University of Miami Law Review


As the six-year anniversary of the passage of the Affordable Care Act (“ACA”) comes to a close, a critical review of one of the key inventions of the ACA—Accountable Care Organizations (“ACOs”)—is timely as part of the greater narrative around affordable, quality health care in America. This Comment begins with a discussion of the statutory creation, philosophy and vision, and organizational structure of ACOs in the context of the passage of the ACA in 2010. Then, it will critically review ACOs from three perspectives based on the ACO model’s mission to provide better care for more people at a lower cost. The first critical perspective will address the concept of “bending the cost curve” to understand whether ACOs have effectively reduced costs, both statutorily and practically. The second critical perspective will consider the “quality of care” framework used to “grade” ACOs, questioning whether this grading system is effective—or even sufficient—to improve the quality of health care. The third critical perspective will evaluate whether ACOs have enabled greater access to care for all Americans—an aspiration for a renewed American health care system—or simply intensified the marginalization of access to health care in this country. It is undeniable that the ACO model of care could greatly impact health outcomes in the United States by restructuring the delivery system of patient care.