This presentation will focus on the current state of the US health care system, its recent history, and where it is going, specifically as it relates to the Affordable Care Act (ACA) and the improvements this legislation intends to achieve.  Key concepts will include the problems posed by access, cost, and quality—particularly, the exacerbation of the uninsured problem in the 20 years prior to the ACA, the growth in per capita cost at a rate roughly double that of CPI, and the continuing emphasis on improving quality and outcomes.  This presentation will also concisely explain how the ACA addresses these issues.

The ACA could not have been implemented without the development of actuarial tools, such as risk adjustment, that foster social equity and fairness among competitors in a market-based managed competition approach.  Given the size of the US and complexity of the current fragmented system, the scale of the undertaking of the ACA is extremely large.  The interplay between state vs. federal government will be considered, as will state-specific variations in the roll-out of reform and exchanges.

A brief overview of the multi-payer US system will be provided, as will the changes in the number, scale, and organizational structure of payers and providers due to the ACA, such as the rise in Accountable Care Organizations, Patient-Centered Medical Homes, and cooperatives.  The effect of the ACA on national, regional, and community health plans, which each have different strengths and weaknesses, will also be touched on.

The international problem of cost-growth created by advances in medical technology and longevity will also be presented, as it affects all nations.

The presentation will also consider in detail the recent efforts in Massachusetts to address cost growth. Massachusetts is home to the most expensive health care in the country and perhaps in the world. The presentation will review recent legislation and initiatives both by government and the industry to ‘bend the cost curve.’