U.S. Healthcare reform and the pharmaceutical market: Projections from institutional history

Fiercely contested before, during, and after its passage, the 2010 Patient Protection and Affordable Care Act (ACA) is presently restructuring the U.S. healthcare market. This article describes the history of healthcare reform initiatives in the United States, analyzes the policy context in which the ACA was passed, and develops forecasts for the pharmaceutical market as insurance coverage grows. The institutional history of the U.S. healthcare system is revealing of the power of entrenched private interests, especially insurance and pharmaceutical firms, and of widespread opposition to price controls on prescription drugs or other forms of care. The ACA conforms to path dependency in the U.S. health system, continuing a unique mix of public and private insurance and private delivery of care. Building on the institutional analysis, the article develops specific projections for the U.S. prescription drug market in 2015 and 2020. The article concludes with a discussion of anticipated changes to pharmaceutical market structure under the ACA and the sustainability of free-market pricing for prescription drugs in the United States.