Strategic Planning & Timelines

Safety-net hospitals have long played an important role in the U.S. health care system in serving vulnerable populations, providing high cost services, and training medical and nursing students.  However, under the ACA, safety-net hospitals now face challenges competing for newly insured patients and continuing to serve the remaining uninsured (including adults in states not expanding Medicaid and undocumented immigrants who remain ineligible for Medicaid or new ACA coverage). They also face reductions in financing for uncompensated care. This brief examines four safety-net hospitals to learn how they were preparing for the full implementation of health reform, in order to gain additional insight into the strategies being used and challenges being faced among safety-net hospitals across the country.
 

The Affordable Care Act (ACA) ensures that most insurance plans (so-called ‘non-grandfathered’ plans) provide coverage for certain preventive health services without cost sharing for plan or policy years beginning on or after September 23, 2010. This includes screening for colon cancer for adults over 50, Pap smears and mammograms for women, well-child visits, flu shots for all children and adults, and many more services. This report examines the impact of ACA’s expanded preventive services coverage to date.

A new Commonwealth Fund survey finds that in the wake of the ACA’s first open enrollment period, significantly fewer working-age adults are uninsured than just before the sign-up period began, and many have used their new coverage to obtain needed care. The uninsured rate for people ages 19 to 64 declined from 20 percent in the July-to-September 2013 period to 15 percent in the April-to-June 2014 period. An estimated 9.5 million fewer adults were uninsured. By June, 60 percent of adults with new coverage through the marketplaces or Medicaid reported they had visited a doctor or hospital or filled a prescription; of these, 62 percent said they could not have accessed or afforded this care previously.

This survey is the first in a series of Kaiser Family Foundation surveys taking a closer look at the entire non-group market. This first survey was conducted from early April to early May 2014, after the close of the first ACA open enrollment period. It reports the views and experience of all non-group enrollees, including those with coverage obtained both inside and outside the Exchanges, and those who were uninsured prior to the ACA as well as those who had a previous source of coverage (non-group or otherwise). The survey found that nearly six in ten Exchange enrollees were previously uninsured, and the majority of non-group enrollees give positive ratings to their new insurance plans and the value of those plans.
 

Churning in health insurance enrollment has long been a problem for many people, as changes in their life circumstances create a cycle of losing and regaining eligibility for coverage. For millions of Americans, the ACA means an end to the worst form of churning—the loss of insurance coverage entirely. However, the law also introduces a new risk: individuals and families with changes in income may move back and forth between Medicaid and subsidized marketplace coverage. This issue brief examines a variety of strategies that states can employ to ease coverage transitions and help keep people insured at all times.
 

This report estimated the effect of the Affordable Care Act (ACA) on 14 large and diverse cities: Los Angeles, Chicago, Houston, Philadelphia, Phoenix, Indianapolis, Columbus, Charlotte, Detroit, Memphis, Seattle, Denver, Atlanta, and Miami. For each city, the researchers estimated changes in health coverage under the ACA, particularly the resulting decline in the uninsured. The report also includes an estimate of the additional federal spending on health care that would flow into these cities. For cities in states that have not expanded Medicaid eligibility, the report provides estimates both with and without expansion.
 

With the enactment of the ACA, millions of previously uninsured individuals will gain insurance coverage through either Medicaid or private plans purchased through the health care marketplaces.  As people gain coverage, providers’ costs associated with caring for uninsured individuals that previously went uncompensated will decline, as more people have a direct source of payment (insurance) for their care.  This report examines uncompensated care in 2013, just before implementation of health reform’s major coverage provisions. These estimates provide an important baseline against which to measure major changes that are occurring under the ACA.
 

Using the 2014 health insurance exchange enrollment data and a micro-simulation model funded in part by the U.S. Department of Health and Human Services, this working paper estimates the national and state impact of the ACA on insurance prices and enrollment from 2015-2024. Estimating the trajectory of health plan prices and enrollment is critical to informing ongoing health care policy debate. Decisions regarding the delayed implementation of the qualified health plan requirements, the delayed enforcement of the employer mandate, and the scheduled termination of the temporary reinsurance and risk corridor programs are estimated to have dramatic impact on insurance prices and enrollment by 2017.
 

Safety net hospitals rely on disproportionate-share hospital (DSH) payments to help cover uncompensated care costs and underpayments by Medicaid. The ACA anticipates that insurance expansion will increase safety net hospitals’ revenues and will reduce DSH payments accordingly. This study examines the impact of the ACA’s Medicaid DSH reductions on California public hospitals’ financial stability by estimating how total DSH costs (uncompensated care costs and Medicaid shortfalls) will change as a result of insurance expansion and the offsetting DSH reductions. The researchers found that decreases in uncompensated care costs resulting from the ACA insurance expansion may not match the DSH reductions because of the high number of people who will remain uninsured, low Medicaid reimbursement rates, and medical cost inflation.
 

This is the ninth issue brief in a series released by Hilltop's Hospital Community Benefit Program. This brief continues the program's examination of state-level community benefit oversight by examining the current hospital-reported programs and initiatives that target specific social and economic factors in ten states. It also identifies standard regulatory tools and characteristics of implementation strategies used by those states that could facilitate hospital investment in activities that address social and economic determinants.