ACA Expansion

On May 2021, President Biden announced a final rule to extend the Affordable Care Act (ACA) to Deferred Action for Childhood Arrival (DACA) recipients, also known as “Dreamers.” However, this move has been criticized by AAF President Douglas Holtz-Eakin, who argued that it disregards the clear intent of the law, as the ACA only covers lawful U.S. residents. The Congressional Budget Office (CBO) recently estimated that the total cost of this rule over the next nine years would be slightly over $7 billion.

The Biden Administration’s rule amends the legal definition of “lawfully present” in the ACA to include DACA recipients. However, this change is not consistent with the legislative language of the ACA, which specifically limits access to the ACA for lawful residents. The ACA was designed to cover U.S. citizens and lawfully present aliens only, and while the president can determine the enforcement of immigration law, he cannot broadly alter the definition of “lawfully present” to enable certain groups to participate in a federal program from which they are otherwise barred.

The expansion of the ACA is not a significant expenditure in the context of total health care spending, but it is another example of the presidency flouting Congress’ authority. Over the past several decades, total health expenditures have continued to rise, with inflation-adjusted, total national health expenditures nearly tripling since 2000.

In a separate analysis, a review of a chart by Henry Roberts, Health Care Policy Intern, discusses the implementation of artificial intelligence (AI) in healthcare. As of May 2024, the U.S. Food and Drug Administration (FDA) had approved 882 artificial intelligence and machine learning medical devices, primarily in the areas of radiology, cardiology, and neurology. Despite the advancements in AI technology, only 38 percent of physicians surveyed in an American Medical Association (AMA) report have implemented any AI tools in their practice.

Physicians surveyed indicated that relieving administrative burdens and improving workflow were the most important areas for AI application. Primary care physicians (PCPs) viewed AI as more useful in several areas, with gaps of 7 percent or more present in the following areas: automating insurance pre-authorization, summarizing medical research, predicting health risks and treatment outcomes for patients, providing patients with health recommendations, and helping draft responses to patient portal messages. Adoption of these technologies is expected to take place over the long run, with physicians most commonly indicating a timeline of two to five years before full implementation.

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