Strategic Planning & Timelines

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.

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.

With the recent release of data from the 2012 American Community Survey (ACS), SHADAC has created reports on state and county health insurance coverage estimates. Each state has an individualized report comparing 2011 coverage estimates with 2012 and examining coverage rates by age, race/ethnicity, citizenship status, education, work experience, and household income. There are several cross-state comparison reports available as well.

The Commonwealth Fund’s Scorecard identifies opportunities for states to improve their health systems for economically disadvantaged populations and provides state benchmarks of achievement. Analyzing 30 indicators of access, prevention and quality, potentially avoidable hospital use, and health outcomes, the Scorecard documents sharp health care disparities among states. Between leading and lagging states, up to a fourfold disparity in performance exists on a range of key health care indicators for low-income populations. If all states could reach the benchmarks set by leading states, an estimated 86,000 fewer people would die prematurely and tens of millions more adults and children would receive timely preventive care.

The share of children who were uninsured fell from 9.4 percent in 2011 to 8.9 percent in 2012 — a historic low — due primarily to gains in private coverage. Enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) among children remained steady, likely in part because of a health reform requirement that states maintain their eligibility rules and procedures for Medicaid and CHIP. The 8.9 percent uninsurance rate among children is more than a quarter below the 1999 level.

Young adults’ participation in the nation’s new insurance marketplaces is essential: as a healthier-than-average population, it allows for comprehensive health plans to be offered at affordable prices to all enrollees over time. There is concern that many young adults (ages 19–29) will remain without health insurance in 2014 despite the Affordable Care Act’s reforms, including subsidized private coverage offered in new state marketplaces and expanded Medicaid eligibility. How things turn out will likely depend on outreach efforts and states’ decisions on expanding Medicaid.