Reports & Analysis

This new Alliance for Health Reform Toolkit, produced with the support of the Robert Wood Johnson Foundation, details the ACA's employer requirements and penalty. It also provides information about the delay in the employer mandate to 2015, and analysis about its impact on employer-based coverage. The Toolkit includes: key facts about the employer mandate; data about trends in employment-based health coverage; links to news articles and reports explaining and analyzing the issue; and health care experts who understand the issue and its implications, along with contact info.

On August 30, 2013, the IRS published final regulations implementing the shared responsibility provisions of the ACA. The regulations address, among other matters, the complex question of when Medicaid eligibility amounts to minimum essential coverage (MEC) for purposes of the Act’s tax penalties. Because people with MEC are barred from receiving premium and cost sharing assistance for Marketplace plans, the final rules also have important implications in the area of health policy for children and adults with disabilities, who may need both basic insurance and supplemental Medicaid coverage for their more extensive health care needs. Many of Medicaid’s most important disability-related eligibility categories are optional with states and, therefore, monitoring whether and how agency policy on when Medicaid counts as MEC will be an important issue to watch over time.

As part of the Agency for Healthcare Research and Quality (AHRQ)'s Infrastructure for Maintaining Primary Care Transformation initiative, NASHP worked with four states (Idaho, Maryland, Montana, and West Virginia) that sought to adapt aspects of North Carolina’s nationally recognized model of primary care practice transformation. This report summarizes the value of primary care transformation for the states, describes the North Carolina model, and outlines states' successes, challenges and lessons learned. 

The Centers for Medicare and Medicaid Services and states are partnering to transform health care systems by creating and testing new models of care delivery and payment. Interviews with officials from states participating in the State Innovation Models (SIM) Initiative reveal that the readiness of providers and payers to adopt innovations varies, requiring different starting points, goals, and strategies. State governments also have policy levers to encourage efficient deployment of a diverse health care workforce. As federal officials review states’ innovation plans, set timetables, and provide technical assistance, they can also take steps to accommodate the budgetary, political, and time constraints that states are facing.

Since the passage of the Affordable Care Act, there has been much speculation about how many employers will stop offering health insurance once the act’s major coverage provisions take effect. Some observers predict little aggregate effect, but others believe that 2014 will mark the beginning of the end for our current system of employer-sponsored insurance. This report uses theoretical and empirical evidence to address the question, “How will employers’ offerings of health insurance change under health reform?” 

With health insurance exchanges now open for business, a new report shows stark differences in outreach and enrollment assistance efforts across 10 states. Researchers say states that established their own unique, state-based insurance marketplaces have developed innovative marketing campaigns supported by new programs designed to help consumers navigate the application and enrollment process. In contrast, states that deferred to federally run marketplaces and national outreach efforts may not be supported by the same level of marketing and assistance, and thus may not achieve the same level of enrollment.

Though the economy continues to add jobs at a moderate pace, some of the jobs added in recent months have been part-time, prompting critics of health reform to argue that it is the culprit. The Affordable Care Act (ACA) requires larger employers (those with at least 50 full-time-equivalent workers) to offer health coverage to their full-time employees or pay a penalty.  The critics claim that this requirement creates a disincentive to hire full-timers and that one can already see the shift to part-time work in the data. Recent data, however, provide scant evidence that health reform is causing a significant shift toward part-time work, and there’s every reason to believe that the ultimate effect will be small as a share of total employment.

While states differ in their approaches to the education and outreach campaigns for their Marketplaces, they have a common mission of educating consumers about their coverage options. Many of the campaigns utilize creative and innovative strategies that move beyond typical government outreach efforts and target populations that are hard-to-reach and/or have high rates of uninsurance. While not exhaustive, this analysis reflects examples of state marketing efforts based on publicly available information as of September 2013. 

Survey data show that the largest barrier to health coverage is difficulty finding a plan that families can afford. Beginning in 2014, the Affordable Care Act (ACA) introduces major reforms, including the start of a new advance payment Premium Tax Credit designed to lower the cost of coverage for qualified families purchasing in the new Health Insurance Marketplaces (exchanges). These advanceable and refundable features of the new tax credits introduce new elements that most consumers haven’t previously encountered. These facts raise the possibility that consumer confusion might be a barrier to using this new program to enroll in affordable coverage.

Beginning in 2014, millions of Americans will become eligible for a new premium tax credit that will help them pay for health coverage. This collection of frequently asked questions explains who will be eligible for this tax credit, how the size of an individual or family’s credit will be calculated, how midyear changes in income and household size will affect tax credit eligibility, and how the reconciliation between the tax credit amount a person receives and the amount for which he or she was eligible will be handled.