Strategic Planning & Timelines

The nation’s uninsurance rate has dropped significantly since the ACA was enacted. But millions of Americans remain uninsured. In order to get a full picture of the lives of the uninsured and explore their feelings around enrolling in health insurance, the Robert Wood Johnson Foundation commissioned a national survey, conducted by PerryUndem and GMMB, with uninsured adults at the conclusion of the second open enrollment period for the health insurance marketplace.

This paper presents findings from a study that surveyed nearly 3,000 low-income adults in late 2014 to compare experiences in three states with markedly different policies regarding the ACA: Kentucky, which expanded Medicaid, created a successful state Marketplace, and supported outreach efforts; Arkansas, which enacted the private option and a federal-state partnership Marketplace, but with legislative limitations on outreach; and Texas, which did not expand Medicaid and passed restrictions on navigators. It found that application rates, successful enrollment, and positive experiences with the ACA were highest in Kentucky, followed by Arkansas, with Texas performing worst. The paper explores these findings and the factors that most greatly contributed to successful enrollment.

Policymakers are considering changes to the ACA in case the Supreme Court rules in King v. Burwell that federal premium subsidies are not available for individual market plans in states participating in the federally-facilitated marketplace (FFM). Various proposals would provide transitional coverage to those losing subsidies as well as make other changes to the ACA. Many of these changes also are being included in proposals to replace the ACA more broadly. This issue brief examines the general approaches that are included in one or more of the proposals.

With support from the Gary and Mary West Health Policy Center, the APCD Council has developed a manual for states to develop all-payer claims databases. The manual is a first-of-its-kind resource that provides states with detailed guidance on common data standards, collection, aggregation and analysis involved with establishing and using these databases.

New estimates from the Commonwealth Fund Biennial Health Insurance Survey, 2014, indicate that 23 percent of 19-to-64-year-old adults who were insured all year—or 31 million people—had such high out-of-pocket costs or deductibles relative to their incomes that they were underinsured. These estimates are nearly double those found in 2003 when the measure was first introduced in the survey. The share of continuously insured adults with high deductibles has tripled, rising from 3 percent in 2003 to 11 percent in 2014. Half of underinsured adults reported problems with medical bills or debt and more than two of five reported not getting needed care because of cost.