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September 2014 St@teside

Health Reform Resources

SCI keeps its Federal Reform Resources webpage up-to-date with the most recent information from the states, the federal government, and health policy organizations in an effort to guide our readers through the health reform implementation process. We know there are several places to go for the latest health reform resources, and we thank you for using SCI as one of your trusted sources. Here are some of the most recent resources that can be found on our Federal Reform page:

Insurance Market Reforms

Analysis of 2015 Premium Changes In The Affordable Care Act’s Health Insurance Marketplaces

Kaiser Family Foundation

In the first year of full implementation, enrollment in the Affordable Care Act’s (ACA) health insurance marketplaces largely fulfilled expectations, following a rocky beginning. Now, attention is turning to 2015, and one of the first tangible tests of how well the ACA is working will be the changes in premiums in the new health insurance marketplaces. This brief presents an initial analysis of premium changes for marketplace plans for individuals in 15 states plus the District of Columbia, where comprehensive data is available on rates or rate filings for all insurers.

Risk Corridors and Reinsurance in Health Insurance Marketplaces: Insurance for Insurers

National Bureau of Economic Research

In order to encourage entry and lower prices, most regulated markets for health insurance include policies that seek to reduce the uncertainty faced by insurers. In addition to risk adjustment of premiums paid to plans, the Health Insurance Marketplaces established by the ACA implement reinsurance and risk corridors. Reinsurance limits insurer costs associated with specific individuals, while risk corridors protect against aggregate losses. Both tighten the insurer’s distribution of expected costs. This paper considers the economic costs and consequences of reinsurance and risk corridors.

Insurance Exchanges

Final Rule on Annual Eligibility Redeterminations for Marketplace Participation and Insurance Affordability Programs

Department of Health and Human Services

This final rule specifies additional options for annual eligibility redeterminations, as well as renewal and re-enrollment notice requirements for qualified health plans offered through the Marketplace, beginning with annual redeterminations for coverage for benefit year 2015. This final rule provides additional flexibility for Marketplaces, including the ability to propose unique approaches that meet specific needs of their state, while streamlining the consumer experience.

Are Americans Finding Affordable Coverage in the Health Insurance Marketplaces?

The Commonwealth Fund

By the end of the first open enrollment period for coverage offered through the ACA’s marketplaces, increasing numbers of people said they found it easy to find a plan they could afford, according to The Commonwealth Fund’s Affordable Care Act Tracking Survey, April–June 2014. Adults with low or moderate incomes were more likely to say it was easy to find an affordable plan than were adults with higher incomes. Adults with low or moderate incomes who purchased a plan through the marketplaces this year have similar premium costs and deductibles as adults in the same income ranges with employer-provided coverage. A majority of adults with marketplace coverage gave high ratings to their insurance and were confident in their ability to afford the care they need when sick.


Medicaid Primary Care Rate Increase: Considerations Beyond 2014

Center for Health Care Strategies, Inc.

The Medicaid primary care rate increase, a provision of the ACA, requires Medicaid programs to reimburse primary care providers at Medicare levels for two years. The increase was intended to ensure sufficient provider participation as the Medicaid population expands. As the temporary provision enters its final months, a number of state and federal policymakers are considering extending the rate increase into 2015 and beyond. This new brief draws from interviews with policy experts and stakeholders across the country to assesses the policy's successes and failures. The brief examines the rate increase through the provider's lens, reviews its impact in meeting access and quality goals, and outlines considerations for states interested in extending and strengthening the provision to better meet its goals.

State Strategies for Integrating Physical and Behavioral Health Services in a Changing Medicaid Environment

The Commonwealth Fund

States across the country are embracing integrated care delivery models as part of their efforts to deliver high-quality, cost-effective care to Medicaid beneficiaries with both physical and behavioral health needs. The Medicaid expansion authorized by the ACA brings greater import to these efforts, as millions of previously uninsured low-income adults—many at increased risk of having behavioral health conditions—gain coverage. Drawing on a review of the literature and interviews with consumers, providers, payers, and policymakers, this report explores strategies states are deploying to promote integrated care for this medically complex and high-cost Medicaid population.

Strategic Planning

Providing Coverage for the Remaining Uninsured: Strategies from States and Localities

National Academy for State Health Policy

The number of uninsured nonelderly adults fell by an estimated 10.3 million between September 2013 and early March 2014 because of provisions in the ACA for private insurance reforms, the establishment of the Health Insurance Marketplace, and Medicaid expansion. Yet the remaining uninsured population is expected to reach 30 million by 2017. While the health care safety net is able to provide care to many of the remaining uninsured, a number of public and private initiatives at the state and local levels have sought to find additional solutions. This fact sheet describes a number of such examples.

A First Look at Children's Health Insurance Coverage under the ACA in 2014

Urban Institute

The Urban Institute’s Health Reform Monitoring Survey (HRMS) has been tracking health insurance coverage among nonelderly adults since the first quarter of 2013. The HRMS, which was designed to provide early feedback on implementation of the ACA, found that uninsured rates had declined by 4.0 percentage points among nonelderly adults between September 2013 and June 2014, with larger declines found in states that have expanded Medicaid. Beginning in June 2013, the HRMS added a supplement to track changes in coverage and other outcomes for children under the ACA. This brief examines findings from the HRMS children’s supplement. 

How are CHIPRA Quality Demonstration States Testing the Children's Electronic Health Record Format?

Agency for Healthcare Research and Quality

This new Evaluation Highlight focuses on how North Carolina and Pennsylvania are testing the success of the Children’s Electronic Health Record Format’s requirements, such as usability and interoperability. The highlight also focuseson how well these requirements support the provision of primary care to children and how readily they can be incorporated into existing EHRs.

Delivery System Redesign

Measuring and Assigning Accountability for Healthcare Spending

Center for Healthcare Quality and Payment Reform

The federal government, commercial health plans, and other organizations are increasingly using measures of healthcare spending for the purposes of rewarding or penalizing physicians, hospitals, and other healthcare providers, defining provider networks, and encouraging patients to use particular providers. This report describes six fundamental problems with the current attribution and risk adjustment systems that are being used in these measures and explains how these problems could seriously harm both patients and healthcare providers. The report also describes how these problems can be solved using improved methodologies.