Strategic Planning & Timelines

The Urban Institute’s Health Reform Monitoring Survey (HRMS) has been tracking health insurance coverage among nonelderly adults since the first quarter of 2013.1 The HRMS, which was designed to provide early feedback on implementation of the ACA, found that uninsured rates had declined by 4.0 percentage points among nonelderly adults between September 2013 and June 2014, with larger declines found in states that have expanded Medicaid. Beginning in June 2013, the HRMS added a supplement to track changes in coverage and other outcomes for children under the ACA. This brief examines findings from the HRMS children’s supplement.

The combined effects of the Affordable Care Act’s coverage expansions, faster economic growth, and population aging are expected to fuel health spending growth in 2014 and thereafter (5.6 percent in 2014 and 6.0 percent per year for 2015–23). However, the average rate of increase through 2023 is projected to be slower than the 7.2 percent average growth experienced during 1990–2008. Because health spending is projected to grow 1.1 percentage points faster than the average economic growth during 2013–23, the health share of the gross domestic product is expected to rise from 17.2 percent in 2012 to 19.3 percent in 2023.
 

Navigators and others helping people apply for health coverage need to understand basic tax filing rules because eligibility for Medicaid, the Children’s Health Insurance Program (CHIP), and premium tax credits for coverage bought through Marketplaces is based on Internal Revenue Code definitions of income and household. The guide provides basic information on relevant tax rules, including when someone is required to file taxes, what filing status options are available, the rules for claiming someone as a tax dependent, and what sources of income are taxable and therefore counted in determining eligibility for Medicaid, CHIP, and premium tax credits.  It also shows how Medicaid uses an individual’s tax filing status to determine who is in his or her household, and how Medicaid’s household rules differ from those used for premium tax credits.
 

Three months after the first Marketplace open enrollment period closed, 13.9 percent of adults still remain uninsured as of June 2014. This brief assesses the demographic and socioeconomic characteristics of the remaining uninsured, their access to employer-sponsored insurance (ESI), their awareness of key ACA provisions, and the reasons they say they remain uninsured. This early look at the characteristics of the remaining uninsured provides valuable information for ongoing Medicaid outreach and enrollment efforts, as well as preparations for the next open enrollment period in the Marketplaces.
 

States have taken different approaches to implementing the Affordable Care Act (ACA) and have had varied enrollment experiences to date. This brief highlights the experiences of four states—Colorado, Connecticut, Kentucky, and Washington—that established a State-based Marketplace (SBM), implemented the ACA’s Medicaid expansion, and achieved success enrolling eligible individuals into coverage. Based on interviews with key stakeholders in each state, it identifies effective strategies that contributed to enrollment and current priorities looking forward.