Reports & Analysis

Attempts to tie health and housing policy are gaining momentum, amid evidence that housing, a social determinant of health, is an important factor in the health status of various populations. More than 610,000 people experience homelessness in the U.S., and over 250,000 individuals within that population have a severe mental illness or a chronic substance use disorder, according to the Department of Housing and Urban Development. This new toolkit provides a detailed look into federal, state and local initiatives, as well as cost implications for health and housing programs.
 

While millions of Americans have newly gained health insurance coverage under the ACA, there is evidence that coverage alone does not necessarily translate into access to health care. This memo provides background information on health insurance literacy, summarizes the research around current consumer knowledge, and offers recommendations on how marketplaces can increase health insurance literacy. Additionally, the State Health Reform Assistance Network has compiled a library of health insurance literacy materials developed by four marketplaces. These resources are intended to serve as examples of what marketplaces can provide to consumers and to groups working on improving health insurance literacy and boosting enrollment.
 

The ACA required Medicaid to cover all children with incomes up to 138 percent of the federal poverty level (FPL) as of January 2014. Whereas all states were previously required to cover children under age 6 in families with incomes up to 138 percent of FPL and children ages 6 to 18 up to 100 percent of FPL through Medicaid, children ages 6 to 18 with family incomes between 100 and 138 percent of FPL were permitted to be covered through separate CHIP. At the time the ACA was enacted, 21 states covered these so-called “stairstep” children through separate CHIP and thus needed to transition them to Medicaid in order to comply with the ACA requirement. Such a transition raises concerns about continuity of coverage and access for children transitioning, along with concerns about potential confusion for parents and providers. This report describes 10 states’ approaches to the transition, identifying common challenges and lessons learned that could support future transitions between health coverage programs.
 

Two models have dominated the policy literature on health insurance exchanges, with many hybrids borrowing elements of each. At one end of the policy spectrum, the insurance exchange can serve as a “marketplace” or “clearinghouse” where buyers and sellers transact with minimal regulation of the product features and prices. At the other end of the policy spectrum, the exchange serves as an “active purchaser” of health insurance on behalf of its clients, the individual consumers. This blogpost discusses what it means to be an active purchaser, and offers a case study comparing Covered California, which uses an active purchaser model, to two other exchange models and some early indications of the benefits of active purchasing.
 

This analysis presents changes in premiums for the lowest- and second-lowest cost silver marketplace plans in major cities in 13 states and the District of Columbia, for which complete data on rates for all insurers are publically available. This page will be updated as complete rate information becomes available for more states
 

Through reforms to cost containment and expanded access to health insurance plans, the Affordable Care Act (ACA) has begun to shape the delivery and cost of health care services to Americans. Many of these reforms are still taking hold, and it is too soon to completely know how they are affecting the health care system. But looking beyond these considerations, it appears that many enduring economic challenges persist in the markets that provide health care and health insurance to consumers. This paper offers six economic facts that highlight continuing challenges and complexities in health care and health insurance markets on which the policy debate should focus.
 

These tables contain state and county health insurance coverage estimates for 2014. These estimates come from the 2014 American Community Survey (ACS) via the U.S. Census Bureau’s American FactFinder (AFF) tool and were released on September 17, 2015. A map is also available with data on state and county uninsurance rates by characteristics (for example, age, race/ethnicity, and poverty level) for 2014 and comparison year 2013.

This annual survey of employers provides a detailed look at trends in employer-sponsored health coverage including premiums, employee contributions, cost-sharing provisions, and employer opinions. The 2015 survey included almost 2,000 interviews with non-federal public and private firms. The 2015 survey also includes information on the use of incentives for employer wellness programs, plan cost-sharing as well as firm offer rates.

States are developing accountable care organizations (ACOs) for their Medicaid populations to target health care costs and improve health care quality by better coordinating care for high-need, high-cost patients and reducing inappropriate inpatient and emergency department visits. Many high-need, high-cost Medicaid patients have mental health and substance use issues and are often not well-served in the current fragmented health care system. In response, states are increasingly looking to integrate behavioral health into their Medicaid ACO programs to help move the needle on cost and quality. This technical assistance tool examines four broad strategies states can use to integrate behavioral health services into ACOs.

Similar to other reports recently released, new data examining hospital discharges in 16 states show increases in Medicaid discharges and declines in uninsured or self-pay discharges in states that implemented the Medicaid expansion. These trends hold true for all hospital discharges as well as for specific services such as mental health or asthma. This information adds to a growing body of evidence demonstrating how coverage expansions are affecting providers and may lead to decreases in uncompensated care for the uninsured.