Strategic Planning & Timelines

The ACA presented new challenges for states to develop models for health system and payment reform, implement health insurance marketplaces, and expand Medicaid. This created a need for states to fully understand and utilize data sources in order to effectively implement, monitor, and evaluate health care reform. To assist states in this effort, SHADAC, with support from the Office of the Assistant Secretary for Planning and Evaluation, developed a series of white papers that are focused on innovative uses of data resources and analytic approaches that states can apply to monitor and evaluate health care reform efforts. The series provides an overview of data sources available to state policymakers, such as state-level administrative data, health insurer filings, marketplace enrollment data, and survey data. The series also highlights key analytic questions that states could use the data sources to address.
 

Spending on specialty medications is growing by more than 15 percent annually, and it is expected to account for approximately half ($235 billion) of total annual pharmacy spending by 2018. Among the numerous reasons for the high cost of this heterogeneous group of medications are the increasing size of target patient populations, the high cost of drug development, and a complex and uncoordinated delivery system. This article describes the evolution of the specialty market, characterize the current state of specialty medication use, and articulate key challenges and potential solutions.
 

Under the 2010 Affordable Care Act, millions of Americans gained health coverage in 2014. Coverage is key to accessing affordable, high-quality care, but consumers who struggle to understand how health insurance works and how to estimate out-of-pocket costs are at risk of going without needed care even if they are covered. This brief outlines what health insurance aspects pose the greatest problems for consumers, which groups need more assistance to enroll and use benefits, and what topics and skills consumer-counseling efforts should focus on.
 

This new Evaluation Highlight focuses on how North Carolina and Pennsylvania are testing the success of the Children’s Electronic Health Record Format’s requirements, such as usability and interoperability. The highlight also focuses onhow well these requirements support the provision of primary care to children and how readily they can be incorporated into existing EHRs.
 

The Urban Institute’s Health Reform Monitoring Survey (HRMS) has been tracking health insurance coverage among nonelderly adults since the first quarter of 2013.1 The HRMS, which was designed to provide early feedback on implementation of the ACA, found that uninsured rates had declined by 4.0 percentage points among nonelderly adults between September 2013 and June 2014, with larger declines found in states that have expanded Medicaid. Beginning in June 2013, the HRMS added a supplement to track changes in coverage and other outcomes for children under the ACA. This brief examines findings from the HRMS children’s supplement.

The number of uninsured nonelderly adults fell by an estimated 10.3 million between September 2013 and early March 2014 because of provisions in the Affordable Care Act for private insurance reforms, the establishment of the Health Insurance Marketplace, and Medicaid expansion. Yet the remaining uninsured population is expected to reach 30 million by 2017. While the health care safety net is able to provide care to many of the remaining uninsured, a number of public and private initiatives at the state and local levels have sought to find additional solutions. This fact sheet describes a number of such examples.
 

The combined effects of the Affordable Care Act’s coverage expansions, faster economic growth, and population aging are expected to fuel health spending growth in 2014 and thereafter (5.6 percent in 2014 and 6.0 percent per year for 2015–23). However, the average rate of increase through 2023 is projected to be slower than the 7.2 percent average growth experienced during 1990–2008. Because health spending is projected to grow 1.1 percentage points faster than the average economic growth during 2013–23, the health share of the gross domestic product is expected to rise from 17.2 percent in 2012 to 19.3 percent in 2023.
 

States have taken different approaches to implementing the Affordable Care Act (ACA) and have had varied enrollment experiences to date. This brief highlights the experiences of four states—Colorado, Connecticut, Kentucky, and Washington—that established a State-based Marketplace (SBM), implemented the ACA’s Medicaid expansion, and achieved success enrolling eligible individuals into coverage. Based on interviews with key stakeholders in each state, it identifies effective strategies that contributed to enrollment and current priorities looking forward.
 

Three months after the first Marketplace open enrollment period closed, 13.9 percent of adults still remain uninsured as of June 2014. This brief assesses the demographic and socioeconomic characteristics of the remaining uninsured, their access to employer-sponsored insurance (ESI), their awareness of key ACA provisions, and the reasons they say they remain uninsured. This early look at the characteristics of the remaining uninsured provides valuable information for ongoing Medicaid outreach and enrollment efforts, as well as preparations for the next open enrollment period in the Marketplaces.
 

Navigators and others helping people apply for health coverage need to understand basic tax filing rules because eligibility for Medicaid, the Children’s Health Insurance Program (CHIP), and premium tax credits for coverage bought through Marketplaces is based on Internal Revenue Code definitions of income and household. The guide provides basic information on relevant tax rules, including when someone is required to file taxes, what filing status options are available, the rules for claiming someone as a tax dependent, and what sources of income are taxable and therefore counted in determining eligibility for Medicaid, CHIP, and premium tax credits.  It also shows how Medicaid uses an individual’s tax filing status to determine who is in his or her household, and how Medicaid’s household rules differ from those used for premium tax credits.