC)
    A recent study explored whether there is a relationship between the healthcare spending of uninsured individuals – sorted by citizenship status – prior to and during the [...]
  • Source: (Flickr / Creative Commons)

    ACA Progress Report: What has changed so far?

    August 11, 2014 // 2 Comments

    The first open enrollment period for the Affordable Care Act closed on March 31, with 8 million Americans enrolled by the deadline. The marketplace re-opens in November, [...]
  • Source: Kaiser Family Foundation analysis. Original data and detailed source information are available at
Produced by: Jessica Stephens, MPH; Samantha Artiga, MHSA; Barbara Lyons, PhD; Anne Jankiewicz; and David Rousseau, MPH.
    Source: Kaiser Family Foundation analysis. Original data and detailed source information are available at by: Jessica Stephens, MPH; [...]