Health Expenditure and Reimbursement in the Affordable Care Act: Relevant to the Shortage of Neurologists

The “Affordable Care Act” (ACA, also called “Obama Care”) is the name for the comprehensive health care reform law and its amendments [1]. The law addresses the coverage of health insurance, healthcare costs, and preventive care. The ACA features three main objectives: 1) to make affordable health insurance available to more people who are with household incomes between 100% and 400% of the federal poverty level (FPL); 2) to expand the Medicaid program to cover all adults with income below 138% of the FPL; and 3) to support innovative medical care delivery methods designed to lower the costs of health care generally [1]. In fact, the ACA has achieved a historic advancement in health-equity in the USA as the ACA has made health insurance more accessible [1, 2]. This landmark law improved the healthcare for women and families, children, elderly, disable people, LGBTQI+ and communities. However, there are still millions of Americans uninsured or underinsured due to high costs, even with subsidies potentially available [3]. Higher out-of-pocket expenses for private insurances and disrupted markets in some geographic locations chip away the affordability of the ACA-compliant plans [3]. Notably, the ACA-induced net gain in healthcare coverage was almost entirely due to an increase in Medicaid enrollment [4] and little or no change was recognized in quality, utilization, and the total costs of health care [5].