N Engl J Med. 2012 Dec 6;367(23):2165-7. doi: 10.1056/NEJMp1213674. Epub 2012 Nov 21.
The future of Obamacare.
Source
University of North Carolina, Chapel Hill, USA.
"State resistance to Medicaid expansion and exchanges highlights a broader issue: Obamacare emulates the successful formula that Massachusetts has used to increase access to insurance, but it cannot copy the state's political environment. Health care reform in Massachusetts enjoyed broad bipartisan support. It remains to be seen whether the ACA's individual mandate will have the same impact in states whose citizens are less supportive of reform and whose political leaders oppose the law. Moreover, will states that only reluctantly expand Medicaid and sponsor exchanges be as successful as more enthusiastic states in enrolling eligible persons into Medicaid and insurance-subsidy programs? Even after the law is fully implemented, the Congressional Budget Office estimates that 30 million U.S. residents will remain uninsured. Will Obamacare's coverage provisions grow stronger or weaker over time?
In addition, there remain political challenges to getting more Americans behind the ACA. More than two and a half years after its enactment, the public is still deeply divided over Obamacare, with more Americans disapproving than approving of the law. That division reflects partisan polarization, the contentious debate over the law's enactment, and the legacy of “death panels” and other myths spread by opponents to stoke the public's fears. Those fears are enduring: 39% of Americans still incorrectly believe that the ACA creates a government panel to make end-of-life care decisions for Medicare beneficiaries, and another 22% aren't sure whether it does.3"
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