Health Care Costs and Payment Models


Aims: To decrease the number of uninsured Americans and reduce health care costs



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Affordable Care Act

Aims: To decrease the number of uninsured Americans and reduce health care costs

  • Aims: To decrease the number of uninsured Americans and reduce health care costs
  • Passed in 2010, upheld in Supreme Court in 2012, 2015
  • Expansion of coverage:
    • Individual mandate (removed in the 2017 tax bill effective 2019)
    • Medicaid expansion: Set the Medicaid minimum income eligibility across the US to <138% of the federal poverty level
    • Health insurance exchanges: competitive markets with clear information to assist persons in purchasing insurance; subsidized for families <400% poverty limit

Affordable Care Act7

Ongoing challenges:


Access to Health Care7

Ongoing challenges:

Ms. O is a 62 year-old woman presenting to the ED with dense right hemiparesis and aphasia. CT scan confirms a large MCA infarct and her labs reveal previously undiagnosed hyperlipidemia. Review of a prior ED visit for an unrelated issue reveals that she has untreated hypertension. She is uninsured and has not seen a doctor in over ten years.

  • Ms. O is a 62 year-old woman presenting to the ED with dense right hemiparesis and aphasia. CT scan confirms a large MCA infarct and her labs reveal previously undiagnosed hyperlipidemia. Review of a prior ED visit for an unrelated issue reveals that she has untreated hypertension. She is uninsured and has not seen a doctor in over ten years.
  • How did her lack of health insurance contribute to this outcome?

Case: Access to Health Care

Does Health Insurance Make a Difference?7,8

  • Fewer regular medical visits and preventive health screenings
  • Increased mortality (likely owing to greater morbidity from undiagnosed medical conditions)
  • Less care during hospitalization


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