Reports & Analysis

The failure of the health insurance cooperative operating in Iowa and Nebraska, together with the significant financial losses experienced by most others, have raised questions about the viability of the Affordable Care Act’s Consumer Operated and Oriented Plan (CO-OP) program. The program, which offers low-interest loans to co-ops, was designed to inject competition into highly concentrated markets and provide more affordable, consumer-focused alternatives to traditional insurance companies. This new blog post explains what’s behind the CO-OP program’s mixed performance so far and also points to reasons why success is still within reach.

States are realizing the potential benefits associated with integrating medical care and social services, and are beginning to take the first steps toward developing financing and payment models that encourage this connection. This brief reviews potential financing mechanisms to facilitate integration, with a particular focus on Medicaid. Drawing from interviews with experts across the country, it offers models ranging from one‐time seed funding for pilot projects to blended or braided financing arrangements that support comprehensive integration. The brief also highlights payment methodologies designed to influence providers to incorporate social services into their care efforts, with a focus on moving away from fee‐for‐service and toward value‐based payment strategies.

Arkansas, Minnesota, Oregon, and Vermont are at the forefront of state efforts to coordinate value-based payment approaches across multiple public and private payers. Each is deploying some combination of payment and delivery system redesign that includes episode-based payment, patient-centered medical homes (PCMHs), and total cost of care arrangements among its Medicaid, Medicare, and commercially insured populations. This report, after describing multi-payer activity generally, examines the extent to which self-insured employers are participating in the kind of delivery system transformation envisioned by the Centers for Medicare & Medicaid Services (CMS) State Innovation Models (SIM) program. The report also provides a summary of current recruitment efforts in each state and synthesizes lessons learned for public officials interested in further outreach to the employer community.

Hospital community benefit policy is evolving differently by state. Since passage of the ACA in 2010 and subsequent rulemaking, state community benefit policy has increasingly moved beyond a focus on financial assistance policies to pursuing strategies that address the social determinants of health and promote community health. In this issue brief, Hilltop’s Hospital Community Benefit Program examines state-level community benefit oversight by studying specific changes to community benefit statutes, regulations, and policies in 5 select states – Colorado, Illinois, Minnesota, New Hampshire, and New York. The Hilltop Institute also has released an update of its interactive map detailing each state’s community benefit laws.

The enactment of the Affordable Care Act (ACA) ushered in sweeping changes to the U.S. health care system. While the law touched almost every aspect of our health care system, the parts of the law that have garnered the most attention, and generated the most controversy, are those relating to the availability and affordability of health insurance coverage. The coverage provisions in the law were aimed at improving access to insurance, enhancing the quality of coverage by imposing minimum benefit standards, and increasing the affordability of coverage through expanded public programs and new subsidies for private coverage. This brief examines these coverage provisions, providing an update on how they have been implemented and assessing their impact. It also discusses key issues looking ahead.

In January 2014, the ACA extended access to health insurance coverage to an estimated 30 million previously uninsured people. This issue brief provides state-level estimates of the increased demand for physician and hospital services that is expected to result from expanded access and assesses the sufficiency of the existing supply of providers to accommodate the anticipated increase in demand. Increases of the magnitude likely to be generated by the Affordable Care Act will have modest effects on the demand for health services, and the existing supply of providers should be sufficient to accommodate this increased demand.

As states continue to look for new ways to balance their budgets, early results from states that have expanded Medicaid show significant state budget savings after just the first year of expansion. Twenty-six states have expanded Medicaid—this brief focuses on the budget impact in two states: Kentucky and Arkansas. Both states report expansion-related savings and Arkansas reports new revenues. When projected forward, these financial gains are likely to exceed expansion-related costs for years to come. These early savings point to Medicaid expansion paying for itself, at least through SFY 2021, while generating major gains in coverage and reducing the number of uninsured.