Analysis of the Patient Protection and Affordable Care Act (H.R. 3590)

O n December 24, 2009, the Patient Protection and Affordable Care Act (H.R. 3590) was passed in the U.S. Senate by a vote of 60–39. RAND undertook an analysis of the provisions of this bill related to expanding coverage for people who currently do not have health insurance. Using the COMPARE microsimulation model, RAND estimated the potential effects between 2010 and 2019 of H.R. 3590 on changes in the number of uninsured, the costs to the federal government and the nation, revenues from penalty payments, and consumers’ health care spending. Although the bill would be enacted in 2010, many of the coverage-related provisions would not take effect until 2014. We also estimated the effects associated with different scenarios for expanding coverage. These scenarios provide insights into how the various provisions of the bill (i.e., the individual mandate, employer fees for not offering insurance, and Medicaid expansion) contribute to the estimated changes in coverage and spending. Moreover, these analyses illustrate how sensitive the estimates are to key design choices (e.g., the size of the penalty associated with an individual mandate) or modeling assumptions (e.g., administrative costs for insurance offered through the Health Benefit Exchanges).