Reports & Analysis

With several of the Affordable Care Act’s (ACA) major provisions going into effect in January 2014, including single risk pool rating, guaranteed issue, actuarial value metal tiers, and essential health benefits, there has been concern about the impact of these market reforms on health insurance rates and their distribution. To help state regulators tackle these issues, the National Association of Insurance Commissioners (NAIC) released this paper at its Spring 2013 National Meeting detailing the options that states have to help minimize rate increases. 

England, France, Germany, the Netherlands, and Sweden spend less as a share of gross domestic product on hospital care than the United States while delivering high-quality services. All five European countries have hospital payment systems based on diagnosis-related groups (DRGs) that classify patients of similar clinical characteristics and comparable costs. These European systems, discussed in more detail in the article, suggest potential innovations for reforming DRG-based hospital payment in the United States.

In an effort to improve both the affordability and quality of health care in America, key health care stakeholders from the insurance, hospital, physician, business, and consumer sectors—America’s Health Insurance Plans (AHIP), Ascension Health, Families USA, the National Coalition on Health Care, and the Pacific Business Group on Health—worked together to reach consensus about what is needed to control costs and improve quality. This blueprint highlights the group’s five recommendations for aligning incentives to transform care delivery and strengthen the infrastructure needed to achieve improved savings and health outcomes.

Qualified Health Plans (QHPs) offered on state and federal exchanges must include a sufficient number of Essential Community Providers (ECPs) – such as community health centers, Ryan White providers, and others – in their networks, but these providers may not know how to identify or connect to QHPs. This fact sheet reviews ECP guidance and upcoming deadlines, and provides tips to help connect safety net providers and health plans.

Medicaid cost $432 billion in 2011, and Medicaid spending is expected to grow to $795 billion by 2021. Concerns over Medicaid’s contribution to fiscal pressures at both the federal and state levels have led some policy makers to urge reforms. One such proposed reform would be to impose a cap on the amount of federal spending per Medicaid beneficiary, or what’s called a “per capita cap,” so that any program spending growth would be linked to enrollment, not rising per beneficiary spending. This policy brief examines the issues surrounding per capita caps in Medicaid and explores other policy options for states and the federal government.

This chart, prepared by Manatt Health Solutions, allows states to explore different mechanisms to address the cost-sharing cliff in the Exchange and also to promote continuity of coverage and care as consumers transition across Insurance Affordability Programs. The chart provides a side-by-side analysis of coverage alternatives under state and federal consideration including: the Basic Health Program (BHP); the Bridge Plan; Qualified Health Plan (QHP) Premium and Cost-Sharing Support; maintaining existing Medicaid expansions above 133 percent FPL; and Premium Assistance. These options are compared against subsidized QHP coverage available under the ACA.

This brief discusses some of the key policy decisions states are making and briefly describes these programs in a handful of states. This brief is not intended to offer comprehensive examination of all state activity, but rather provides a snapshot of key decisions in a few states. States were included in this snapshot if they had released a detailed RFP or other policy documents describing how these assistance programs would be structured.

With the arrival of the insurance exchanges, an estimated 22 million people will have the opportunity to choose their coverage through an exchange.  Exchange leaders have a critical role to play in supporting consumers in their search for high quality, affordable options that best meet their individual needs. The Pacific Business Group on Health (PBGH) has created a set of resources that exchanges can use as they build their consumer choice decision support.

Beginning in 2014, the Affordable Care Act (ACA) will extend health coverage to millions of Americans. This will be done, in part, by offering tax credits to low- and middle-income Americans, which will help to offset a portion of the cost of health insurance premiums and allow many previously uninsured individuals and families to purchase private coverage. This report takes a closer look at these premium tax credits and estimate how many people across the country could benefit from them.