The Patient Protection and Affordable Care Act (ACA) was signed into law on March 23, 2010. The law contained provisions aimed at expanding health insurance coverage for Americans, controlling the growth of health care costs, and improving the delivery of health care, and many of those provisions required state-level decisions and actions. At that time, the North Carolina Department of Health and Human Services and North Carolina Department of Insurance asked the North Carolina Institute of Medicine (NCIOM) to convene stakeholders to examine the ACA and make recommendations for implementing the law to serve the best interest of the state as a whole. This task force included an Advisory Group and eight workgroups, which met for 12-18 months each beginning in August 2010, and published a collective report with 44 recommendations in January 2013.

To mark the 10-year anniversary of the passage of the ACA, the NCIOM has produced an update on the implementation status of those task force recommendations [1]. In total, 10 recommendations were fully implemented, 25 were partially implemented, and nine were not implemented.

In the years since the ACA was passed, North Carolina has seen a mixture of successes, ongoing work, and some missed opportunities. Our successes include:

• A strong Navigator program that helps North Carolina have one of the highest rates of Health Benefits Exchange sign-ups of any state.
• State university and community college systems that are working to improve the diversity and distribution of our future health care workforce.
• A Health Information Exchange - NC HealthConnex – that continues to expand the use of health care data for quality improvement.

Yet, one of the greatest opportunities that the ACA offered states to increase access to care is the ability to expand Medicaid eligibility, and North Carolina has yet to do so. The NCIOM task force on the Affordable Care Act, and many other NCIOM task forces since then, called on the North Carolina General Assembly to implement this policy change that would improve access to health care for an estimated 591,000 North Carolinians. Evidence continues to grow, showing that expansion of Medicaid eligibility leads to positive health and economic impacts. Findings include decreased mortality overall and for some specific conditions; reduced food insecurity, poverty, and evictions; improved self-reported health; and overall state savings due to reduced costs in other areas.

[1] The November-December issue of the North Carolina Medical Journal also marks the 10-year anniversary of the ACA with an issue that includes perspectives on the impact of the law on community health, payment systems, hospitals, chronic illness, and more.