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The Future of the Affordable Care Act: Reassessment and Revision

July 2016

Stuart M. Butler, PhD, MA


The article functions as a critique of Obama’s article “United States Healthcare Reform: Progress to Date and Next Steps”. While Butler does acknowledge the benefits of the ACA, he outlines its’ multiple shortcomings. One of his primary complaints is with the health exchange program; while enrollments for Medicaid are up, the health exchange program is not being utilized due to the relatively high premiums and out of pocket costs. In essence, the program is meant for more for those with much lower incomes (who are eligible for Medicaid) than those with middling incomes. Butler also states that while the ACA could possibly slow down growth of per capita spending, others believe it will increase. Butler believes that the ACA should be examined more closely on a fundamental level to better provide for non-poor families and allow for more clear guidance and flexibility to the states in regards to Medicaid expansion. Butler also stresses the need to consider healthcare in the context of other social determinants of health, not limited to but including housing, transportation, social services, etc.

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Policy Implications

When considering revisions to Obamacare, care must be taken to account for those who may not benefit from Medicaid. For those who do benefit from Medicaid, the amount of flexibility that states should be given needs to be considered.

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