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October 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

Changes in Claims, Premiums, and Medical Loss Ratios Across and Within States' Individual Markets Between 2010 and 2014
Urban Institute
This brief uses data submitted by insurers on medical loss ratios (MLRs) from 2010 to 2014 to assess how the Affordable Care Act’s (ACA’s) provisions impacted states’ individual health insurance markets. It compares average net MLRs by state and examines the distribution of net MLRs across insurers in each state. In the individual market, researchers found: average net MLRs rose because of rising net claims relative to net premiums, almost all states had average net MLRs higher than 80 percent by 2014, and average net MLRs varied from 83 percent at the 25th percentile to 99 percent at the 75th percentile.

Insurance Exchanges

Health Insurance Marketplace: Uninsured Populations Eligible to Enroll for 2016
U.S. Department of Health and Human Services
A central aim of the Affordable Care Act is to increase the number of Americans with health insurance coverage. Over the past two years, significant progress has been made towards this goal as measured by the decline in the proportion of Americans who lack health insurance coverage, with an estimated 17.6 million uninsured people having gained health insurance coverage since several of the ACA coverage provisions took effect. This brief examines the composition of people that remained uninsured though the first quarter of 2015 and may be eligible to purchase insurance coverage from a Qualified Health Plan through the Marketplaces. It also presents data on the attitudes and experiences of the uninsured, drawn from a number of private surveys.


Medicaid Reforms to Expand Coverage, Control Costs and Improve Care: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2015 and 2016
Kaiser Family Foundation
This report provides an in-depth examination of the changes taking place in Medicaid programs across the country. The findings in this report are drawn from the 15th annual budget survey of Medicaid officials in all 50 states and the District of Columbia. This report highlights policy changes implemented in state Medicaid programs in FY 2015 and those planned for implementation in FY 2016 based on information provided by the nation’s state Medicaid directors. Policy changes and initiatives described in this report include those in eligibility and enrollment, managed care, delivery and payment system reforms, provider payment rates, and covered benefits. The report also looks at the key issues and challenges now facing Medicaid programs.

Medicaid Adult Dental Benefits: An Overview
Center for Health Care Strategies
Access to oral health care for low-income adults is a persistent challenge in the U.S. Poor oral health can elevate risks for chronic conditions such as diabetes and heart disease, and can lead to lost workdays, reduced employability, and the preventable use of costly acute care. As many states expand Medicaid coverage for adults through the ACA, there are new opportunities to expand much-needed dental coverage and avoid the dangerous and costly consequences of untreated dental disease. This fact sheet identifies key challenges related to oral health care access and utilization for low-income adults, and outlines states’ current coverage of dental benefits for adults in Medicaid. It also suggests opportunities for states to increase oral health care coverage and access for this population.

Strategic Planning

Six Economic Facts about Health Care and Health Insurance Markets after the Affordable Care Act
The Brookings Institution
Through reforms to cost containment and expanded access to health insurance plans, the ACA has begun to shape the delivery and cost of healthcare services to Americans. Many of these reforms are still taking hold, and it is too soon to completely know how they are affecting the healthcare system. But looking beyond these considerations, it appears that many enduring economic challenges persist in the markets that provide health care and health insurance to consumers. This paper offers six economic facts that highlight continuing challenges and complexities in health care and health insurance markets on which the policy debate should focus.

To Enroll or Not to Enroll? Why Many Americans Have Gained Insurance Under the Affordable Care Act While Others Have Not
The Commonwealth Fund
According to the most recent Commonwealth Fund ACA Tracking Survey, March–May 2015, an estimated 25 million adults remain uninsured. To achieve the ACA’s goal of near-universal coverage, policymakers must understand why some people are enrolling in the law’s marketplace plans or in Medicaid coverage and why others are not. This analysis of the survey finds that affordability—whether real or perceived—is playing a significant role in adults’ choice of marketplace plans and the decision whether to enroll at all. People who have gained coverage report significantly more positive experiences shopping for health plans than do those who did not enroll. Getting personal assistance appears to make a critical difference in whether people gain health insurance.

Health Insurance for People Involved in the Justice System: Outreach and Enrollment Strategies
Families USA
This brief describes the outreach and enrollment strategies that enrollment assisters can use to help people involved in the criminal justice system get health coverage. By focusing on this population, assisters will not only help these individuals enroll in health coverage and receive needed care, they will reach and enroll more uninsured consumers. Enrollment assisters in many states are working to help the justice-involved population enroll in health coverage. This brief provides an overview of why it is important to focus on this population and offers assisters tangible steps to begin this work.

New Estimates of Eligibility for ACA Coverage among the Uninsured
Kaiser Family Foundation
The ACA extends health insurance coverage to people who lack access to an affordable coverage option. Under the ACA, Medicaid coverage is extended to low-income adults in states that have opted to expand eligibility, and tax credits are available for middle-income people who purchase coverage through a health insurance marketplace. Millions of people have enrolled in these new coverage options, but millions of others are still uninsured. Some remain ineligible for coverage, and others may be unaware of the availability of new coverage options or still find coverage unaffordable even with financial assistance. This analysis provides national and state-by-state estimates of eligibility for ACA coverage options among those who remained uninsured.

Delivery System Redesign

Performance Measurement for Rural Low-Volume Providers
National Quality Forum
Challenges such as geographic isolation, small practice size, heterogeneity in settings and patient population, and low case volume make participation in performance measurement and improvement efforts especially challenging for many rural providers. This report presents 14 recommendations from a multi-stakeholder committee that was tasked to address these and other challenges of healthcare performance measurement for rural providers, particularly in the context of the Centers for Medicare and Medicaid Services pay-for-performance programs. The resulting recommendations can help advance the integration of rural providers into CMS quality improvement efforts. The recommendations also can be used to enhance the quality measurement and improvement efforts of other public- and private-sector stakeholders.