Choice in the American healthcare system: Changing dynamics under the Affordable Care Act

Implementation of the Affordable Care Act (ACA) in the United States changed the available options of healthcare coverage and providers. Through a comparative case study methodology, this article analyzes variations and trends in choice of provider and/or health plan and implications for consumers. Choice is explored at the national and state level for public and private health insurance options. This includes employer-based insurance, marketplace options, and the public Medicare and Medicaid programs. Findings indicate that too much choice can create confusion and lead to economically inefficient plan selection. Employer structuring of choice retains a wide choice of providers, but passes more cost on to employees. ACA marketplaces come short of structuring managed competition where choice drives efficiency. While the previously uninsured have far better options under reform, the system-wide range, degree, and complexity of choice tend to favor insurers over consumers.