Reports & Analysis

Effective outreach, enrollment, and retention efforts are essential for ensuring that these new coverage opportunities under the ACA translate into increased coverage. One potential avenue for targeted outreach is through text messaging and other mobile technology, which has become an increasingly common source of communication, particularly among low-income adults targeted by the coverage expansions. To provide greater insight into the potential role of text messaging as an outreach vehicle, this brief focuses on the use of standard cell phones and smartphones for text messages and internet access and illustrates how one text messaging initiative, Text4baby, a free, personalized maternal child health education text messaging service for pregnant women and new mothers, is helping eligible pregnant women and their families connect to health coverage.
 

Under the ACA, changes in income and family circumstances are likely to produce frequent transitions in eligibility for Medicaid and health insurance Marketplace coverage for low- and middle-income adults. This report provides state-by-state estimates of potential eligibility changes (“churning”) if all states expanded Medicaid under health reform, and identifies predictors of rates of churning within states. The authors found that, even in states with the least churning, more than 40 percent of adults likely to enroll in Medicaid or subsidized Marketplace coverage would experience a change in eligibility within twelve months. Policy options for states to reduce the frequency and impact of coverage changes include adopting twelve-month continuous eligibility for adults in Medicaid, creating a Basic Health Program, using Medicaid funds to subsidize Marketplace coverage for low-income adults, and encouraging the same health insurers to offer plans in Medicaid and the Marketplaces.
 

The Affordable Care Act seeks to help small employers offer coverage by reforming the small-group market and establishing Small Business Health Options Program (SHOP) marketplaces. Seventeen states and the District of Columbia chose to operate their own SHOP marketplaces in 2014, with the federal government operating the SHOP marketplace in 33 states. This brief examines state decisions to enhance the value of SHOP marketplaces for small employers and finds that most have set predictable participation and eligibility requirements and will offer a competitive choice of insurers and plans. While not all SHOP marketplaces are yet functioning as intended, their establishment offers an opportunity to identify successful strategies for improving the affordability and accessibility of coverage for small employers.

This issue brief offers an early look into how competitive the health insurance marketplaces are under the Affordable Care Act in selected states. Through analysis of enrollment data released by seven states (California, Connecticut, Minnesota, New York, Nevada, Rhode Island, and Washington), this brief finds that exchange markets in California and New York are shaping up to be more competitive than their individual markets were in 2012 while those of Connecticut and Washington show less competition. In several states, market shares of individual insurers have shifted significantly compared to the individual market prior to the ACA, pointing to the potential for greater price competition in the future and the influence of new entrants to the market.

This guide focuses on the private insurance reforms of the Affordable Care Act, including the health insurance marketplaces, rating, benefit and cost standards, and premium tax credits. It is intended to supplement the Navigator training available from the U.S. Department of Health and Human Services. This comprehensive resource addresses more than 230 enrollment questions about private insurance reforms, and is divided into four sections: individuals with no coverage; individuals who currently have coverage or an offer of coverage from their employer; coverage for small business employers; and post-enrollment issues.

This report summarizes the current state of knowledge about value-based purchasing (VBP) based on a review of the published literature, a review of publicly available documentation from VBP programs, and discussions with an expert panel composed of VBP program sponsors, health care providers and health systems, and academic researchers with VBP evaluation expertise. Three types of VBP models were the focus of the review: (1) pay-for-performance programs, (2) accountable care organizations, and (3) bundled payment programs. The authors report on VBP program goals and what constitutes success; the evidence on the impact of these programs; factors that characterize high- and low-performing providers in VBP programs; the measures, incentive structures, and benchmarks used by VBP programs; evidence on spillover effects and unintended consequences; and gaps in the knowledge base.

This paper provides a review of a series of papers that examine early implementation of the Affordable Care Act in eight states, and the very different design choices that they have made in implementing the law. The paper examines coverage expansion; financial impacts; the development of information technology systems; outreach, education and enrollment assistance; insurer participation, competition and premiums in marketplaces; insurance market reforms; development of SHOP marketplaces; and issues of provider capacity. The law will work very differently for residents in different states around the country and there will be different outcomes both in terms of coverage and economic impacts.

The expansion of Medicaid eligibility to Americans with incomes up to 138 percent of the federal poverty level should greatly increase access to coverage and services for people recently released from jail and, thus, improve health outcomes and reduce recidivism in this population. The population is disproportionately male, minority, and poor; suffers from high rates of mental and substance abuse disorders; and is expected to make up a substantial portion of the Medicaid expansion population. To ensure connections to needed services after release from jail, states could help inmates determine their eligibility and enroll in Medicaid; take advantage of federal grants to automate systems that determine eligibility; and include a robust array of behavioral health services in Medicaid benefit packages.

Early evidence from across the nation suggests that consumer assisters are playing a vital role in helping people enroll in the new coverage options made possible by the Affordable Care Act. The State Health Reform Assistance Network has engaged with a number of states to develop easy to understand materials to educate consumer assisters about various issues that may confuse consumers and the assisters trying to help them during the eligibility determination and enrollment process. The following resource guides, prepared by Manatt Health Solutions, were developed to help consumer assisters answer some of the most common eligibility and enrollment questions: Minimum Essential Coverage; Household Composition Eligibility Rules; MAGI Household Income Eligibility Rules; and Immigrant Eligibility.

The National Health Council and its patient advocacy members have created this web tool where people can enter their unique health needs – the number of doctor visits, specialist visits, hospitalizations, and specific medications (both generic and brand name) – to learn how the different metal plans in their state’s Marketplace can affect their out-of-pocket costs. The tool generates a personalized report that a patient can print off or e-mail, and the report helps the person focus in on the metal plan level that more appropriately meets his or her needs.