5 factors will shape what happens to ACA in next 5 years

The Affordable Care Act faced hurdles and achieved milestones in its first five years. Now that its anniversary has passed, attention turns to what's in store for the future of healthcare reform.

An analysis from the Brookings Institute and a report from Wolters Kluwer each examine the tenuous and unpredictable future of the ACA.

For starters, both reports point to the upcoming King v. Burwell decision on subsidized insurance offered on federal exchanges and Republican opposition to the ACA as the largest challenges facing healthcare reform. "Despite having reached the age of five, the ACA continues to live on a precipice," Brooking's Henry J. Aaron wrote.

Here are three additional factors that will influence the healthcare reform in the next five years.

  • If the slowdown of healthcare spending growth can persist, then initiatives such as bundled payments and accountable care organizations will be hailed as successes, the Brookings analysis said. If not, expect more drastic reform, either by making patients pay even more or by shifting to a single-payer system.
  • Companies have been coping with the employer mandate, FierceHealthPayer previously reported, but that may change in the years ahead. Providing healthcare coverage has proven to be less of an issue than reporting on ACA compliance, the Wolters Kluwer report said, But that may change s the employer mandate expands to cover firms with 50 or more employers in 2016 and as momentum grows to redefine the full-time work week as 40 hours.
  • As health insurance exchanges recover from administrative and technical challenges, they may emerge as more convenient and less expensive options for employers now required to offer healthcare benefits, Brookings said. If this happens, the ties that bind employees to their employers for health coverage may start to come undone.

Both reports concluded that, despite the challeges that the ACA has faced and will face, the law remains sustainable and is highly unlikely to be repealed in full.

For more:
- here's the Brookings analysis
- read the Wolters Kluwer report (.pdf - free registration required)

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King v. Burwell Supreme Court case: What you need to know [Special Report]
ACA's long-term impact on employer-sponsored plans
Companies coping with employer mandate
Economist: Slow growth in healthcare spending is likely here to stay
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