- Ashish K Jha, dean
- Brown University School of Public Health, Providence, Rhode Island, USA
- ashish_jha{at}brown.edu
The incoming US administration has signalled its intent to make large changes to the federal government’s approach to medicine and public health. With Republicans holding control of both houses of Congress and a conservative Supreme Court, the potential for change is high if the administration can address internal disagreements.
Much of that change is likely to centre on health insurance coverage, which for most Americans is provided through Medicaid (the federal and state programme for people on low incomes), Medicare (for people over 65 and those with disabilities), or private insurance, obtained either through employers or through the public marketplaces (exchanges) created under the Affordable Care Act (ACA).
Most policies available through Medicaid, Medicare, and ACA exchanges are decided at federal level, but healthcare is mostly administered by states. This means health outcomes may largely depend on how individual states can adjust to likely changes in federal policy or funding.
Policy challenges
Medicare, Medicaid, and the ACA exchanges have undergone substantial changes in the past decade, and the new federal administration will create important policy issues for each of them. More than half of Medicare beneficiaries are included in the private version of the programme known as Medicare …
