The Affordable Care Act of 2010 promises to reshape American health care. The legislation calls for expanding health insurance coverage, restructuring the delivery system to improve quality and value, eliminating health care disparities, strengthening public health, enlarging the health care workforce and encouraging prevention and wellness in communities and workplaces. Yet, despite passage of this historic legislation, formidable challenges remain. The most immediate of these is the difficult task of implementing the reforms. Health insurance exchanges, for example, are complex organizations that require careful design and whose establishment may face financial, legal and political obstacles in some states. Additional policy reforms are needed to bring health care spending under control and to meet the health needs of millions of Americans not touched by the new law. Even with well implemented system reforms, larger problems still face the nation—some with deep economic, political and social roots, such as childhood obesity, substance abuse, HIV/AIDS, depression and other mental disorders, and some infectious diseases and conditions associated with unhealthy lifestyles. These problems burden the health care system and public health agencies with challenges that lie beyond their traditional missions. Compared with other industrialized nations, the United States continues to perform poorly on numerous indicators of health status.

 As our nation struggles with the need to reform our health care system in ways that promote the health of our people, improve access to health care and increase the quality, equity and efficiency of care delivery, the field of health policy research offers exciting opportunities. Clearly, any sector of the economy that is expanding to consume almost one-fifth of the gross domestic product deserves the attention of the most gifted scholars. As the health sector has grown in size and complexity over the past three decades, so too has the need for research and analysis to guide development of health policy at the national, state and local levels.

 The social science disciplines of economics, political science and sociology have made important contributions to health policy research, providing useful and insightful frameworks for understanding and analyzing the health sector and its problems.

In the current environment—marked by an aging population, the increased prevalence of chronic illness and of conditions associated with culture and lifestyle, and an overburdened public health system—the U.S. urgently needs social scientists who will apply their disciplinary perspectives to the study of complex policy questions.

Economists may inform the discussion by:

• assessing the effects of continued health spending growth on federal and state budgets, as well as alternative policy options for controlling such growth and increasing the value obtained from health care;
• analyzing the implications and effects of different tax policies on the health and well-being of populations and of individuals;
• analyzing the effects of organizational changes on the cost and quality of care and on the willingness of competing organizations to serve diverse population groups;
• studying the economic burden of disease on different populations caused by disparities in access to care; and
• evaluating the impact of health care workforce policy changes on patients’ health outcomes and on the entry of new professionals to the workforce.

Political scientists may furnish fresh insights into such areas as:

• the politics of health reform, including the ways in which legislative battles over reform proposals are strategically framed and fought, and how political disagreements over policy implementation are addressed and resolved;
• the respective roles of federal and state government in health reform, including regulation of the financing and delivery of care;
• the role of public opinion in shaping policy formulation;
• the balance of power among major players that may shift as a result of changing policies;
• the influence that interest groups and the media exert over health policy decisions; and
• the political and social forces that empower and mobilize communities to address health problems.

Sociologists may contribute to the policy analysis and debate by:

• analyzing the social and cultural factors that impede the ability of diverse population subgroups to enroll in public programs and to obtain needed health care;
• increasing our understanding of the effects of changes in the structure and organization of the health care delivery system;
• assessing the impact of the changing roles and functions of health care providers;
• providing a framework for understanding how social movements affect the nation’s health; and
• expanding our knowledge of the socioeconomic and cultural determinants of health.

The interplay among all three disciplines, when brought to bear on any single issue, results in a rich, multidisciplinary perspective that enhances problem definition and resolution. To ensure that health policy research continues to benefit from these disciplinary perspectives — and from the interaction among them — the Foundation established the Robert Wood Johnson Foundation Scholars in Health Policy Research Program in 1992. It is part of the Foundation's rich history of programs and projects in its Human Capital Portfolio that seek to build and maintain a strong and diverse leadership and workforce in health and health care, as well as to help develop specific fields.