Strategic Planning & Timelines

This report presents data on the population targeted for coverage expansions under the ACA, and aims to help policymakers target early efforts and evaluate the ACA’s longer-term effects. The report is based on a new series of comprehensive surveys of the low and moderate income population that provides data on these groups’ experience with health coverage, current patterns of care, and family situation. This report, based on the baseline 2013 Kaiser Survey of Low-Income Americans and the ACA, provides a snapshot of health insurance coverage, health care use and barriers to care, and financial security among insured and uninsured adults across the income spectrum at the starting line of ACA implementation.

The ACA is designed to improve access to coverage for millions of Americans. Because states are the primary implementers of these requirements, this report examines the status of state action on the three major components of health reform—the market reforms, the establishment of health insurance marketplaces, and Medicaid expansion. The analysis finds that nearly all states will require or encourage compliance with the market reforms, every state will have a marketplace, and more than half the states will expand their Medicaid programs. The analysis also shows that federal regulators have stepped in where states have been unable or unwilling to take action.

This map tracks enrollment data from state marketplaces, the federal marketplace and Medicaid/CHIP agencies for individuals and families enrolling in Qualified Health Plans (QHPs) and Medicaid/CHIP. The map also provides state-by-state estimates for those eligible for marketplace and Medicaid/CHIP coverage from Kaiser Family Foundation and Urban Institute analyses.

The ACA includes coverage options for people across the income spectrum, but there are big differences in eligibility for coverage depending on whether a state expands Medicaid or not. In states that expand Medicaid, all legal residents with incomes up to four times the poverty level are eligible for financial assistance if other coverage is not available. In states that do not expand, some uninsured people (particularly children) are already eligible for Medicaid or CHIP, though many adults below poverty will fall into a “coverage gap” with no assistance. This interactive map allows you to see how many currently uninsured people in each state are estimated to be eligible for Medicaid or tax credits, or in the coverage gap. State profile fact sheets are also available for more details on how the ACA could expand coverage in each state.

Low enrollment levels in the health insurance marketplaces in the first year may also mean disproportionate enrollment of high cost individuals. This could lead to higher premiums and destabilization of the non-group market, but this is unlikely. First, policies put in place in the law, specifically risk corridors and risk adjustment, will provide insurers with some significant financial protection. Second, low enrollment does not necessarily mean adverse selection – there are strong incentives for young adults to enroll. Third, insurers cannot necessarily recoup any 2014 losses by raising 2015 premiums. Insurers will need to set premiums for 2015 based on the expected enrollment in 2015, not based on any losses that may occur in 2014.

The ACA was passed against a backdrop of decades of rapid growth in health care spending in the United States. While much of this historical increase reflects the development of new treatments that have greatly improved health and well-being, there is widespread agreement that the system suffered from serious inefficiencies that increased costs and reduced the quality of care that patients receive. A key goal of the ACA was to begin wringing these inefficiencies out of the health care system, simultaneously reducing the growth of health care spending – and its burden on families, employers, and state and federal budgets – while increasing the quality of the care delivered. This report analyzes recent trends in health care costs, the forces driving those trends, and their likely economic benefits.
 

This report examines how many of the uninsured in each state would be eligible for health coverage assistance programs - i.e. Medicaid, the Children's Health Insurance Program and subsidized private coverage through the new health insurance marketplaces - under the Affordable Care Act. The report also estimates the anticipated decrease in the uninsured population under the ACA in each state. Finally, the report examines the share of those remaining uninsured under the ACA in each state who would be eligible for, but not enrolled in, assistance programs.

The Affordable Care Act became law more than three years ago, but polls find that the majority of Americans still do not understand the law and how it will affect them. The Marketplaces, run by either states or the federal government, allow people to shop for insurance, find out whether they qualify for federal subsidies, and enroll in a health plan. Educating people about the new Marketplaces, which are now open to consumers, and helping them understand their insurance options will require a massive outreach effort carried out in part by navigators and in-person assisters. The troublesome launch of the Marketplaces, in which most people could not shop online, highlights the importance of consumer assistance in getting people enrolled.

Key provisions of the 2010 Affordable Care Act create new Marketplaces for people who purchase insurance directly and provide new premium tax credits to help people with low or moderate incomes afford that coverage. We estimate that about 17 million people who are now uninsured or who buy insurance on their own (“nongroup purchasers”) will be eligible for premium tax credits in 2014. This issue brief provides national and state estimates for tax credit eligibility for people in these groups.
 

This brief estimates the number of uninsured community health center (CHC) patients who would gain coverage under the Affordable Care Act using data from the 2009 HRSA Survey of CHC patients and 2011 Uniform Data System. The authors find that were all states to implement the Affordable Care Act Medicaid expansion, an estimated 5 million uninsured health center patients would be eligible for coverage. However, over one million uninsured patients – 72 percent of whom live in southern states – who would have been eligible for coverage will remain uninsured because of states’ decisions to opt out of the expansion.