The Affordable Care Act of 2010 provides provisions regarding the delivery-system reform through changes in the way government pays for health care, the organization of health care delivery, workforce policy, and nimbleness of the government. Even with the "three-legged stool" at the basis of health care reform in the ACA, which includes banning discrimination in the insurance market, the individual mandate, and provision of low-income subsidies for insurance purchase, results from the extensive list of ACA initiatives are yet too preliminary to be able to draw definitive conclusions about the effectiveness of the program. Some American consumers have purchased marketplace insurance plans with substantial deductibles in order to minimize premiums. This could leave them with large out-of-pocket payments and limited access to necessary care. Ex-post analysis indicates that employers are shifting the costs of health insurance onto their employees through deductibles.
There have been a number of solutions suggested by policymakers and government officials to eliminate waste and reduce administrative costs and the ACA has already taken the initiative to reduce costs by reducing Medicare readmissions and hospital-acquired conditions. There is wide support for a transition to a value-based care system to control and reduce costs, improve outcomes, and obtain more value for each dollar spent. The Pay-for-Value Programs for Hospitals and Physicians of ACA creates incentives for hospitals and physicians to improve their performance based on a number of quality and cost metrics; the effects remain to be assessed. Accountable care organizations (ACO) serve to promote integration and coordination of ambulatory, inpatient, and post-acute care services and many experts see this as a bridge from fragmented fee-for-service care to integrated health care systems.
Individuals depend on society and government for health, and in the coming years policymakers must be able to address the quintessential question: Would it be possible to eliminate health care spending without reducing the quality of care? And the issue is too complex to be solved by a single reform program.