Strategic Planning & Timelines

The Agency for Healthcare Research and Quality (AHRQ) has released its annual report on progress and opportunities for improving health care quality and reducing health care disparities. This report focuses on national trends in the quality of health care provided to the American people and the prevailing disparities in health care delivery as it relates to racial factors and socioeconomic factors. It is important to note that the report provides a snapshot of health care prior to implementation of most of the health insurance expansions and consumer protections included in the ACA and serves as a baseline against which to track progress in upcoming years. This year’s report also provides expanded analyses of people with disabilities, including children with special health care needs and adults with multiple chronic conditions.
 

The ACA has the potential to dramatically improve rates of health insurance coverage for low-income Americans, including many vulnerable populations. This fact sheet highlights particularly vulnerable populations that could benefit from insurance coverage, but may have trouble getting access, including: (1) racial and ethnic minority populations; (2) homeless individuals; (3) the jail-involved population; and (4) veterans.  The fact sheet outlines opportunities to connect these individuals to coverage with an eye toward the next open enrollment period.
 

The Commonwealth Fund’s Scorecard on State Health System Performance, 2014, assesses states on 42 indicators of health care access, quality, costs, and outcomes over the 2007–2012 period. Changes in health system performance were mixed overall, with states making progress on some indicators while losing ground on others. In a few areas that were the focus of national and state attention—childhood immunizations, hospital readmissions, safe prescribing, and cancer deaths—there were widespread gains. But more often than not, states exhibited little or no improvement. Persistent disparities in performance across and within states and evidence of poor care coordination highlight the importance of insurance expansions, health care delivery reforms, and payment changes in promoting a more equitable, high-quality health system.
 

A recent report by the CBO concluded that the ACA could reduce the number of people working, almost entirely because workers would choose to work less due to incentives in the law.  This report places the ACA and its employment effects in the context of other social programs.  It assesses the evidence on likely employment effects from four recent and directly relevant studies.  The best evidence to date suggests the employment effects of the ACA are likely to be small, and that the CBO estimate may be toward the high end of the range of potential ACA effects on employment.
 

By the end of March, enrollment in Marketplace plans created by the ACA was reported at just over 7 million and the Centers for Medicare and Medicaid Services (CMS) reported that Medicaid enrollment increased between the beginning of October 2013 and the end of February 2014. However, neither the Marketplace enrollment figures nor the CMS Medicaid report provide an accurate picture of how many uninsured people have gained coverage since open enrollment began, because both sets of enrollment figures may include newly insured people as well as those who had other sources of coverage before 2014. This report uses the March 2014 Health Reform Monitoring Survey to examine changes in health insurance coverage in early March 2014 relative to coverage over the prior year, including more disaggregated information on coverage changes and additional details on the statistical precision of the estimates.

State budget officers provide a unique perspective on how the crucial delivery of a key service such as health care fits into the framework of state budgets. This report looks at five core areas pertinent to state budgets as a means to analyze the implementation of the Affordable Care Act and other health reforms. The five core areas are: explaining health care cost trends; bracing for budget volatility; monitoring health insurance marketplaces; evaluating Medicaid managed care expansions; and assessing the impacts of care delivery and payment reforms. This report provides the framework on how to analyze the changes in health care and will launch continued discussions on these crucial issues that have significant budget implications.
 

Before the implementation of the major ACA insurance reforms, data from U.S. census surveys indicated nearly 32 million insured people under age 65 were in households spending a high share of their income on medical care. Adding these “underinsured” people to the estimated 47.3 million uninsured, the state share of the population at risk for not being able to afford care ranged from 14 percent in Massachusetts to 36 percent to 38 percent in Idaho, Florida, Nevada, New Mexico, and Texas. The report provides state baselines to assess changes in coverage and affordability and compare states as insurance expansions and market reforms are implemented.
 

This is the first in a series of regional reports examining ACA implementation, focusing on the start of the initial six-month ACA open enrollment period beginning October 1, 2013. The first report examines the Western region where the state governments have generally embraced the ACA, and includes reports on Arizona, California, Colorado, Idaho, Oregon, New Mexico, Nevada and Washington. An overview report that describes the policy setting and goal alignment of these western states is also available.
 

This paper provides a review of a series of papers that examine early implementation of the Affordable Care Act in eight states, and the very different design choices that they have made in implementing the law. The paper examines coverage expansion; financial impacts; the development of information technology systems; outreach, education and enrollment assistance; insurer participation, competition and premiums in marketplaces; insurance market reforms; development of SHOP marketplaces; and issues of provider capacity. The law will work very differently for residents in different states around the country and there will be different outcomes both in terms of coverage and economic impacts.

This analysis estimates the geographic concentration of the uninsured across U.S. counties. The estimates are from the 2011 Small Area Health Insurance Estimates (SAHIE) program at the U.S. Census Bureau. The SAHIE program models health insurance coverage by combining survey estimates with administrative records, population estimates, and the decennial census. This method produces annual estimates for all counties and includes a limited set of demographic features.  The advantage of using the SAHIE is that it is the only source for annual estimates uninsured for all counties.