An economic perspective on the affordable care act: Expectations and reality

Sayeh Nikpay, India Pungarcher, Austin Frakt

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


The Affordable Care Act (ACA) was enacted in 2010 to address both high uninsured rates and rising health care spending through insurance expansion reforms and efforts to reduce waste. It was expected to have a variety of impacts in areas within the purview of economics, including effects on health care coverage, access to care, financial security, labor market decisions, health, and health care spending. To varying degrees, legislative, executive, and judicial actions have altered its implementation, affecting the extent to which expectations in each of these dimensions have been realized.We reviewtheACA's reforms, the subsequent actions that countered them, and the expected and realized effects on coverage, access to care, financial security, health, labor market decisions, and health care spending.

Original languageEnglish (US)
Pages (from-to)889-904
Number of pages16
JournalJournal of health politics, policy and law
Issue number5
StatePublished - Oct 2020

Bibliographical note

Funding Information:
Sayeh Nikpay was supported by a National Heart, Lung, and Blood Institute K12 award while writing this article. Austin Frakt was supported by a grant from the Laura and John Arnold Foundation. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs, the US government, or any other institution with which the authors are affiliated.

Publisher Copyright:
© 2020 by Duke University Press.


  • Affordable Care Act
  • Economics
  • Health policy


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