Reports & Analysis

Most employers who provide health insurance to employees subsidize their premiums and provide a comprehensive benefit package. Before the ACA, people who lacked health insurance through a job and purchased it on their own paid the full cost of their plans, which often came with more limited benefits and higher deductibles. Findings from The Commonwealth Fund Affordable Care Act Tracking Survey, March–May 2015, indicate that the law’s tax credits have made premium costs in health plans sold through the marketplaces roughly comparable to employer plans, at least for people with low and moderate incomes.

Interest in new implementation approaches to health insurance marketplaces has increased as states seek to ensure the long-term financial stability of their exchanges and exercise local control over marketplace oversight. This brief explores the experiences of four states—Idaho, Nevada, New Mexico, and Oregon—that established their own exchanges but have operated them with support from the federal HealthCare.gov eligibility and enrollment platform. Drawing on discussions with policymakers, insurers, and brokers, this brief examines how these supported state-run marketplaces perform their key functions.

Large data sets that can be analyzed to determine patterns of behavior – popularly called “big data” – are being used in ever-expanding ways. State insurance regulators have adopted the use of big data to conduct oversight of certain kinds of insurance, such as workers’ compensation and life insurance. However, those agencies providing oversight of health insurers have undertaken only modest efforts to collect, analyze, and use large sets of claims, enrollment or sales data to understand market trends and how consumers are using their health insurance to access and pay for care. This issue brief discusses how insurance regulators and third parties are currently using data collection, and how it could change under yet-to-be-implemented provisions within the Affordable Care Act as means for improving health plan oversight and compliance.

States and the federal government are investing heavily in state demonstrations to reform the health care delivery system, and gauging the impact of these demonstrations through monitoring and evaluation requires time and effort from both state and federal officials. Greater alignment between state and federal evaluation and monitoring activities and across programs could streamline reporting requirements, ease administrative burden, and improve the effectiveness and efficiency of monitoring and evaluation. In June 2015, the National Academy for State Health Policy convened state and federal leaders to identify actionable steps toward a shared federal and state agenda on improving the monitoring and evaluation of state demonstrations. This brief reflects on the convening’s discussion.

With the Supreme Court ruling in favor of the government in King v. Burwell, opinion polls suggest that some Americans are taking a fresh look at the ACA, and reassessing its merits. A key question for them – and one that is rarely discussed – is how the ACA will improve the health of those who gain insurance coverage. This blogpost reviews the evidence to determine the health benefits of health insurance.

Through the Medicaid Accountable Care Organization Learning Collaborative, the Center for Health Care Strategies has developed a library of practical resources for states considering and implementing accountable care organizations (ACOs) for Medicaid populations. These resources are designed to help states and provider organizations develop and launch Medicaid ACOs.

Since the June 2012 Supreme Court decision effectively made Medicaid expansion under the ACA optional for states, the effects of the Medicaid expansion on state budgets and economies have been key issues for policymakers. This brief provides some insight into the underlying economic and fiscal conditions in expansion and non-expansion states leading up to 2014. The brief will provide a framework against which to measure the impact of expansion decisions going forward.

The Marketplace Survey Improvement Guide helps Marketplaces improve consumers’ experiences when they shop for and enroll in a health plan. The Guide provides seven evidence-based strategies that will help Marketplaces improve the consumer experience by giving consumers accurate and relevant information in a timely manner and helping consumers understand and use that information. The Guide also offers recommendations on where to focus improvement efforts.

The ACA provided for new publicly funded consumer assistance entities to help people on an ongoing basis as they apply for health coverage and subsidies and resolve questions and problems with their insurance once covered. These assistance professionals have unique insights into how ACA implementation is progressing, what is changing and what challenges remain. This report discusses the results of the 2015 Kaiser Family Foundation survey of Health Insurance Marketplace Assister Programs and Brokers, and compares the Assister Programs’ capacity and experiences during their first two years of operations under the ACA.

The new health insurance exchanges are the core of the ACA’s reforms, but how the law improves the nonsubsidized portion of the individual market is also important. This issue brief compares products sold on and off the exchanges to gain insight into how the ACA’s market reforms are functioning. Initial concerns that insurers might seek to enroll lower-risk customers outside the exchanges have not materialized. Instead, more generous benefit plans, which appeal to people with health problems, constitute a greater portion of plans sold off-exchange than those sold on-exchange.