Reports & Analysis

This infographic demonstrates the estimated impact that the ACA will have on the number of self-employed Americans.

Analysts estimate that 1.5 million more people will launch their own business and become self-employed because of key provisions in the Affordable Care Act (ACA) that will make purchasing high-quality insurance on the open market more accessible and affordable. Significant barriers to coverage will be eliminated through Medicaid expansion, coverage for preexisting conditions, and other assistance such as federal tax credits, enabling more people to start their own business without the risk of being denied coverage or not being able to afford premiums. The report is accompanied by an infographic detailing how many more people will be self-insured in nearly every state once the ACA is implemented.

The Affordable Care Act (ACA) will significantly increase coverage options through an expansion of Medicaid and the creation of new health insurance exchange marketplaces. However, effective outreach and enrollment efforts will be key to ensuring that new coverage opportunities translate into increased coverage. Based on a review of existing research, this brief identifies five key lessons learned through previous Medicaid and CHIP experience to help inform outreach and enrollment under the ACA. The brief is part of the “Getting into Gear for 2014″ series examining key implementation issues as states prepare for the ACA coverage expansions.

This chart tracks state Medicaid expansion decisions and includes additional details on key elements of Medicaid expansion bills that have been introduced in state legislatures, such as proposals to provide coverage to the expansion population through qualified health plans on the exchange, special requirements related to cost sharing or care delivery, or options allowing a state to discontinue participation in the expansion. This chart is a record of legislation introduced, but does not track the exact status of bills moving around in state legislatures.

An estimated 47 million Americans will transition at least once annually between Medicaid and subsidized health insurance exchanges starting next year. Only close collaboration between CMS and state exchanges will avoid interruption in insurance coverage and cost increases during these transitions. In her updated Health Reform GPS implementation brief, George Washington University's Sara Rosenbaum reviews FAQs recently issued by CMS that address issues related to Medicaid/Exchange alignment.

Since US Supreme Court’s ruling on the ACA that allowed states to opt out of the health reform law’s Medicaid expansion, fourteen governors have announced that their states will not expand their Medicaid programs. This paper’s authors used the RAND COMPARE microsimulation to analyze how opting out of Medicaid expansion would affect coverage and spending, and whether alternative policy options—such as partial expansion of Medicaid—could cover as many people at lower costs to states. They concluded that in terms of coverage, cost, and federal payments, states would do best to expand Medicaid.

The ACA specifies a standard definition of income – Modified Adjusted Gross Income (MAGI) – that will be used to determine eligibility for both Medicaid and the Exchange-based premium tax credits and cost-sharing reductions. The adoption of MAGI creates a number of issues for states, particularly when applying MAGI to eligibility determination for Medicaid. In this brief, the author reviews the income that is included in MAGI and how income is currently counted in determining Medicaid eligibility. Issues related to measuring MAGI on a monthly basis for Medicaid eligibility determination are discussed, and the author offers some thoughts on how states might begin to address these issues in their application of MAGI to determine eligibility for Medicaid.

Across the country, states are increasingly capitalizing on a wave of momentum supporting multi-payer health system transformation. The federal government is building on existing state multi-payer activity, and spurring new public-private payment and delivery system reforms with initiatives like the State Innovation Models (SIM) program. This Multi-Payer Resource Center, a web-based toolkit, is designed to support states and others in answering key questions about convening, infrastructure, payment, attribution, and evaluation as they seek to implement multi-payer initiatives.

The best opportunity to pursue cost containment in the next five to ten years is through reforming provider payment to gradually diminish the role of fee-for-service reimbursement. Public and private payers have launched many promising payment reform pilots aimed at blending fee-for-service with payment approaches based on broader units of care, such as an episode or patients’ total needs over a period of time, a crucial first step. But meaningful cost containment from payment reform will not be achieved until Medicare and Medicaid establish stronger incentives for providers to contract in this way, with discouragement of nonparticipation increasing over time.

This implementation timeline is an interactive tool designed to explain how and when the provisions of the health reform law will be implemented over the next several years.