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JAMA Forum Archive, 2012-2019: Health policy commentary from leaders in the field
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Expanding Health Care Coverage as a Step Toward Cost Control

President Obama’s federal health reform through the Affordable Care Act (ACA) is designed to significantly expand health insurance coverage. When it was initially passed in March 2010, the Congressional Budget Office (CBO) estimated that 32 million uninsured Americans individuals would gain coverage as a result, half through private insurance and half through expansion of Medicaid. The Supreme Court decision on June 28, 2012, largely upheld the ACA but rendered the expansion of Medicaid less certain by removing financial penalties on states that choose not to participate.

Taking the Supreme Court decision into consideration, the CBO reestimated the effect of the ACA and now predicts that 29 million uninsured individuals will gain coverage as a result of this law, including 18 million through private insurance and 11 million through Medicaid. The provisions that will have the largest effect on coverage expansion do not take effect until January 2014, but some elements of the law have already been implemented.

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