Regardless of the outcome of this year's election, one result is fairly certain—the new administration will take a second look at the Affordable Care Act.
The landmark health reform legislation President Barack Obama signed into law in 2010 led to a major expansion of health insurance accessibility, and set off the most significant overhaul of the U.S. healthcare system since the advent of Medicare and Medicaid in 1965. These milestones of change to our health insurance system, enacted decades apart, share a link to one of the largest social science experiments in U.S. history.
Called the Health Insurance Experiment, the study was launched in 1971 by RAND Corp. researchers who brought nonpartisan, unbiased analysis to the discussion—an essential component of almost any healthcare debate, whether it's regarding the ACA or the pros and cons of other insurance reforms being tested across the industry.
The Health Insurance Experiment sought to answer: How much more medical care would people use if it was free, and what would be the consequences for their health? At the time, the national debate centered on free, universal healthcare and whether the benefits would justify the costs. HMOs were still a relatively novel concept in the U.S. In addition, more than 20 million people had signed up for Medicare, and the federal government was looking for hard data on cost-sharing.
Between 1974 and 1982, RAND conducted field work for the study, funded by what is now HHS. More than 7,700 people were randomly assigned to one of several insurance plans that reflected an array of cost-sharing options. One major finding showed that those who paid for a share of their healthcare generally used fewer services than those who received free care, yet there was effectively little or no difference in health outcomes between the groups. There were exceptions—free care led to health improvements among the poorest and sickest, and the study suggested that cost-sharing should be minimal or nonexistent for the poor.