"Medicine & Law in the Era of the Affordable Care Act" by Carolyn Brokowski

“MEDICINE & LAW IN THE ERA OF THE
AFFORDABLE CARE ACT”
Carolyn Brokowski
Sherwin B. Nuland Summer Institute
in Bioethics, Yale University
7/24/2016
h"p://drexel.edu/scdc/career-­‐services/law-­‐school/
h"ps://www.quora.com/What-­‐is-­‐the-­‐history-­‐behind-­‐the-­‐symbol-­‐of-­‐medicine.

CONTENTS
I. THE UNITED STATES’ HEALTH CARE SYSTEM
BEFORE THE AFFORDABLE CARE ACT (ACA)
II. WHAT THE LAW DOES
III. SOME SUPREME COURT CHALLENGES
IV. IS THE ACA WORKING?
V. FUTURE DIRECTIONS: REVISITING THE PUBLIC
OPTION
VI. REFERENCES

I. THE UNITED STATES’ HEALTH CARE SYSTEM
BEFORE THE AFFORDABLE CARE ACT (ACA)

I. THE UNITED STATES’ HEALTH CARE SYSTEM
BEFORE THE AFFORDABLE CARE ACT (ACA)
h"p://mercatus.org/publica?on/health-­‐care-­‐spending-­‐united-­‐states-­‐affordable-­‐care-­‐act.

https://www.washingtonpost.com/world/national-security/studyiraq-afghan-war-costs-to-top-4-trillion/2013/03/28/
b82a5dce-97ed-11e2-814b-063623d80a60_story.html.
Bilmes, Linda J. "The Financial Legacy of Iraq and Afghanistan: How Wartime Spending Decisions Will Constrain Future
National Security Budgets." HKS Faculty Research Working Paper Series RWP13-006, March 2013.

II. WHAT THE LAW DOES

III. SOME SUPREME COURT
CHALLENGES
1. U.S. Dep’t Health and Human Services v. Florida
(2012)
2. National Federation of Independent Business v.
Sibelius (2012)
3. Burwell v. Hobby Lobby Stores, Inc. (2014)
4. King v. Burwell (2015)
5. Zubik v. Burwell (2016)

IV. IS THE ACA WORKING? (+)
Access
Affordability
Quality
http://www.hhs.gov/healthcare/facts-and-features/fact-sheets/aca-is-working/
index.html.

1. Access
i. Strong enrollment in the health insurance market
place
ii. Historic reduction in the uninsured
iii. Progress in fighting health inequality
iv. Medicaid expansion
v. Reducing uncompensated care in hospitals
http://www.hhs.gov/healthcare/facts-and-features/fact-sheets/aca-is-working/
index.html.

2. Quality
i. Improved patient safety
ii. Fewer avoidable hospital readmissions
iii. Alternative care models are driving value
iv. Higher quality of coverage
http://www.hhs.gov/healthcare/facts-and-features/fact-sheets/aca-is-working/
index.html.

3. Affordability
i. Health care coverage is more affordable
ii. Choice, competition, & premiums
iii. Health care cost growth has slowed sharply
http://www.hhs.gov/healthcare/facts-and-features/fact-sheets/aca-is-working/
index.html.

V. IS THE ACA WORKING? (-)

1,000.0
FEDERAL HEALTH CARE SPENDING:
1980-2014
900.0
$BILLIONS
800.0
700.0
600.0
500.0
400.0
300.0
200.0
100.0
TOTAL MEDICARE +
MEDICAID ($BILLIONS)
MEDICARE ($(BILLIONS)
MEDICAID ($BILLIONS)
NIH ($BILLIONS)
0.0
1980 1990 2000 2010 2020
FISCAL YEAR
Brokowski, in progress

CORPORATE MEDICINE ON STEROIDS:
INSURANCE
MERGERS & ACQUISITIONS
Aetna
($47B)
Humana
($35B)
Anthem
($39B)
Cigna
($54B)
United
Healthcare
($60B)

From the American Society of Anesthesiologists:
https://www.asahq.org/about-asa/newsroom/news-releases/2016/05/physiciananesthesiologists-oppose-va-policy.

VI. FUTURE DIRECTIONS: REVISITING THE
PUBLIC OPTION

VII. REFERENCES
• Patient Protection and Affordable Care Act, 42 U.S.C. § 18001 (2010).
• http://drexel.edu/scdc/career-services/law-school/
• https://www.quora.com/What-is-the-history-behind-the-symbol-ofmedicine
• http://mercatus.org/publication/health-care-spending-united-statesaffordable-care-act
• https://www.washingtonpost.com/world/national-security/study-iraqafghan-war-costs-to-top-4-trillion/2013/03/28/
b82a5dce-97ed-11e2-814b-063623d80a60_story.html
• Bilmes, Linda J. "The Financial Legacy of Iraq and Afghanistan: How
Wartime Spending Decisions Will Constrain Future National Security
Budgets." HKS Faculty Research Working Paper Series RWP13-006,
March 2013.
• . Skinner, J., & Chandra, A. (2016). The Past and Future of the Affordable
Care Act. JAMA. doi:10.1001/jama.2016.10158
• https://www.asahq.org/about-asa/newsroom/news-releases/2016/05/
physician-anesthesiologists-oppose-va-policy
• Obama, B. (2016). United States Health Care Reform: Progress to Date and
Next Steps. JAMA. doi:10.1001/jama.2016.9797

VII. REFERENCES
• http://www.hhs.gov/healthcare/facts-and-features/fact-sheets/
aca-is-working/index.html.