Health Policy and the Affordable Care Act

The American health care system has many problems. 50 million people are uninsured. Quality is extremely uneven, with peaks of greatness at leading academic centers but overall poor quality in both process measures and outcomes such as asthma deaths. Finally, the U.S. health care system spends over $8000 per patient per year, nearly double the next highest country. In March 2010, the Affordable Care Act was enacted. Over the next decade or more, the Act will dramatically re-structure the American health care system.

This course will explore the history and structure of the current American health care system, including the history of and problems with employment-based health insurance, the challenges surrounding access, cost and quality, and the medical malpractice conundrum. The course will then explore the history of health care reform and the challenges that were overcome to achieve health reform in America. Finally, we will delineate the specific ways that the Affordable Care Act improves access and quality, and will control costs. Throughout lessons regarding health economics, health policy, and medical practice will be elucidated.

This class is open to anyone that is interested in gaining a better understanding of the US health care system and the challenges of health care reform. There are no prerequisites or required knowledge of the health system.

Week 1 – Growth in US Health Care
Much of the impetus for health care reform is provided by the need to “bend the cost curve.”  Over the past few decades, health care cost growth has consistently outpaced overall economic growth, taking up an increasing share of our Gross Domestic Product (GDP) and government budgets.  We will discuss the factors that drive cost growth.

Live Q & A with Dr. Emanuel
Dr. Emanuel will host a live online Q & A session on topics related to health care and current events.

Week 2 – Structure of the US Health Care
How do Americans get their health care? Who pays for it? How did the system we have today come to be?  These are some of the questions we will answer this week when we look at the structure of the US health care system

Week 3 – Access to and Quality of Health Care in the US
Most Americans receive insurance through their employer or the government (e.g. Medicaid, Medicare, CHIP).  Before the ACA, approximately 50 million Americans did not have health insurance. This week we explore access to health care insurance, the profile of the average uninsured person, disparities in quality and outcomes, and the link between insurance and access to health care.

Week 4 – Health Care Malpractice
In some physician specialties, as many as one in four practitioners a year have a medical malpractice claim filed against them, making this a matter of frequent public and policy debate. We will discuss medical errors, the workings of the malpractice system, liability insurance, and the contribution of negligence and malpractice costs to the health system’s overall bottom line. 

Week 5 – History of health care reform; The ACA: An Overview
Health care reform in America has been 100 years in the making, starting with Theodore Roosevelt and continuing through the Clinton administration. We discuss past attempts at health care reform and why they met with resistance. We then move on to an overview of the 2010 Affordable Care Act.

Week 6 - The ACA: Access to Health Care
The overview of the ACA continues with a discussion of the provisions designed to expand access to health care.  We will cover employer-sponsored health insurance provisions. This session will feature a guest lecture by J. Sanford Schwartz, M.D.

Week 7 – The ACA: Cost Control
This week we will discuss projections of health care cost growth under the ACA, followed by mechanisms through which the ACA aims to tackle health care cost growth.

Week 8 – The ACA: Health Care Delivery and Quality
The final topic of the course is the ACA’s impact on the quality and delivery of care. The ACA includes provisions for institutional innovations, i.e. changes in how the system delivers care.  It also contains rules and incentives for providers to cut down on mistakes and deliver proven, valuable care. This week will provide a forward-looking overview of what we will change in the medical sector.