Reports & Analysis

This brief examines the cost and use of health care among low-income nonelderly adults who are covered by Medicaid relative to their expected service use and costs if they instead had employer-sponsored insurance coverage or were uninsured. The analysis controls for a wide array of factors that also influence utilization and spending in an effort to isolate the specific effects of Medicaid coverage. Consistent with previous research, the analysis underscores how Medicaid facilitates access to care for program beneficiaries.

States expanding Medicaid eligibility under the ACA can substantially expedite Medicaid enrollment and retention for SNAP participants, 97 percent of whom will qualify for Medicaid, according to this study. Even in states where SNAP provides broad-based categorical eligibility that extends SNAP’s gross income limits to at least 185 percent of the federal poverty level, 94 percent of SNAP recipients will qualify for Medicaid. Data showing SNAP receipt can thus verify Medicaid applicants’ financial eligibility, allow administrative renewal for Medicaid beneficiaries, and facilitate Medicaid enrollment for numerous eligible consumers when expanded coverage begins in early 2014.

Medicaid provides critical health insurance coverage to tens of millions of children, adults, elderly and people with disabilities every year. Under the Affordable Care Act (ACA), millions more will gain Medicaid coverage, beginning in 2014. However, Medicaid can be like a leaky sieve: every year millions of people enroll, only to subsequently lose their coverage, even though they are still eligible, due to cumbersome paperwork requirements and small, often short-term, increases in income. The problem of beneficiaries entering and exiting Medicaid is sometimes called “churning.” This report examines the impact of churning in every state.

One in four consumers who will apply for health coverage through the new health insurance marketplaces speak a language other than English at home. The Affordable Care Act and federal civil rights laws require marketplaces to provide language services for people with limited English proficiency (LEP). It is critical that marketplaces develop robust standards to ensure that these language services enable LEP consumers to successfully enroll in, use, and retain coverage. This checklist provides a list of recommendations that advocates can use to encourage their states to address the needs of LEP consumers in their health insurance marketplace.

Beginning in 2014, the Affordable Care Act (ACA) introduces major reforms, including the start of a new advance payment Premium Tax Credit designed to lower the cost of coverage for qualified families purchasing in the new Health Insurance Marketplaces (exchanges).  While employer-provided coverage receives significant tax preferences, tax credits for individual or non-group health insurance have not been used in a broad way. What’s more, the advanceable and refundable nature of these new tax credits introduce new elements that most consumers have not previously encountered. Taken together, these facts raise the possibility that consumer confusion might be a barrier to using this new program to enroll in affordable coverage. 

This report proposes system-wide health care reforms that could save the United States $300 billion dollars in the coming decade and $1 trillion over the next 20 years, as well as improve care quality and patient health. The report focuses on changes that will shift payment from the current fee-for-service payment models to models that are more person-centered.

The major insurance coverage provisions of the Affordable Care Act go into effect in January 2014, providing new insurance options for people without health insurance and insurance market protections for consumers. The Commonwealth Fund Biennial Health Insurance Survey of 2012 finds that the reform law has significantly increased health insurance coverage of young adults, and the findings also underscore why it is critical that implementation continue on schedule.

Accountable care organizations (ACOs) are gaining momentum in Medicaid as an innovative model to improve health care quality and reduce costs. As states design ACO programs for Medicaid populations, they must identify a robust set of quality measures that align with state and national goals and include a diverse array of measures to accurately evaluate the program's success. This technical assistance tool was developed to help states select quality measures for Medicaid ACO programs. It can be used to facilitate quality strategy discussions with the Centers for Medicare & Medicaid Services to achieve regulatory approval.

To foster competition among health plans featured in the insurance exchanges, the ACA requires that at least two participating plans be multi-state health plans—plans that can cross state lines and be sold nationwide. In this updated implementation brief, the authors review the final Multi-State Plan Program regulations and outline key questions, including how the plans will work under conflicting state laws, and how the plans will be phased into the market.

In December 2012, AcademyHealth’s Research Insights project convened an expert meeting of leading academic researchers together with policy audiences to discuss how well physicians, organizations, and payers respond to and implement strategies to improve value in the U.S. health care system. Based on this discussion, a Research Insights report was released in April 2013. The report summarizes the meeting’s discussions from the different participant perspectives: payers, patients, and providers (including both clinical organizations and individual physicians). The report underscores the need for more precise performance measurement and better data as key issues for successful payment reform efforts.