Potential Impacts of Federal Health Care Reform on Public Transit

Document Type


Publication Date


Subject Area

mode - paratransit, mode - mass transit, place - north america


Health care facilities, Health care services, Law, Legal factors, Medical trips, Public transit, Travel demand


In March 2010, President Obama signed into law the most dramatic overhaul of the American health care system since the creation of Medicare in 1965. When fully phased in, the Patient Protection and Affordable Care Act (ACA) will (1) mandate that Americans purchase health insurance, (2) significantly broaden the eligibility requirements for Medicaid, and (3) provide subsidies for the purchase of health insurance. The Congressional Budget Office has estimated that by 2022, the law will have added about 30 million newly insured people to the U.S. health care system. Therefore, transit agencies and operators can expect changes in demand for transportation to and from health care services. This digest presents the results of National Cooperative Highway Research Program Project 20-65, Task 39, “Impacts of the New Health Care Bill on Mass Transit.” The purpose of this report is to highlight the provisions of the ACA that are likely to have the largest and most direct impacts on public transit agencies and operations, particularly those in rural and small urban areas. The report also describes pre-existing legal requirements that govern the roles public transit can currently play in transportation related to health care, including: (1) the laws and regulations laying out how public transit can participate in the provision of non-emergency medical transportation for Medicaid participants, and (2) the Americans with Disabilities Act and related regulations of the Federal Transit Administration. The report then uses five case studies to illustrate how the ACA could affect four particular transit systems and one broker of human services transportation that are operating in different geographic and policy environments. Finally, the report assesses ways in which transit agencies and government agencies can monitor and communicate the effects of the ACA on public transit.


Permission to publish the abstract has been given by Transportation Research Board, Washington, copyright remains with them.