Reports & Analysis

This survey is the first in a series of Kaiser Family Foundation surveys taking a closer look at the entire non-group market. This first survey was conducted from early April to early May 2014, after the close of the first ACA open enrollment period. It reports the views and experience of all non-group enrollees, including those with coverage obtained both inside and outside the Exchanges, and those who were uninsured prior to the ACA as well as those who had a previous source of coverage (non-group or otherwise). The survey found that nearly six in ten Exchange enrollees were previously uninsured, and the majority of non-group enrollees give positive ratings to their new insurance plans and the value of those plans.
 

Churning in health insurance enrollment has long been a problem for many people, as changes in their life circumstances create a cycle of losing and regaining eligibility for coverage. For millions of Americans, the ACA means an end to the worst form of churning—the loss of insurance coverage entirely. However, the law also introduces a new risk: individuals and families with changes in income may move back and forth between Medicaid and subsidized marketplace coverage. This issue brief examines a variety of strategies that states can employ to ease coverage transitions and help keep people insured at all times.
 

This report estimated the effect of the Affordable Care Act (ACA) on 14 large and diverse cities: Los Angeles, Chicago, Houston, Philadelphia, Phoenix, Indianapolis, Columbus, Charlotte, Detroit, Memphis, Seattle, Denver, Atlanta, and Miami. For each city, the researchers estimated changes in health coverage under the ACA, particularly the resulting decline in the uninsured. The report also includes an estimate of the additional federal spending on health care that would flow into these cities. For cities in states that have not expanded Medicaid eligibility, the report provides estimates both with and without expansion.
 

The Centers for Medicare and Medicaid Services recently released information on how many additional people were enrolled in coverage through Medicaid and CHIP since October 1, 2013, when the first open-enrollment period for the new health insurance marketplaces was launched, through April 2014, the most recent information available. This brief assesses how reported changes in enrollment in Medicaid and CHIP during this period compare with changes in Medicaid/CHIP enrollment projected by the end of 2016 by the Urban Institute’s Health Insurance Policy Simulation Model (HIPSM).
 

To guide stakeholders through the overwhelming volume of recent developments and upcoming issues for the Affordable Care Act (ACA), Breakaway offers this ACA Dashboard, providing a visual and concise overview of key ACA updates in one place. Breakaway will provide comprehensive updates to the ACA Dashboard each month, covering the latest developments and offering a snapshot of Breakaway's health insurance exchange data and analysis.
 

Health insurers participating in the new Marketplaces are filing rates for 2015 during the next few months. Some states have already released data on proposed rates. There is substantial economic, policy, and political interest in the magnitude of proposed rate changes. This brief provides background for understanding the economic drivers of proposed rates, state and federal rate review authority, the effects of rate changes on Marketplace enrollees and federal spending on premium credits, and the economic and political dynamics of the rate review and approval process.
 

In this new analysis, Avalere Health finds that average proposed premiums for individual market exchange plans will increase modestly in 2015, based on initial rate filings in nine states. Across the nine-state group, average monthly silver premiums will rise by 8 percent from $324 in 2014 to $350 in 2015. In particular, average monthly silver premiums will rise in eight of the states, ranging from a 2.5 percent increase in Rhode Island to a 16 percent average increase in Indiana. Oregon was the only state examined in which average premiums will decrease for 2015—falling 1.4 percent or $3 per month.
 

Physicians’ involvement in accountable care organizations (ACOs) will influence how clinicians and patients perceive the ACO model, how effective these organizations are at improving quality and costs, and how future ACOs will be organized. This first-ever survey of public and private ACOs found that 51 percent of ACOs were physician-led, with another 33 percent jointly led by physicians and hospitals. In 78 percent of ACOs, physicians constituted a majority of the governing board, and physicians owned 40 percent of ACOs. The broad reach of physician leadership has important implications for the future evolution of ACOs. It seems likely that the challenge of fundamentally changing care delivery as the country moves away from fee-for-service payment will not be accomplished without strong, effective leadership from physicians.
 

With the enactment of the ACA, millions of previously uninsured individuals will gain insurance coverage through either Medicaid or private plans purchased through the health care marketplaces.  As people gain coverage, providers’ costs associated with caring for uninsured individuals that previously went uncompensated will decline, as more people have a direct source of payment (insurance) for their care.  This report examines uncompensated care in 2013, just before implementation of health reform’s major coverage provisions. These estimates provide an important baseline against which to measure major changes that are occurring under the ACA.
 

Despite growing evidence documenting the impact of social factors on health, providers have rarely addressed patients’ social needs in clinical settings. But today, changes in the health care landscape are catapulting social determinants of health from an academic topic to an on-the-ground reality for providers, with public and private payers holding providers accountable for patients’ health and health care costs and linking payments to outcomes. With the confluence of sound economics and good policy, investing in interventions that address patients’ social as well as clinical needs is starting to make good business sense.