ABSTRACT
This essay places the essays in this volume in the context of policy development for health-and long-term care (LTC), by positioning the Patient Protection and Affordable Care Act (ACA) of 2010 within the American tradition of incrementalism. It discusses how most of the law’s provisions constitute incremental advances in existing strategies and fail to address the fundamental and structural issues that prevent genuine advancement in this policy area. Instead, we see a continuation of current strategies for improving services for older people, some of which nonetheless hold considerable promise, including strategies to expand home-and community-based care, improve and expand the long-term care workforce, address prevailing deficiencies in nursing home quality, and better coordinate care received by LTC recipients and other frail and disabled individuals. The primary exception to this, the Community Living Assistance Services and Supports (CLASS) Act, is unlikely to be implemented in its existing form; however, debate over its design reveals the fundamental lack of agreement in the American policy community about the appropriate role of government in long-term care. Ultimately, the impact of the ACA will be mediated by the extent to which both the federal and state governments opt to invest in it, through funding, implementing, and enforcing the ACA’s provisions.
