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SCI keeps its Federal Reform Resources web page 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:

 

 

Network adequacy refers to a health plan’s ability to deliver the benefits promised by providing reasonable access to a sufficient number of in-network primary care and specialty physicians, as well as all health care services included under the terms of the contract. States have taken different approaches in regulating the adequacy of health plan networks based on their state-specific market, and they have a variety of options available to maintain robust health insurance markets by balancing access needs with the goals of controlling costs and attracting a healthy number of insurers. This brief, prepared by the Georgetown University Health Policy Institute, examines various state approaches to network adequacy policy and offers ideas about ways states can use network adequacy rules to address a range of policy issues. 

 

This analysis of rate review activities in calendar year 2012 shows that the rate review process saved consumers approximately $1.2 billion on their premiums when compared to the amount initially requested by insurers. In the individual market, the average rate request increase dropped by 12 percent after rate review, saving consumers an estimated $311 million. In addition to the $1.2 billion saved due to rate review, consumers received an additional $500 million in medical loss ratio rebates for 2012, for a total $1.7 billion in savings in 2012. Moreover, insurers were much less likely to submit requests for rate increases of 10 percent or more in 2012 than in previous years, and it is likely that this change in issuer behavior is a result of the Affordable Care Act policy that requires requests for increases of 10 percent or more to be justified and reviewed.

 

 

With open enrollment in new insurance marketplaces set to begin October 1, this analysis provides an early look at insurance premiums in 17 states and DC that have publicly released comprehensive data about their rates and the impact of tax credits that will offset part of the costs for low- and moderate-income families. The analysis compares the premiums in the largest cities in each of the 17 states plus DC for individuals and families in different circumstances to illustrate the insurance rates they might pay, with and without the tax credits.

 

Starting January 1, 2014, new federal subsidies will be available for lower- to middle-income people to purchase private, nongroup coverage through new health insurance exchanges. A key issue for the exchanges is whether enough younger and healthier people will sign up for coverage to avoid significant adverse selection in which only older and sicker uninsured adults enroll, thus driving up premiums. This brief examines which uninsured adults ages 18 to 64 are most likely to purchase insurance through the exchanges.

 

This set of Frequently Asked Questions (FAQ) provides guidance on how health insurance Marketplaces will verify incomes of applicants that qualify for premium tax credits or cost-sharing reductions. CMS has determined that they will have sufficient resources to request and process additional income documentation such that the sample size is 100 percent. However, state-based Marketplaces are allowed to determine their own sample size percentage for this group, as long as it is statistically significant.

 

 

Between 2010 and 2012, nearly one-third (32 percent) of U.S. adults ages 19 to 64, or an estimated 55 million people, were either continuously uninsured or spent a period of time uninsured. Data from the 2011 and 2012 Commonwealth Fund Health Insurance Tracking Surveys of U.S. Adults show that people with incomes below 133 percent of the federal poverty level (i.e., the level that will make them eligible for Medicaid in 2014 under the Affordable Care Act) were uninsured at the highest rates. Yet, fewer than half the states are currently planning to expand their Medicaid programs. In those states that have not yet decided to expand, as many as two of five (42 percent) adults who were uninsured for any time over the two years would not have access to the new coverage provisions in the law.

 

A key method of stabilizing Medicaid coverage is to provide beneficiaries with twelve months of continuous eligibility. Following the passage of the Children’s Health Insurance Program Reauthorization Act in 2009, seven states adopted the continuous-eligibility option for children. That policy change led to a 1.8-percentage-point increase in the average length of child enrollment during fiscal year 2010 and increased annual costs for children by about 2.2 percent. The Medicaid and CHIP Payment and Access Commission has recommended offering states the option of giving adults twelve-month continuous eligibility for Medicaid. This study’s findings suggest that continuous eligibility could promote more stable coverage for adults enrolled in Medicaid at a modest cost.

 

 

The share of children who were uninsured fell from 9.4 percent in 2011 to 8.9 percent in 2012 — a historic low — due primarily to gains in private coverage. Enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) among children remained steady, likely in part because of a health reform requirement that states maintain their eligibility rules and procedures for Medicaid and CHIP. The 8.9 percent uninsurance rate among children is more than a quarter below the 1999 level.

 

The Commonwealth Fund’s Scorecard identifies opportunities for states to improve their health systems for economically disadvantaged populations and provides state benchmarks of achievement. Analyzing 30 indicators of access, prevention and quality, potentially avoidable hospital use, and health outcomes, the Scorecard documents sharp health care disparities among states. Between leading and lagging states, up to a fourfold disparity in performance exists on a range of key health care indicators for low-income populations. If all states could reach the benchmarks set by leading states, an estimated 86,000 fewer people would die prematurely and tens of millions more adults and children would receive timely preventive care.

 

This report presents data on income, poverty, and health insurance coverage in the United States based on information collected in the 2013 and earlier Current Population 

Survey Annual Social and Economic Supplements (CPS ASEC) conducted by the U.S. Census Bureau. It found that the percentage of people without health insurance decreased between 2011 and 2012, while the number of uninsured in 2012 was not statistically different from 2011.

 

With the recent release of data from the 2012 American Community Survey (ACS), SHADAC has created reports on state and county health insurance coverage estimates. Each state has an individualized report comparing 2011 coverage estimates with 2012 and examining coverage rates by age, race/ethnicity, citizenship status, education, work experience, and household income. There are several cross-state comparison reports available as well. SHADAC included a discussion of the ACS estimates in its webinar, “2012 Health Insurance Coverage Estimates,” which can be viewed here. 

 

 

This article describes how a geographic health information system in Durham, North Carolina, links health system and social and environmental data via shared geography to provide a multidimensional understanding of individual and community health status and vulnerabilities. Geographic health information systems can be useful in supporting the Institute for Healthcare Improvement’s Triple Aim Initiative to improve the experience of care, improve the health of populations, and reduce per capita costs of health care. A geographic health information system can also provide a comprehensive information base for community health assessment and intervention for accountable care that includes the entire population of a geographic area.