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The JAMA Forum
May 23/30, 2017

Is the Affordable Care Act Imploding?

Author Affiliations
  • 1Larry Levitt, MPP, is Senior Vice President for Special Initiatives at the Kaiser Family Foundation and Senior Advisor to the President of the Foundation. Among other duties, he is Co-Executive Director of the Kaiser Initiative on Health Reform and Private Insurance
JAMA. 2017;317(20):2051-2052. doi:10.1001/jama.2017.5582

President Trump has said on various occasions that the Affordable Care Act (ACA) is implodingexploding, or collapsing.

There is very little evidence for this.

The ACA includes 2 main components. One is an expansion of Medicaid. The other is new rules for private insurance plans along with tax credits to make coverage more affordable for low- and middle-income persons buying through new insurance marketplaces.

The Medicaid component—which expanded eligibility up to 138% of the poverty level for all adults—seems to be working just fine, with 11.2 million newly eligible people enrolledNineteen states have chosen not to expand Medicaid at this point (following an earlier Supreme Court decision that made the expansion optional for states). But the program can hardly be described as collapsing.