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The Patient Protection And Affordable Care Act

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On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (ACA), the most comprehensive reform of the U.S. medical system in at least 45 years. The ACA transforms the non-group insurance market in the United States, mandates that most residents have health insurance, significantly expands public insurance and subsidizes private insurance coverage, raises revenues from a variety of new taxes, and reduces and reorganizes spending under the nation’s largest health insurance plan, Medicare. If fully implemented, the ACA promises to lead to a dramatically different health care landscape for the United States in the years to come. Projecting the impacts of such fundamental reform to the health care system is fraught with difficulty. But such projections were required for the legislative process, and were delivered by the Congressional Budget Office (CBO). CBO projected that the ACA would increase health insurance coverage by 32 million people and would raise federal government spending by almost $1 trillion over the subsequent decade, but would raise revenues and reduce spending by even more so that the bill overall reduced the federal budget deficit. These CBO projections were central to the legislative debate over the ACA. In this paper, I will discuss the impact of the ACA in more detail, and describe evidence that sheds light upon the accuracy of the projections. I begin by reviewing in broad detail the structure of the ACA. The

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