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Is health care a right or an entitlement? This question persists in the ongoing political, legal, and social turbulence surrounding efforts toward accessible and affordable health care in the United States.

The analysis is drawn from a review of the literature and interviewing a subject matter expert employed by a health maintenance organization in Michigan.

Since the early 1900s, federal legislation has been proposed to establish some type of health care structure that could sufficiently address the varying health care needs of Americans. These multiple attempts toward national health care reform invoke the inquiry of the federal government’s role and function to facilitate access to and management of health care. The passage of the Patient Protection and Affordable Care Act (PPACA) amplifies the conditions and consequences of implementing health care reform effectively.

For college students, the complexities of both the health care and higher education systems can be overwhelming, especially for those students who may already be struggling to pay for and/or finance their schooling and satisfy academic requirements to matriculate while simultaneously striving to maintain a reasonable level of health to complete their education. College students are but one of many vulnerable populations in the United States impacted by the complicated policies and procedures of accessing, delivering, funding, and paying for health care.

This study aims to examine the effect of the Patient Protection and Affordable Care Act (PPACA) on for-profit hospitals in the USA.

The study uses the event study methodology to examine the stock market’s reaction to the passage of the PPACA.

The results of the analysis do not show a negative effect; on the contrary, the stock prices of for-profit hospitals increased, on average, by 6%. The cumulative abnormal returns were 5.64% with a generalized z-value of 3.851 with a significance level of 0.001 (two-tailed test). This translates into an average gain of $230,537,096 for the four days (dates) that a positive step was taken in making the Affordable Care Act (ACA) a law of the country.

Because the study suggests that for-profit hospitals will be profitable under the PPACA, one could expect to see growth or, at the minimum, expansion in for-profit hospitals under the Act. Furthermore, and consistent with the principles of marketing, one would expect all the for-profit hospitals, at this nascent stage of the ACA, to pull resources together to promote the benefits of having the ACA.

To the best of the author’s knowledge, this is the first study to examine the effect of the PPACA on the operations of for-profit hospitals.

This paper aims to discuss key provisions of the Affordable Care Act (ACA) and the obstacles faced by the federal government in achieving its goal. The ACA is designed to provide most Americans with an access to affordable health care.

Using data obtained from government sources, case law and current literature, the paper first discusses the history and background of the ACA. It evaluates the law’s current status, the benefits it achieved and the legal, economic, political and social challenges that lie ahead.

Although the Supreme Court upheld most of the ACA’s provisions, opponents at the federal and state level are still attempting to overturn or undercut it. The ACA itself is so complicated that it has generated confusion among employers, consumers and even those who are charged with enforcing it. The extent to which the ACA can be successfully implemented is unclear, and adjustments must be made as the federal government struggles to implement key components.

This paper should be of interest to academics, health-care and legal professionals, and to anyone who needs clarification and analysis of a still-evolving law that is certain to have an impact on most Americans.

As the new Patient Protection and Affordable Care Act (ACA) achieves full implementation in 2014–2015, public perceptions regarding improvement in access and quality of care due to the ACA provide a fertile area for sociological research. The aim of this chapter is to determine if race is independently associated with perceptions of quality of care and access to care after ACA implementation. And, secondarily, we examined if such a relationship remained stable after considering SES (education and income) alone and SES with other relevant individual characteristics.

Data come from a telephone survey of a representative sample of Georgia residents aged 18 years or older. For each domain of the dependent variables (quality of care and access to care), three models were fitted with a nested design. The first model included only race. The second model included only race and SES. Model 3 included race, SES, and the following individual characteristics: (1) self-rated health status; (2) sense of coherence (SOC; a construct used to explain why some people are more disposed than others to illness after stressful situations); (3) travel time to doctor’s office; (4) importance of short wait times as doctor’s office; (5) political affiliation; and (6) geographic location (rural/non-rural).

Race was significantly associated with both the quality of care and the access to care. Non-White respondents were more likely to perceive improvements to both as a result of the ACA. Likewise, respondents with either higher education or income were also more likely to perceive improvements in quality and access as a result of the ACA. However, these associations were partly explained by respondents’ self-reported political affiliations.

Results of this study show that public perceptions toward the ACA and its impact on quality and access to care seem to differ based on an individuals’ race, income level and political affiliation. This may be a reflection of the media blitzkrieg that surrounds the ACA rather than a direct consequence of the policy itself. A concerted effort to develop communication strategies and outreach efforts by race and SES that can better educate the general population on the ACA may alleviate some of the reservations that are inherent to any major policy implementation, especially in terms of healthcare quality and access.

The implementation of the Patient Protection and Affordable Care Act has facilitated the development of an innovative and integrated delivery care system, Accountable Care Organizations (ACOs). It is timely, to identify how health care managers in rural health clinics (RHCs) are responding to the ACO model. This research examines RHC managers’ perceived benefits and barriers for implementing ACOs from an organizational ecology perspective.

A survey was conducted in spring of 2012 covering the present RHC network working infrastructures – (1) Organizational social network; (2) organizational care delivery structure; (3) ACO knowledge, perceived benefits, and perceived barriers; (4) quality and disease management programs; and (5) health information technology (HIT) infrastructure. One thousand one hundred sixty clinics were surveyed in the United States. They cover eight southeastern states (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee) and California. A total of 91 responses were received.

RHC managers’ personal perceptions on ACO’s benefits and knowledge level explained the most variance in their willingness to join ACOs. Individual perceptions appear to be more influential than organizational and context factors in the predictive analysis.

The study is primarily focused in the Southeastern region of the United States. The generalizability is limited to this region. The predictors of RHCs’ participation in ACOs are germane to guide the development of organizational strategies for enhancing the general knowledge about the innovativeness of delivering coordinated care and containing health care costs inspired by the Affordable Care Act.

RHCs are lagged behind the growth curve of ACO adoption. The diffusion of new knowledge about pros and cons of ACO is essential to reinforce the health care reform in the United States.

The purpose of this paper is to show the link between the comparative effectiveness research (CER) and the interest in developing drugs for rare disease by the pharmaceutical industry. Total healthcare spending is on the rise without having a corresponding better health outcome. As such, with the growing role of government in healthcare, measuring and demonstrating value is beginning to expand beyond the private sector to metrics applied in the public sector. A modern approach to comparative effective research began its rapid rise in the USA when the American Recovery and Reinvestment Act of 2009 allocated $1.1 billion for CER. This paper analyzes the implication and impact on the pharmaceutical industry.

The paper reviews the basic definitions of CER and its areas of strength and weakness. It used real examples of drugs to show the impact of the Reinvestment Act of 2009 on the rise of orphan drugs.

The study shows that the act encouraged the development of orphan drugs, mainly because of the low budget impact due to a smaller patient base. Provisions of the Affordable Care Act provide incentives for such rare disease indications, as no one can be denied coverage with pre-existing conditions.

The study is limited by the number of available rare drugs and the ongoing process of implementation of the Affordable Care Act.

The study shows the cost-effective method of treating medical conditions.

Development of orphan drugs opens up access to care for many patients at a cost-effective price.

This paper shows the link between the CER and the interest in developing drugs for rare disease by the pharmaceutical industry. It also brings out the possible implication of the Affordable Care Act on the pharmaceutical industry with respect to its strategies for drug development and drug portfolio.

While the Affordable Care Act (ACA) promised to reduce inequalities in insurance coverage between Latinos and non-Latinos by expanding coverage, it also excluded a large portion of noncitizen immigrants. Past research has demonstrated that among Latinos, further inequalities have developed between citizens and noncitizens after the ACA took effect, but it is unclear if this pattern is unique to Latinos or is evident among non-Latinos as well. I use data from the 2011 to 2016 waves of the National Health Interview Survey (NHIS) (n = 369,386) to test how the relationship between citizenship status (native citizen, naturalized citizen, or noncitizen) and insurance coverage changed after the ACA, adjusting for health, demographic, and socioeconomic factors. I disaggregate the analysis by ethnicity to test whether this change differs between Latinos and non-Latinos. The analysis finds that after the ACA, naturalized citizens across ethnic groups moved toward parity with native citizens in health insurance coverage while the benefits of the ACA for noncitizens were conditional on ethnicity. For non-Latinos, lacking citizenship became less disadvantageous for predicting insurance coverage while for Latinos, lacking citizenship became even more disadvantageous in predicting insurance coverage. This bifurcation among noncitizens by ethnicity implies that while the ACA has strengthened institutional boundaries between citizens and noncitizens, this distinction is primarily affecting Latinos. The conclusion offers considerations on how legal systems of stratification influence population health processes.

This paper aims to explore the perspectives of Ohio physicians on the Patient Protection and Affordable Care Act (ACA) of 2010. While much has been debated about ACA, relatively few studies have focused on how ACA will impact on physicians' practice behavior.

The research data came from a mailed survey of ninety physicians randomly selected from the Cigna Directory of Physicians practicing in Ohio. Study examined how informed were physicians about ACA, and explored how much the effect of ACA has been discussed in their practice, how they think ACA will impact their practice, and whether or not they are in favor of the provisions under the Act.

Overwhelmingly, while the physicians surveyed were familiar with the specific provisions of ACA, almost half of them opposed it. Primary care physicians reported generally favorable opinions about ACA. All but one of the physicians concluded that ACA, much like managed care provisions, has undermined and will continue to reduce the autonomy and professional independence of physicians.

This study is limited by its small sample and reliance on a small set of physicians.

This study has practical implications for examining how Ohio physicians are responding to the new health care reform in the United States. It has broader implications for addressing the problem of the uninsured and the role of the federal government in health care provision.

If physicians are opposed to this reform as the study seems to suggest, it might have broader implications for future career aspirations for physicians.

So far as we can tell, there has not been any exploratory study in Ohio examining the perspectives of physicians on ACA.

The purpose of this paper is to examine the influence of insurance coverage changes over time for patients with diabetes on expenditures and access to care before and after the Affordable Care Act (ACA).

The Medical Expenditure Panel Survey (MEPS) from 2002–2017 was used. Access included having a usual source of care, having delay in care or having delay in obtaining prescription medicine. Expenditures included inpatient, outpatient, office-based, prescription and emergency costs. Panels were broken into four time categories: 2002–2005 (pre-ACA), 2006–2009 (pre-ACA), 2010–2013 (post-ACA) and 2014–2017 (post-ACA). Logistic models for access and two-part regression models for cost were used to understand differences by insurance type over time.

Type of insurance changed significantly over time, with an increase for public insurance from 30.7% in 2002–2005 to 36.5% in 2014–2017 and a decrease in private insurance from 62.4% in 2002–2005 to 58.2% in 2014–2017. Compared to those with private insurance, those who were uninsured had lower inpatient ($2,147 less), outpatient ($431 less), office-based ($1,555 less), prescription ($1,869 less) and emergency cost ($92 less). Uninsured were also more likely to have delay in getting medical care (OR = 2.22; 95% CI 1.86, 3.06) and prescription medicine (OR = 1.85; 95% CI 1.53, 2.24) compared with privately insured groups.

Though insurance coverage among patients with diabetes did not increase significantly, the type of insurance changed overtime and fewer individuals reported having a usual source of care. Uninsured individuals spent less across all cost types and were more likely to report delay in care despite the passage of the ACA.

Procedures can be categorized as certain surgeries based on their necessity and outcomes while others are classified as uncertain surgeries based on these areas. To account for this variance, policies such as the Affordable Care Act (ACA) call for health care providers to engage in shared decision making (SDM) with patients to ensure they are informed of treatment options and asked their preferences. Yet, gender may influence the decision-making process. Thus, this project examines the decision process and how gender impacts patients’ participation in decisions to undergo certain surgeries compared to uncertain surgeries.

This research project analyzed data from the National Survey of Medical Decisions 2006–2007 which surveyed the medical decisions of US residents 40 and older.

First, the data reveals that women felt more informed having uncertain surgeries compared to men. Second, patients were less likely asked their preference for surgery when undergoing certain surgeries compared to uncertain surgeries. Third, compared to men, women having uncertain surgeries were less likely to make the final decision to have surgery, compared to sharing the final decision with health care providers.

Due to the sample size, this project could not perform three-way interactions between gender, race, and surgery type.

Gender influences the level patients feel informed having uncertain surgeries. Though policy calls for SDM, health care providers are less likely to ask patients their preference for surgery regarding certain surgeries, relative to uncertain surgeries. Gender impacts the final decision-making process regarding whether patients should have uncertain surgeries.