Strategic Planning & Timelines

Since the ACA’s health insurance marketplaces opened and states began to expand Medicaid eligibility, uninsured rates among Latinos have begun to decline for the first time in decades. Studies of the effects of health insurance suggest that these higher coverage rates will contribute to better access to care, increased use of preventive services, better management of chronic illness and, eventually, longer and healthier lives for many Latinos. Despite these historic declines in the number of uninsured, the Commonwealth Fund Biennial Health Insurance Survey finds Latinos continue to have the highest uninsured rates among major U.S. racial or ethnic groups.

Since the Great Recession peaked in 2010, the economic picture has steadily improved, and in 2013, GDP increased relative to 2012 and the unemployment rate fell but remained fairly high at 7.4 percent. In addition, the uninsured rate decreased slightly (0.1 percentage point) in 2013, continuing the trend from 2011 and 2012. Despite these improvements, rates of coverage through employer sponsored insurance have declined since 2010, though more slowly in recent years than at the height of the recession. Gains in coverage since 2010 have been largely due to increases in coverage through public programs such as Medicaid and the Children’s Health Insurance Program (CHIP). This brief further examines coverage patterns for the nonelderly population from 2008 through 2013 using data from the American Community Survey.

Since the ACA’s first open enrollment period began in late 2013, there has been rapid enrollment growth in Medicaid and in private health insurance plans purchased through the new Marketplaces. However, administrative data on Medicaid enrollment and enrollment in Marketplace health plans do not show how health insurance coverage is changing under the ACA, because not all of those enrolling were previously uninsured. Household survey data are needed to track changes over time in the share of the population that is uninsured. This report uses the Urban Institute’s Health Reform Monitoring Survey (HRMS) to examine trends in health insurance coverage since the first quarter of 2013. According to HRMS data, the uninsurance rate among nonelderly adults has declined 7.5 percentage points between September 2013 and March 2015, representing 15 million fewer adults without health insurance.

The ACA required states to make large-scale changes to their eligibility systems for Medicaid in order to create streamlined processing with the health plan coverage and subsidies that are available through health insurance marketplaces. To support these changes, the U.S. Department of Health and Human Services made enhanced federal Medicaid matching funds available for states to update or build their systems, and states have also been given the opportunity of a cost allocation waiver that allows them to temporarily use this enhanced funding to support technology and services improvements to eligibility systems shared by Medicaid and other health and human services programs. This issue brief highlights examples of technology and services innovations that states are implementing in support of integration among health and human services programs and discusses common themes across efforts.

Across the country’s four largest states, uninsured rates vary for adults ages 19 to 64: 12 percent of New Yorkers, 17 percent of Californians, 21 percent of Floridians, and 30 percent of Texans lacked health coverage in 2014. Differences also extend to the proportion of residents reporting problems getting needed care because of cost, which was significantly lower in New York and California compared with Florida and Texas. These differences stem from a variety of factors, including whether states have expanded eligibility for Medicaid, the state’s uninsured rate prior to the Affordable Care Act taking effect, differences in the cost protections provided by private health insurance, and demographics.

Hospital community benefit policy is evolving differently by state. Since passage of the ACA in 2010 and subsequent rulemaking, state community benefit policy has increasingly moved beyond a focus on financial assistance policies to pursuing strategies that address the social determinants of health and promote community health. In this issue brief, Hilltop’s Hospital Community Benefit Program examines state-level community benefit oversight by studying specific changes to community benefit statutes, regulations, and policies in 5 select states – Colorado, Illinois, Minnesota, New Hampshire, and New York. The Hilltop Institute also has released an update of its interactive map detailing each state’s community benefit laws.

The enactment of the Affordable Care Act (ACA) ushered in sweeping changes to the U.S. health care system. While the law touched almost every aspect of our health care system, the parts of the law that have garnered the most attention, and generated the most controversy, are those relating to the availability and affordability of health insurance coverage. The coverage provisions in the law were aimed at improving access to insurance, enhancing the quality of coverage by imposing minimum benefit standards, and increasing the affordability of coverage through expanded public programs and new subsidies for private coverage. This brief examines these coverage provisions, providing an update on how they have been implemented and assessing their impact. It also discusses key issues looking ahead.

In January 2014, the ACA extended access to health insurance coverage to an estimated 30 million previously uninsured people. This issue brief provides state-level estimates of the increased demand for physician and hospital services that is expected to result from expanded access and assesses the sufficiency of the existing supply of providers to accommodate the anticipated increase in demand. Increases of the magnitude likely to be generated by the Affordable Care Act will have modest effects on the demand for health services, and the existing supply of providers should be sufficient to accommodate this increased demand.