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date: 18 September 2019

Abstract and Keywords

This chapter examines the interaction between public and private health insurance in the United States and the implications of the Affordable Care Act (ACA) with respect to that interaction. After providing background on public and private health insurance generally, the chapter examines how, prior to the passage of the ACA, reforms had been aimed at incorporating private market features into public programs. The chapter then explains how the ACA changed that trajectory, by incorporating public insurance features into private insurance markets. The chapter concludes that, while public and private health insurance in the United States remain separate and fragmented, there has been some convergence of the two, as each system incorporates the best features of the other. The chapter ends with a brief look at entrepreneurial efforts by Arkansas and Vermont that may push public and private health insurance coverage even closer together in those states.

Keywords: private health insurance, United States, Affordable Care Act, Medicare, Medicaid, employer-provided health insurance, crowding out, public health insurance, Arkansas, Vermont

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