Strategic Planning & Timelines

While the ACA afforded states the choice to host a health insurance exchange or expand Medicaid, it required all states to make major changes to Medicaid eligibility policy, including adding mandatory coverage of new groups, implementing streamlined eligibility and renewal processes, incorporating new eligibility and verification requirements, and coordinating enrollment systems with exchanges. As a result, states had to create or significantly modify existing systems, collaborate and coordinate with other state and federal agencies, and develop new processes to support enrollment. This brief examines states’ early experiences implementing the ACA’s eligibility and enrollment requirements; highlights promising practices and lessons learned; provides some context on the state experience; and concludes with possible areas of focus for future enrollment and implementation efforts.

As of Spring 2015, states had completed the second open enrollment period for the new health insurance marketplaces established by the ACA and most of the 30 states that have adopted the Medicaid expansion to low-income adults were well into their second year of implementation. This brief provides an on-the-ground view of ACA implementation after completion of the second open enrollment period based on 40 in-person interviews conducted in five states – Colorado, Kentucky, Utah, Virginia, and Washington. The report presents key findings related to enrollment systems; enrollment and renewal; outreach, marketing, and enrollment assistance; and access to and utilization of care. It concludes with key priorities identified by stakeholders looking ahead.

This paper presents findings from a study that surveyed nearly 3,000 low-income adults in late 2014 to compare experiences in three states with markedly different policies regarding the ACA: Kentucky, which expanded Medicaid, created a successful state Marketplace, and supported outreach efforts; Arkansas, which enacted the private option and a federal-state partnership Marketplace, but with legislative limitations on outreach; and Texas, which did not expand Medicaid and passed restrictions on navigators. It found that application rates, successful enrollment, and positive experiences with the ACA were highest in Kentucky, followed by Arkansas, with Texas performing worst. The paper explores these findings and the factors that most greatly contributed to successful enrollment.

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.

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.

Dollars spent on health care are dollars not available for other uses. Understanding the rate at which costs are growing—and the growth rate the economy can bear—is important for the financial health of any state. This report looks at total cost of care measurement activities in four states and the policy priorities in each state that are driving the activity. It examines the questions these states had to ask and in determining total cost of care measurement—where data come from, what to count, how to count—and how they answered them.

The Robert Wood Johnson Foundation’s “Plan Choice Challenge” was a recent competition facilitated by Health 2.0 to spur the development of innovative technology applications that better support consumers as they shop for and purchase health insurance. This webinar featured background on the challenge from Health 2.0, an overview of the winning apps, and insights into what states should consider as they explore plan selection tools. States had a chance to ask questions of the vendors who developed the winning applications—Consumers’ CHECKBOOK (first place), Stride Health (second place) and Clear Health Analytics (third place).

New estimates from the Commonwealth Fund Biennial Health Insurance Survey, 2014, indicate that 23 percent of 19-to-64-year-old adults who were insured all year—or 31 million people—had such high out-of-pocket costs or deductibles relative to their incomes that they were underinsured. These estimates are nearly double those found in 2003 when the measure was first introduced in the survey. The share of continuously insured adults with high deductibles has tripled, rising from 3 percent in 2003 to 11 percent in 2014. Half of underinsured adults reported problems with medical bills or debt and more than two of five reported not getting needed care because of cost.