Reports & Analysis

This survey reports on the views and experiences of people purchasing health insurance coverage in the non-group market. Over the past few years, the ACA has had a significant impact on this group, as new rules took effect that standardized coverage, guaranteed coverage for those with pre-existing conditions, and established income-based federal financial assistance to those buying insurance through new health insurance Exchanges or Marketplaces. Starting on January 1, 2014, all coverage newly purchased either through a Marketplace or directly from an insurance company had to follow new rules under the ACA (i.e. “ACA-compliant”).

In March of 2012, the U.S. Department of Health and Human Services issued a regulation defining student health plans as individual health insurance under federal law. As a result, they are now subject to the same consumer protections afforded to all those covered by individual health insurance set forth in the Public Health Service Act, as amended by the Affordable Care Act (ACA). This issue brief examines student health plans, which cover over 1 million students, and investigates the interplay between federal and state regulation with regard to these plans.

While many health care organizations are motivated to identify and reduce racial and ethnic disparities in the health and health care of their patients, most lack the tools and resources to do so effectively. To identify ways to address disparities more effectively, Aligning Forces for Quality, an initiative of the Robert Wood Johnson Foundation, partnered with Finding Answers: Disparities Research for Change and the Center for Health Care Strategies to work with nine outpatient practices and their communities. This paper shares the lessons learned from these nine organizations in implementing innovative programming to address disparities in their patient populations. It includes concrete recommendations that other health care organizations can use to improve the quality of their health care delivery systems and implement interventions to address inequities in patient care and outcomes.

Medical home initiatives across the United States are demonstrating that multipayer reform, although complex and difficult to implement, is feasible when committed stakeholders negotiate strategies that are responsive to the local context. Seventeen multipayer medical home initiatives launched between 2008 and 2014 all navigated four critical decision-making points germane to any multipayer payment model: convening stakeholders; establishing provider participation criteria; determining payment; and measuring performance. This brief explores the lessons learned from these experiences.

Since the ACA’s health insurance marketplaces opened and states began to expand Medicaid eligibility, uninsured rates among Latinos have begun to decline for the first time in decades. Studies of the effects of health insurance suggest that these higher coverage rates will contribute to better access to care, increased use of preventive services, better management of chronic illness and, eventually, longer and healthier lives for many Latinos. Despite these historic declines in the number of uninsured, the Commonwealth Fund Biennial Health Insurance Survey finds Latinos continue to have the highest uninsured rates among major U.S. racial or ethnic groups.

Ever since the Supreme Court ruled in June 2012 that states could effectively choose whether or not to accept the ACA’s expansion of Medicaid eligibility, that choice has been one of the most prominent and often one of the most contentious issues for states. This report provides state-level estimates of Medicaid enrollment and the number of uninsured in 2016 for the 21 states that have not expanded eligibility. It also provides estimates of Medicaid and uncompensated care spending for the period 2015 to 2024.

The ACA gives states the option of providing less-generous Medicaid coverage to adults who become eligible through the law’s expansion of the program. Based on a review of the benefit design choices made by states that had expanded Medicaid by the end of 2014, this brief finds that states have chosen to offer more generous coverage than what is required under federal law, either narrowing or eliminating the distinction between coverage levels for newly eligible adults and those for traditional adult beneficiaries, such as pregnant women, parents and guardians, or beneficiaries with disabilities. This suggests that states view the newly eligible beneficiaries as having the elevated health and health care needs that are common among low-income populations.

The ACA created the Small Business Health Options Program (SHOP) Marketplaces to help small businesses provide health insurance to their employees. This study compares the numbers of carriers and plans and premium levels in 2014 for plans offered through SHOP Marketplaces with those of plans offered only outside of the Marketplaces. An average of 4.3 carriers participated in each state’s Marketplace, offering a total of forty-seven plans. Premiums for plans offered through SHOP Marketplaces were, on average, 7 percent less than those in the same metal tier offered only outside of the Marketplaces. Lower premiums and the participation of multiple carriers in most states are a source of optimism for future enrollment growth in SHOP Marketplaces. Lack of broker buy-in in many states and burdensome enrollment processes are major impediments to success.

The individual insurance market has changed substantially under the ACA. Starting in 2014, the health law put in place new rules for what types of plans can be sold, required insurance companies to guarantee access to everyone regardless of health status, and limited the factors insurers could use in setting premiums. As of the end of open enrollment in 2014, 8 million people had signed up for coverage through the Marketplaces. However, it has been unclear precisely how many of these Marketplace enrollees were previously uninsured or how many would have purchased individual coverage directly from an insurer in the absence of the ACA. This analysis of recently-submitted 2014 filings by insurers to state insurance departments shows that 15.5 million people had major medical coverage in the individual insurance market – both inside and outside of the Marketplaces – as of December 31, 2014. Enrollment was up 4.8 million over the end of 2013, a 46 percent increase.

Health plans with relatively narrow provider networks have generated widespread debate, mainly concerning the level of regulatory oversight necessary to ensure plans provide consumers meaningful access to care. The Affordable Care Act (ACA) created the first federal standard for network adequacy in the commercial insurance market for plans offered through the law’s insurance marketplaces. However, states continue to play a primary role in setting and enforcing network rules. This brief examines state network adequacy standards for marketplace plans in the 50 states and District of Columbia.