Reports & Analysis

The nation’s uninsurance rate has dropped significantly since the ACA was enacted. But millions of Americans remain uninsured. In order to get a full picture of the lives of the uninsured and explore their feelings around enrolling in health insurance, the Robert Wood Johnson Foundation commissioned a national survey, conducted by PerryUndem and GMMB, with uninsured adults at the conclusion of the second open enrollment period for the health insurance marketplace.

The Commonwealth Fund’s third Affordable Care Act Tracking Survey finds that 86 percent of people who are currently insured through Affordable Care Act (ACA) marketplace plans or newly covered by Medicaid are very or somewhat satisfied with their coverage. Nearly seven of 10 adults with new coverage have used it to get health care; many said they previously wouldn’t have been able to afford that care. Fielded between March and May of 2015, this survey monitors how working-age adults who have marketplace or Medicaid coverage through the ACA are using their insurance to get services. The survey also asks people how they view their health plan and physicians.

Since 2010, eight states have negotiated with the federal government to implement Delivery System Reform Incentive Payment (DSRIP) or “DSRIP-like” programs. These programs are a component of Section 1115 demonstrations that incentivizes system transformation and quality improvements in hospitals and other providers serving high volumes of low-income patients. DSRIPs aim to meet strategic goals, based on the Triple Aim principles of better care, improved health, and lower costs by incentivizing reforms that transition away from episodic treatment of disease toward prevention and management of health and wellness among patient populations. This report provides an in-depth cross-state analysis of current DSRIP and DSRIP-like programs. It describes implementation experiences from the federal, state, and provider perspectives.

Eighteen states are currently participating in the Medicaid Balancing Incentive Program (BIP) to increase access to home and community-based services (HCBS) as an alternative to institutional care. Established by the ACA, BIP authorizes $3 billion in enhanced federal funding from October 2011 through September 2015. During the summer of 2014, the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured surveyed BIP states about basic program information, progress with implementing the BIP structural requirements, stakeholder engagement, evaluation activities, and the use of enhanced federal funds in support of other Medicaid LTSS rebalancing efforts. This report documents the key findings.

As states continue to refine the operations of their health insurance exchanges, regardless of the exchange type (state-based exchange, state partnership exchange, or federally facilitated marketplace), it's helpful to compare and contrast operational resources. This chart contains each state's resources and forms for three distinct and fundamentally important areas of exchange operation: applications, appeals, and taxes. With links directly to the states' forms and guides related to these issue areas, this chart serves as a one-stop resource library for those interested in developing new, or revising old, versions of applications, appeals, and tax resources.

Employees of small businesses have much lower rates of insurance coverage and less generous benefits than their peers at bigger companies, owing largely to challenges unique to the small group market. The ACA introduced significant reforms aimed squarely at these problems, but implementation has moved slowly and the ultimate impact of these changes is unclear. This essay takes a look at developments in the small group market since the passage of the ACA and highlights several issues that could threaten the long-term viability of this market as implementation moves forward.

The medical home model of health care delivery has been widely embraced over the past decade. Medical home interventions encourage primary care practices to adopt this model, which aims to provide accessible, well-coordinated, patient-centered care and incorporates elements like disease management, patient registries, and electronic health records. This study evaluating the impact of medical home interventions on quality of care found that a group of physician practices participating in a medical home intervention that included a shared-savings bonus program outperformed a comparison group of practices on clinical quality. Patients in the participating practices also had comparatively fewer hospital and emergency room visits.

With support from the Gary and Mary West Health Policy Center, the APCD Council has developed a manual for states to develop all-payer claims databases. The manual is a first-of-its-kind resource that provides states with detailed guidance on common data standards, collection, aggregation and analysis involved with establishing and using these databases.

Policymakers are considering changes to the ACA in case the Supreme Court rules in King v. Burwell that federal premium subsidies are not available for individual market plans in states participating in the federally-facilitated marketplace (FFM). Various proposals would provide transitional coverage to those losing subsidies as well as make other changes to the ACA. Many of these changes also are being included in proposals to replace the ACA more broadly. This issue brief examines the general approaches that are included in one or more of the proposals.

Behavioral health parity refers to requirements for health insurers to cover mental health and substance use disorder services on terms that are equal to those offered for medical and surgical services.  This issue brief explains how behavioral health parity applies in the Medicaid program, including the major provisions of the Centers for Medicare and Medicaid Services’ April 10, 2015 proposed regulations, and identifies key policy issues at the intersection of behavioral health parity and Medicaid.