examined hospital network data from 120 unique 2014
individual exchange market products in the silver
tier offered by 80 carriers. This analysis spanned 20
urban rating areas and included close to one-fourth
of the U.S. nonelderly uninsured population. 8 According to the study’s findings, 70 percent of the hospital
networks in the exchanges were either narrow or
ultra-narrow, which might eliminate some surgeons
from the network.
One of the major goals of the ACA was to decrease
the number of Americans without health care insurance. Responses from the 2015 ACS Governors
Survey, which was administered a year and a half after
enrollment in the ACA began, show that this goal is
being met. The ACS Governors generally reported
improved access to care nationwide, an increase in
the number of patients who have health insurance, an
increase in the number of patients who have Medicaid
coverage, and a slight increase in caseload.
One might assume that increased access to care
and an increased number of patients with some
form of health care insurance would lead to overall
improved quality of care for surgical patients. However, the survey data do not definitively support this
assumption. Since the inception of the ACA, according to survey respondents, a higher percentage of
patients were delaying their elective surgery and a
higher percentage of patients were presenting at a
later, rather than an earlier, stage of disease.
The ACA will continue to affect the surgical care of
patients in the U.S. for years to come. The Governors
anticipate that the ACS leadership will be able to use
the results from this survey in its efforts to improve
access to quality care for surgical patients nationwide. ♦
1. H.R. 3590: Patient Protection and Affordable Care Act.
(111th). Available at: www.govtrack.us/congress/bills/111/
hr3590. Accessed March 16, 2016.
2. Kaiser Family Foundation. Key Facts about the uninsured
population. October 5, 2015. Available at: http://kff.org/
uninsured/fact-sheet/key-facts-about-the-uninsured-population/. Accessed March 16, 2016.
3. U.S. Department of Health & Human Services. The
Affordable Care Act is working. June 24, 2015. Available at:
aca-is-working/ index.html. Accessed March 16, 2016.
4. Kaiser Family Foundation. The coverage gap: Uninsured
poor adults in states that do not expand Medicaid. October
2013. Available at: https://kaiserfamilyfoundation.files.
poor-adults8.pdf. Accessed March 16, 2016.
5. U. S. Supreme Court. National Federation of Independent
Business vs. Sebelius. October 2011. Available at www.
Accessed March 16, 2016.
6. Rudowitz R, Snyder L, Smith V. The Kaiser Commission
on Medicaid and the Uninsured: Medicaid enrollment and
spending growth: F Y 2015 and 2016. Available at: http://kff.
growth-fy-2015-2016/. Accessed March 30, 2016.
7. Patton M. Health insurance premiums are rising
faster than income. Forbes. June 30, 2015. Available
income/#5cc1ce211eb5. Accessed March 16, 2016.
8. McKinsey & Company. Hospital networks: Configurations
on the exchanges and their impact on premiums.
December 14, 2013. Available at: http://healthcare.
on_Premiums.pdf. Accessed March 16, 2016.