Strategic Planning & Timelines

This map tracks enrollment data from state marketplaces, the federal marketplace and Medicaid/CHIP agencies for individuals and families enrolling in Qualified Health Plans (QHPs) and Medicaid/CHIP. The map also provides state-by-state estimates for those eligible for marketplace and Medicaid/CHIP coverage from Kaiser Family Foundation and Urban Institute analyses.

Low enrollment levels in the health insurance marketplaces in the first year may also mean disproportionate enrollment of high cost individuals. This could lead to higher premiums and destabilization of the non-group market, but this is unlikely. First, policies put in place in the law, specifically risk corridors and risk adjustment, will provide insurers with some significant financial protection. Second, low enrollment does not necessarily mean adverse selection – there are strong incentives for young adults to enroll. Third, insurers cannot necessarily recoup any 2014 losses by raising 2015 premiums. Insurers will need to set premiums for 2015 based on the expected enrollment in 2015, not based on any losses that may occur in 2014.

The ACA includes coverage options for people across the income spectrum, but there are big differences in eligibility for coverage depending on whether a state expands Medicaid or not. In states that expand Medicaid, all legal residents with incomes up to four times the poverty level are eligible for financial assistance if other coverage is not available. In states that do not expand, some uninsured people (particularly children) are already eligible for Medicaid or CHIP, though many adults below poverty will fall into a “coverage gap” with no assistance. This interactive map allows you to see how many currently uninsured people in each state are estimated to be eligible for Medicaid or tax credits, or in the coverage gap. State profile fact sheets are also available for more details on how the ACA could expand coverage in each state.

The ACA was passed against a backdrop of decades of rapid growth in health care spending in the United States. While much of this historical increase reflects the development of new treatments that have greatly improved health and well-being, there is widespread agreement that the system suffered from serious inefficiencies that increased costs and reduced the quality of care that patients receive. A key goal of the ACA was to begin wringing these inefficiencies out of the health care system, simultaneously reducing the growth of health care spending – and its burden on families, employers, and state and federal budgets – while increasing the quality of the care delivered. This report analyzes recent trends in health care costs, the forces driving those trends, and their likely economic benefits.
 

Key provisions of the 2010 Affordable Care Act create new Marketplaces for people who purchase insurance directly and provide new premium tax credits to help people with low or moderate incomes afford that coverage. We estimate that about 17 million people who are now uninsured or who buy insurance on their own (“nongroup purchasers”) will be eligible for premium tax credits in 2014. This issue brief provides national and state estimates for tax credit eligibility for people in these groups.