title: The Affordable Care Act: implications for health-care equity.
abstract: Inequalities in medical care are endemic in the USA. The Affordable Care Act (ACA), passed in 2010 and fully implemented in 2014, was intended to expand coverage and bring about a new era of health-care access. In this review, we evaluate the legislation's impact on health-care equity. We consider the law's coverage expansion, insurance market reforms, cost and affordability provisions, and delivery-system reforms. Although the ACA improved coverage and access-particularly for poorer Americans, women, and minorities-its overall impact was modest in comparison with the gaps present before the law's implementation. Today, 29 million people in the USA remain uninsured, and substantial inequalities in access along economic, gender, and racial lines persist. Although most Americans agree that further reform is needed, the proper direction for reform-especially following the 2016 presidential election-is highly contentious. We discuss proposals for change from opposite sides of the political spectrum, together with their potential impact on health equity.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA; Harvard Medical School, Boston, MA, USA. Electronic address: agaffney@challiance.org.
authors.forename: Adam
authors.initials: A
authors.lastname: Gaffney
authors.affiliation: Division of Social and Community Medicine, Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA; Harvard Medical School, Boston, MA, USA.
authors.forename: Danny
authors.initials: D
authors.lastname: McCormick
mesh_terms: D005260:Female; D000069576:Health Equity / Q000191:economics / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006630:Hispanic or Latino; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D007348:Insurance, Health / Q000191:economics; D017057:Medically Uninsured / Q000208:ethnology / Q000706:statistics & numerical data*; D058991:Patient Protection and Affordable Care Act / Q000706:statistics & numerical data* / Q000639:trends; D014481:United States / Q000453:epidemiology; D044465:White People