We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Viewpoint |

Realizing the Promise of the Affordable Care Act—January 1, 2014

John E. McDonough, DPH, MPA1; Eli Y. Adashi, MD, MS2
[+] Author Affiliations
1Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts
2The Warren Alpert Medical School, Brown University, Providence, Rhode Island
JAMA. 2014;311(6):569-570. doi:10.1001/jama.2013.286067.
Text Size: A A A
Published online


Along the arduous, confusing, and contentious road to the enactment and implementation of the Affordable Care Act (ACA), no single date stands out as more consequential for the health and well-being of the US public as does January 1, 2014. Barring unforeseen circumstances, this date will stand out as transformational in the annals of US health care reform. On that day, 4 fundamental provisions of the ACA will take effect. First, extension of the “guaranteed issue” provision to all individual health insurance policies inclusive of the elimination of “medical underwriting” in the face of a preexisting condition. Second, implementation of the “individual shared responsibility” provision also known as the “individual mandate.” Third, provision of tax credits and cost-sharing subsidies to middle- and lower-income adults for the purchase of individual health insurance. And fourth, expansion of Medicaid coverage in participating states to include previously ineligible low-income adults. Most Americans, including physicians and other health care professionals, may not appreciate the profound nature of these new realities. This oversight could be attributable to the daily dramas and controversies of the government shutdown, the woes of the HealthCare.gov website, the cancelation of individual health insurance policies, and the establishment of limited physician networks. In this Viewpoint, we assess the significance of the reforms in question and the implications thereof for the US health care system.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

4 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles