Reports & Analysis

The Affordable Care Act (ACA) requires health insurers to justify rate increases that are 10 percent or more for non-grandfathered plans in the individual and small-group markets. In analyzing these filings for renewals taking effect from mid-2013 through mid-2014, this brief finds that the average rate increase submitted for review was 13 percent. Insurers attributed the great bulk of these larger rate increases to routine factors, such as trends in medical costs. Most insurers did not attribute any portion of these medical cost trends to factors related to the ACA. The ACA-related factors mentioned most often were nonmedical: the new federal taxes on insurers, and the fee for the transitional reinsurance program.

States purchase health care benefits for more than a third of all Americans — nearly one quarter of all Americans receive coverage through Medicaid and about 14 percent of working Americans are state or local government employees. Because managed care plans oversee health care services for most Medicaid beneficiaries, public employees, and those getting coverage through the marketplaces, health plans are key channels through which state purchasers can accelerate the shift away from fee-for-service reimbursement toward value-based purchasing (VBP). CHCS developed this toolkit – a brief on  Strategic Considerations for State Purchasers, an Implementation Guide for State Purchasers, and Planning Template for Value-Based Purchasing – to help state purchasers design and implement effective VBP strategies within managed care.

Seventeen states currently are implementing accountable care strategies in Medicaid or state employee health programs. State activity runs the gamut from financing accountable care models to developing state standards that certify public and private accountable care organizations, to aligning accountable care principles with the creation of new community-based organizations or Medicaid managed care organization contracts. This article describes the range of strategies taken by states to drive value-based payment mechanisms aligned with accountable care principles. It also shows the power states have to influence financing of these models in Medicaid, state employee health programs, and commercial insurers’ plans, thus creating new opportunities for furthering provider participation.

The ACA presented new challenges for states to develop models for health system and payment reform, implement health insurance marketplaces, and expand Medicaid. This created a need for states to fully understand and utilize data sources in order to effectively implement, monitor, and evaluate health care reform. To assist states in this effort, the Office of the Assistant Secretary for Planning and Evaluation (ASPE) commissioned a series of white papers that are focused on innovative uses of data resources and analytic approaches that states can apply to monitor and evaluate health care reform efforts. The series, prepared by SHADAC, provides an overview of data sources available to state policymakers, such as state-level administrative data, health insurer filings, marketplace enrollment data, and survey data.  The series also highlights key analytic questions that states could use the data sources to address.

The gaps in our health insurance system affect people of all ages, races and ethnicities, and income levels; however, those with the lowest incomes face the greatest risk of being uninsured. Being uninsured affects people’s access to needed medical care and their financial security. This primer first presents basic information about health coverage and the uninsured population leading up to and after the implementation of the Affordable Care Act, who the uninsured are and why they do not have health coverage. It then presents information on the impact lack of insurance can have on health outcomes and personal finances, and provides an understanding of the difference health insurance makes in people’s lives.

Critics frequently characterize the ACA as a threat to the survival of employer-sponsored insurance. The Medicaid expansion and Marketplace subsidies could adversely affect employers’ incentives to offer health insurance and workers’ incentives to take up such offers. This article takes advantage of timely data from the Health Reform Monitoring Survey for June 2013 through September 2014 to examine, from the perspective of workers, early changes in offer, take-up, and coverage rates for employer-sponsored insurance under the ACA. The researchers found no evidence that any of these rates have declined under the ACA.

In some states, policymakers and stakeholders are considering adoption of the Basic Health Program (BHP) option permitted under the ACA. Through BHP, consumers with incomes at or below 200 percent of the federal poverty level (FPL) who would otherwise qualify for subsidized qualified health plans offered in health insurance marketplaces instead are offered state-contracting standard health plans that provide coverage no less generous and affordable than what have been provided in the marketplace. This paper reviews the federal BHP payment methodology; explains how state officials can use information about the characteristics of BHP-eligible consumers to estimate average federal payment amounts; and places the federal payment estimates in context, showing what they can and cannot contribute to a state’s analysis of BHP’s overall fiscal effects.

This report examines the rollout of the ACA in Michigan, particularly focusing on the state’s passage of Medicaid expansion. The report outlines three key components that contributed to its successful efforts to pass Medicaid expansion – the governor's interest in pursuing the expansion, the support of a strong and vocal multi-sector coalition, and the inclusion of two federal waiver requirements – which could serve as model for other states with bipartisan or Republican-led governments seeking Medicaid expansion.

Following the Supreme Court’s ruling that states could decide for themselves whether to expand eligibility for Medicaid under the Affordable Care Act, a number of states have opted to do so using alternative approaches. Under federal waiver, these states have focused on expanding the use of private health insurance, requiring beneficiaries to pay premiums, and incentivizing them to choose cost-effective care. This new brief examines the variety of Medicaid reforms that Arkansas, Michigan, Iowa, and Pennsylvania are currently testing. By linking broader program reforms to the adult coverage expansion, these states can align Medicaid with local political conditions while extending insurance to more than 1 million adults who would otherwise lack a pathway to coverage.

The Affordable Care Act (ACA) protects people from being charged more for insurance based on factors like medical history or gender and establishes new limits on how insurers can adjust premiums for age, tobacco use, and geography. This brief examines how states have implemented these federal reforms in their individual health insurance markets. The authors identify state rating standards for the first year of full implementation of reform and explore critical considerations weighed by policymakers as they determined how to adopt the law’s requirements. Most states took the opportunity to customize at least some aspect of their rating standards.