Strategic Planning & Timelines

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.

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.

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 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.

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.