Reports & Analysis

Young adults are the age group most likely to be without health insurance. But through the Health Insurance Marketplace, young adults can purchase quality, affordable coverage and get lower costs on monthly premiums through tax credits. This report examines data from the 34 Federally-Facilitated and State Partnership Marketplaces and finds that out of 2.9 million single young adults ages 18 to 34 who may be eligible for coverage in the Marketplace, 1.3 million (46 percent) could purchase a bronze plan for $50 per month or less after tax credits. In the 34 states, a total of 1.9 million young adults, representing nearly 7 in 10 (66 percent) of the potentially Marketplace-eligible uninsured ages 18 to 34, may be able to pay $100 or less for coverage in 2014.

In partnership with the Robert Wood Johnson Foundation, Breakaway Policy Strategies is undertaking a review of the plans being offered in all 50 state marketplaces, plus the District of Columbia, that goes well beyond an examination of premiums. This first report provides a snapshot of premiums, deductibles, copayments and coinsurances amounts for primary care physician and specialist visits for silver-level plans in 96 rating areas across 15 state marketplaces.

NCQA’s 2013 State of Health Care Quality Report summarizes Healthcare Effectiveness Data and Information Set (HEDIS) results from calendar year 2012 from health plans covering a record 136 million people, or 43 percent of the US population. The 2013 report’s key findings include: stagnant or declining performance in appropriate use of antibiotics; continued improvement in childhood obesity measures; mixed results regarding childhood immunization; sustained decline in initiation of alcohol and drug treatment; and better experience of care in Medicaid HMOs.

The Federally Qualified Health Center Urban Health Network is a coalition of 10 federally qualified health centers (FQHCs) in the Minneapolis–St. Paul area that pursued an accountable care organization (ACO) through a Medicaid demonstration project with Minnesota. This case study explores: the state context under which the ACO contract emerged; origins of the coalition; the members’ motivations to participate; strategies and processes established to work toward cost and quality benchmarks; challenges faced in pursuing accountable care; and the organizational strengths that facilitated the health centers’ shift from competition to collaboration.

This brief estimates the number of uninsured community health center (CHC) patients who would gain coverage under the Affordable Care Act using data from the 2009 HRSA Survey of CHC patients and 2011 Uniform Data System. The authors find that were all states to implement the Affordable Care Act Medicaid expansion, an estimated 5 million uninsured health center patients would be eligible for coverage. However, over one million uninsured patients – 72 percent of whom live in southern states – who would have been eligible for coverage will remain uninsured because of states’ decisions to opt out of the expansion.

In states that do not expand Medicaid, nearly five million poor uninsured adults have incomes above Medicaid eligibility levels but below poverty and may fall into a “coverage gap” of earning too much to qualify for Medicaid, but not enough to qualify for Marketplace premium tax credits. Most of these people have very limited coverage options and are likely to remain uninsured. This brief describes the coverage gap and presents estimates of the population that falls into this situation.

The Affordable Care Act (ACA) has implications for “boomerang children” and their parents. “Boomerangs,” young adults who (often for financial reasons) move in with their parents, may expose their parents to significant tax penalties, even if the rest of the family has health coverage. This brief summarizes the available demographic information about the boomerang population, and provides an analysis of a common example to illustrate the ACA’s implications to such families.

At the National Academy for State Health Policy’s Annual Conference in October 2013, Dr. Leininger presented on one potential method that Medicaid agencies can use to prepare for the the health needs of its new enrollment population under the ACA. This presentation reviews Dr. Leininger's findings on the feasability of embedding a health needs assessment into Medicaid applications to predict this population's future health needs.

One of the significant changes brought about by the Affordable Care Act (ACA) is the introduction of a new methodology to evaluate eligibility for Insurance Affordability Programs (IAPs): Modified Adjusted Gross Income (MAGI). MAGI will be used to evaluate available income for most Medicaid and Children’s Health Insurance Program (CHIP) applicants and enrollees beginning in 2014. MAGI will also be used to determine eligibility for Advance Premium Tax Credits (APTCs) and Cost Sharing Reductions (CSRs) through the health insurance Marketplaces.  This Advocate’s Guide explains how MAGI works, and sets forth the guidelines that CMS has developed to implement and govern this new methodology.

The findings in this report are drawn from the 13th annual budget survey of Medicaid officials in all 50 states and the District of Columbia. The report highlights trends in Medicaid spending, enrollment and policy initiatives for FY 2013 and FY 2014 with an intense focus on eligibility and enrollment changes tied to the implementation of the ACA as well as payment and delivery system changes.