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September 2015 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 Reform

Big Data: A New Paradigm for Health Plan Oversight and Consumer Protection?
Georgetown University Health Policy Institute
Large data sets that can be analyzed to determine patterns of behavior – popularly called “big data” – are being used in ever-expanding ways. State insurance regulators have adopted the use of big data to conduct oversight of certain kinds of insurance, such as workers’ compensation and life insurance. However, those agencies providing oversight of health insurers have undertaken only modest efforts to collect, analyze, and use large sets of claims, enrollment or sales data to understand market trends and how consumers are using their health insurance to access and pay for care. This issue brief discusses how insurance regulators and third parties are currently using data collection, and how it could change under yet-to-be-implemented provisions within the Affordable Care Act as means for improving health plan oversight and compliance.

Insurance Exchanges

The Experiences of State-Run Marketplaces That Use
The Commonwealth Fund
Interest in new implementation approaches to health insurance marketplaces has increased as states seek to ensure the long-term financial stability of their exchanges and exercise local control over marketplace oversight. This brief explores the experiences of four states—Idaho, Nevada, New Mexico, and Oregon—that established their own exchanges but have operated them with support from the federal eligibility and enrollment platform. Drawing on discussions with policymakers, insurers, and brokers, this brief examines how these supported state-run marketplaces perform their key functions.

Are Marketplace Plans Affordable? Consumer Perspectives from the Commonwealth Fund Affordable Care Act Tracking Survey, March–May 2015
The Commonwealth Fund
Most employers who provide health insurance to employees subsidize their premiums and provide a comprehensive benefit package. Before the ACA, people who lacked health insurance through a job and purchased it on their own paid the full cost of their plans, which often came with more limited benefits and higher deductibles. Findings from The Commonwealth Fund Affordable Care Act Tracking Survey, March–May 2015, indicate that the law’s tax credits have made premium costs in health plans sold through the marketplaces roughly comparable to employer plans, at least for people with low and moderate incomes.


New Analysis Shows States with Medicaid Expansion Experienced Declines in Uninsured Hospital Discharges
Kaiser Family Foundation
Similar to other reports recently released, new data examining hospital discharges in 16 states show increases in Medicaid discharges and declines in uninsured or self-pay discharges in states that implemented the Medicaid expansion. These trends hold true for all hospital discharges as well as for specific services such as mental health or asthma. This information adds to a growing body of evidence demonstrating how coverage expansions are affecting providers and may lead to decreases in uncompensated care for the uninsured.

State Approaches for Integrating Behavioral Health into Medicaid Accountable Care Organizations
Center for Health Care Strategies
States are developing accountable care organizations (ACOs) for their Medicaid populations to target health care costs and improve health care quality by better coordinating care for high-need, high-cost patients and reducing inappropriate inpatient and emergency department visits. Many high-need, high-cost Medicaid patients have mental health and substance use issues and are often not well-served in the current fragmented health care system. In response, states are increasingly looking to integrate behavioral health into their Medicaid ACO programs to help move the needle on cost and quality. This technical assistance tool examines four broad strategies states can use to integrate behavioral health services into ACOs.

Policy Options for Using SNAP to Determine Medicaid Eligibility and an Update on Targeted Enrollment Strategies
Centers for Medicare and Medicaid Services
This letter to state health officials and Medicaid directors clarifies and expands upon the opportunities for facilitating Medicaid and the Children’s Health Insurance Program (CHIP) enrollment. In particular, it is offering states a new opportunity under Medicaid state plan authority to use Supplemental Nutrition Assistance Program (SNAP) gross income to support Medicaid income eligibility determinations at both initial application and renewals for certain populations.

Strategic Planning

2015 Employer Health Benefits Survey
Kaiser Family Foundation
This annual survey of employers provides a detailed look at trends in employer-sponsored health coverage including premiums, employee contributions, cost-sharing provisions, and employer opinions. The 2015 survey included almost 2,000 interviews with non-federal public and private firms. The 2015 survey also includes information on the use of incentives for employer wellness programs, plan cost-sharing as well as firm offer rates.

2014 American Community Survey Tables: State & County Estimates
State Health Access Data Assistance Center
These tables contain state and county health insurance coverage estimates for 2014. These estimates come from the 2014 American Community Survey (ACS) via the U.S. Census Bureau’s American FactFinder (AFF) tool and were released on September 17, 2015. A map is also available with data on state and county uninsurance rates by characteristics (for example, age, race/ethnicity, and poverty level) for 2014 and comparison year 2013.