Heart Failure and the Affordable Care ActPast, Present, and Future
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Author + information
- Jonathan D. Wolfe, MD and
- Karen E. Joynt Maddox, MD, MPH∗ (kjoyntmaddox{at}wustl.edu)
- ↵∗Address for correspondence:
Dr. Karen E. Joynt Maddox, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, Missouri 63110.
Central Illustration
Highlights
• The Affordable Care Act has affected heart failure patients through insurance regulation, coverage expansion, and delivery system reform.
• Some of these elements could have positive effects for heart failure patients.
• The benefit of value-based and alternative payment models for heart failure outcomes is less clear.
• Heart failure clinicians should be aware of how legislation affects clinical practice.
Abstract
The Affordable Care Act (ACA) and other major health care legislative acts have had an important impact on the care of heart failure patients in the United States. The main effects of the ACA include regulation of the health insurance industry, expansion of access to health care, and health care delivery system reform, which included the creation of several alternative payment models. Particular components of the ACA, such as the elimination of annual and lifetime caps on spending, Medicaid expansion, and the individual and employer mandate, could have positive effects for heart failure patients. However, the benefits of value-based and alternative payment models such as the Hospital Readmissions Reduction Program and bundled payment programs for heart failure outcomes are less clear, and controversy exists regarding whether some of these programs may even worsen outcomes. As the population ages and the prevalence of heart failure continues to rise, this syndrome will likely remain a key clinical focus for policymakers. Therefore, heart failure clinicians should be aware of how legislation affects clinical practice and be prepared to adapt to continued changes in health policy.
Footnotes
Dr. Wolfe has reported that he has no relationships relevant to the contents of this paper to disclose. Dr. Joynt Maddox previously performed contract work for the U.S. Department of Health and Human Services.
- Received March 8, 2019.
- Revision received April 17, 2019.
- Accepted April 17, 2019.
- 2019 American College of Cardiology Foundation
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