Reports & Analysis

Having health insurance is a key step to obtaining health care. But insurance alone does not guarantee that consumers will have meaningful access to care. People of color, in particular, may continue to face barriers to health care, including access to health providers that can meet their needs. To help address these obstacles, the provider networks created by private health insurers should be adequate—ensuring that consumers of color can get the right care, at the right time, in a language they understand, without having to travel unreasonably far. This brief reviews: the ideal components of a health insurance provider network that meets the needs of people of color; examples of policies from states to help ensure that private insurance networks are adequate for communities of color; and strategies for advocates to use to put these policies in place.
 

The Affordable Care Act has resulted in considerable competition. In a large number of markets, this has resulted in lower premiums than expected, though there is considerable variability within each metal tier. This analysis assesses the variation in premiums within markets and the effects of competition in 10 states: Alabama, Arkansas, Colorado, Maryland, Massachusetts, New York, Oregon, Rhode Island, Virginia, and West Virginia. Four of the states have fairly limited competition, while the other six are very competitive, especially in urban, more populated markets.
 

This brief describes global and episodic bundling and outlines considerations for state Medicaid agencies when evaluating potential implementation, including the relevance of these strategies for Medicaid agencies employing managed care strategies.

This brief discusses the issues that states will face in making decisions about how to structure health insurance exchanges and health insurance markets.
 

Today, there are roughly 750 ACOs across the nation serving 23.5 million people insured by Medicare, Medicaid, and commercial insurance. This evolving model strives to fulfill the Triple Aim of better health, improved patient experience, and lower costs by shifting more accountability for health outcomes to providers. While not all ACOs have been able to deliver better outcomes at lower costs, many have been able to realize these goals. This brief explores promising trends, emerging opportunities, and potential barriers identified by ACO stakeholders across the country. It also examines how ACOs can build upon initial successes and informs policymakers, researchers, and foundations about key considerations to further the development of effective ACO approaches across the health care market.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) creates strong incentives for physicians to participate in Alternative Payment Models (APMs), and it specifically encourages the development of “Physician-Focused Payment Models” in order to address the many problems with current payment systems that Merit-Based Incentive Payment Systems cannot solve. This report explains the provisions of MACRA relating to APMs and describes the actions HHS should take in the following areas: the regulations defining APMs and alternative payment entities; the processes for soliciting, reviewing, and approving Physician-Focused Payment Models; and the systems and resources to implement Physician-Focused Alternative Payment Models.

The ACA has dramatically increased the pace at which the uninsured rate is falling for Hispanic children. Yet Hispanic children are more likely to be uninsured than other children, making them vulnerable to going without health care and leaving their families exposed to financial risk. Given the high rates of uninsurance among Hispanic children, policymakers, program administrators, and other stakeholders should continue efforts to maximize health coverage for Hispanic children and remove barriers to enrollment. This brief provides a snapshot of uninsured Hispanic children in the U.S., and offers recommendations to further reduce the number of uninsured children.

States control an array of resources that can be used to provide health care and address the social determinants of health. To assist state policymakers seeking to maximize their leverage by working across state agencies to promote health, NASHP has compiled a chart of funding sources that state agencies use to address social determinants, such as stable housing, safe and prosperous neighborhoods and communities, access to healthy food, physical and mental health care, income support, and transportation. While many documents show states how Medicaid resources can be used for social services or housing needs, this chart aims to bring attention to other funding sources that states use specifically to help adult high-cost/high-need residents live healthy and prosperous lives.

The Centers for Medicare and Medicaid Services preliminary spending and enrollment data from the Medicaid Budget and Expenditure System (MBES) that covers the period from January 2014 through December 2014, during which 27 states including D.C., had implemented Medicaid expansion. This brief examines the MBES data to examine the effect the Medicaid expansion on spending and enrollment.

This study examines the experiences of low-income adults during the first year of the ACA Medicaid expansion in three states that adopted different strategies: Kentucky, which expanded traditional Medicaid coverage; Arkansas, which used the private option; and Texas, which did not expand Medicaid. It found that low-income adults in Kentucky and Arkansas were more likely to be insured and less likely to have problems paying medical bills or affording prescriptions than low-income adults in Texas.