Strategic Planning & Timelines

In January 2014, the major coverage provisions of the Affordable Care Act (ACA)—including the expansion of Medicaid eligibility and the availability of subsidized coverage through Health Insurance Marketplaces— went into effect. As the first year of new coverage under the ACA comes to a close and the end of the second open enrollment period nears, there is great interest in understanding why some people continue to lack coverage and in reaching out to the eligible uninsured. This report, based on the 2014 Kaiser Survey of Low-Income Americans and the ACA, profiles the nonelderly adult population that remained uninsured as of Fall 2014.

The Affordable Care Act provides financial assistance via cost sharing reductions (CSR) and premium tax credits to help modest income individuals purchase health insurance and reduce the direct costs of their care. This brief estimates the characteristics of the CSR eligible population using the Urban Institute’s Health Insurance Policy Simulation Model. Researchers found that the CSR eligible individuals are most likely to live in the South, to be single adults without children, and to be White, non-Hispanic. Researchers also estimate the average value of a CSR to be $479 in 2016, with the value varying by the eligible person’s income.

The second open enrollment period, during which eligible individuals may enroll in a Qualified Health Plan for 2015 in a marketplace, runs from November 15, 2014 to February 15, 2015. Some studies show that many do not understand the very terms and concepts necessary to make informed choices. For many people, it is the first time that they will have coverage. In addition, insurance is becoming more “consumer driven,” and often includes higher deductibles, which shifts financial risk to the patient. That increases the stakes and requires an even more sophisticated understanding of health insurance. This toolkit addresses the extent and significance of both health literacy and health insurance literacy for Americans buying and using health insurance.

New results from the Commonwealth Fund Biennial Health Insurance Survey, 2014, indicate that the ACA’s subsidized insurance options and consumer protections reduced the number of uninsured working-age adults from an estimated 37 million people, or 20 percent of the population, in 2010 to 29 million, or 16 percent, by the second half of 2014. Conducted from July to December 2014, for the first time since it began in 2001, the survey also finds declines in the number of people who report cost-related access problems and medical-related financial difficulties.

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, the Office of the Assistant Secretary for Planning and Evaluation (ASPE) commissioned 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, prepared by SHADAC, 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.

The gaps in our health insurance system affect people of all ages, races and ethnicities, and income levels; however, those with the lowest incomes face the greatest risk of being uninsured. Being uninsured affects people’s access to needed medical care and their financial security. This primer first presents basic information about health coverage and the uninsured population leading up to and after the implementation of the Affordable Care Act, who the uninsured are and why they do not have health coverage. It then presents information on the impact lack of insurance can have on health outcomes and personal finances, and provides an understanding of the difference health insurance makes in people’s lives.

Critics frequently characterize the ACA as a threat to the survival of employer-sponsored insurance. The Medicaid expansion and Marketplace subsidies could adversely affect employers’ incentives to offer health insurance and workers’ incentives to take up such offers. This article takes advantage of timely data from the Health Reform Monitoring Survey for June 2013 through September 2014 to examine, from the perspective of workers, early changes in offer, take-up, and coverage rates for employer-sponsored insurance under the ACA. The researchers found no evidence that any of these rates have declined under the ACA.

Whether they have health insurance through an employer or buy it on their own, Americans are paying more out-of-pocket for health care now than they did in the past decade. A Commonwealth Fund survey fielded in the fall of 2014 asked consumers about these costs. More than one in five 19-to-64-year old adults who were insured all year spent 5 percent or more of their income on out-of-pocket costs, not including premiums, and 13 percent spent 10 percent or more. Adults with low incomes had the highest rates of steep out-of-pocket costs. Two of five adults with private insurance who had high deductibles relative to their income said they had delayed needed care because of the deductible.
 

The ACA contains several provisions that may alter the scope and practice of public health. As a result, governmental health departments must evolve in order to accommodate the new health landscape and changing demands on the system. In the wake of these health systems changes, public health faces new opportunities and challenges. This recently-released Research Insights brief examines the role of public health following ACA implementation by looking at three innovative approaches to governmental public health – in Massachusetts, San Diego, and Vermont.

The ACA’s employer mandate requires large firms to pay penalties unless they offer affordable health insurance coverage to full-time employees, raising concerns that employers might lay off workers or reduce hours. This brief estimates the number of workers potentially at risk of losing their jobs or having hours reduced. Fewer than 10 percent, less than 0.03 percent of the U.S. labor force, might see reductions in employment or hours in the short run. Over time, employment patterns might change, leading to fewer firm sizes and work schedules near the thresholds, potentially affecting up to 0.5 percent of the workforce.