The Affordable Care Act (ACA) of 2010, the broadest health care overhaul since the creation of Medicare and Medicaid in 1965, puts in place comprehensive health insurance reforms that will take effect over several years. A key component of the 2010 ACA is a large expansion in health insurance coverage to many more millions of Americans. The Congressional Budget Office has projected that the ACA will extend health insurance coverage to an estimated 32 million uninsured Americans by the end of 2019, including 16 million into public health insurance programs, although projections of uptake of the new coverage are uncertain. Little is known about physicians' and hospitals' potential supply side responses to major coverage expansions such as those under the 2010 ACA. In 2006, however, the American College of Physicians warned that primary care in the United States, the backbone of the nation's health care system, is on the verge of collapse due to a dysfunctional health care financing and delivery system. Moreover, the increased demand for primary care from the ACA will be dwarfed by the increased demand generated in the next decade as a consequence of U.S. population growth and the aging of the baby boomers. In December 2011, AcademyHealth's Research Insights program convened a meeting in Washington, D.C., that brought together about 50 leading researchers and representatives of federal agencies to consider the implications of the ACA for the capacity and willingness of health care providers to provide primary and hospital-based acute care sufficient to address the needs of populations that are newly insured under the ACA. Participants at the meeting reviewed the state of research relevant to the following questions: (1) Is the current capacity to provide primary care and hospital-based acute care sufficient to address the needs of newly insured populations? (2) What do we know about how physicians and hospitals are likely to respond to increases in the demand for care? (3) What policy levers exist for expanding the supply of primary and hospital-based acute care and what are their implications? Participants at the meeting also identified important research questions and data needed to track the impacts of the implementation of the ACA on the supply of primary care and hospital-based acute care. This issue brief presents some of the highlights of the presentations and discussions regarding capacity and trends, responses to increased demand, and policy levers to match supply of primary care and hospital-based acute care with needs.
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