Strategic Planning & Timelines

Before the implementation of the major ACA insurance reforms, data from U.S. census surveys indicated nearly 32 million insured people under age 65 were in households spending a high share of their income on medical care. Adding these “underinsured” people to the estimated 47.3 million uninsured, the state share of the population at risk for not being able to afford care ranged from 14 percent in Massachusetts to 36 percent to 38 percent in Idaho, Florida, Nevada, New Mexico, and Texas. The report provides state baselines to assess changes in coverage and affordability and compare states as insurance expansions and market reforms are implemented.
 

This paper provides a review of a series of papers that examine early implementation of the Affordable Care Act in eight states, and the very different design choices that they have made in implementing the law. The paper examines coverage expansion; financial impacts; the development of information technology systems; outreach, education and enrollment assistance; insurer participation, competition and premiums in marketplaces; insurance market reforms; development of SHOP marketplaces; and issues of provider capacity. The law will work very differently for residents in different states around the country and there will be different outcomes both in terms of coverage and economic impacts.

This analysis estimates the geographic concentration of the uninsured across U.S. counties. The estimates are from the 2011 Small Area Health Insurance Estimates (SAHIE) program at the U.S. Census Bureau. The SAHIE program models health insurance coverage by combining survey estimates with administrative records, population estimates, and the decennial census. This method produces annual estimates for all counties and includes a limited set of demographic features.  The advantage of using the SAHIE is that it is the only source for annual estimates uninsured for all counties.

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 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.