Reports & Analysis

By the end of the first open enrollment period for coverage offered through the ACA’s marketplaces, increasing numbers of people said they found it easy to find a plan they could afford, according to The Commonwealth Fund’s Affordable Care Act Tracking Survey, April–June 2014. Adults with low or moderate incomes were more likely to say it was easy to find an affordable plan than were adults with higher incomes. Adults with low or moderate incomes who purchased a plan through the marketplaces this year have similar premium costs and deductibles as adults in the same income ranges with employer-provided coverage. A majority of adults with marketplace coverage gave high ratings to their insurance and were confident in their ability to afford the care they need when sick.

This final rule specifies additional options for annual eligibility redeterminations, as well as renewal and re-enrollment notice requirements for qualified health plans offered through the Marketplace, beginning with annual redeterminations for coverage for benefit year 2015. This final rule provides additional flexibility for Marketplaces, including the ability to propose unique approaches that meet specific needs of their state, while streamlining the consumer experience.
 

In order to encourage entry and lower prices, most regulated markets for health insurance include policies that seek to reduce the uncertainty faced by insurers. In addition to risk adjustment of premiums paid to plans, the Health Insurance Marketplaces established by the Affordable Care Act implement reinsurance and risk corridors. Reinsurance limits insurer costs associated with specific individuals, while risk corridors protect against aggregate losses. Both tighten the insurer’s distribution of expected costs. This paper considers the economic costs and consequences of reinsurance and risk corridors.
 

In the first year of full implementation, enrollment in the Affordable Care Act’s (ACA) health insurance exchanges largely fulfilled expectations, following a rocky beginning. Now, attention is turning to 2015, and one of the first tangible tests of how well the ACA is working will be the changes in premiums in the new health insurance marketplaces. This brief presents an initial analysis of premium changes for marketplace plans for individuals in 15 states plus the District of Columbia, where comprehensive data was available on rates or rate filings for all insurers.
 

This report describes the efforts of 17 different states to transform their primary care delivery systems in order to improve the health of their populations and reduce costs. Since 2009, the Multi-state Collaborative has provided a forum for its members to collaborate across states and with the federal government, sharing data and lessons learned about investment in primary care transformation. The report highlights how these states went about transforming primary care to patient-centered medical homes (PCMH) through aligned payment reform.
 

The combined effects of the Affordable Care Act’s coverage expansions, faster economic growth, and population aging are expected to fuel health spending growth in 2014 and thereafter (5.6 percent in 2014 and 6.0 percent per year for 2015–23). However, the average rate of increase through 2023 is projected to be slower than the 7.2 percent average growth experienced during 1990–2008. Because health spending is projected to grow 1.1 percentage points faster than the average economic growth during 2013–23, the health share of the gross domestic product is expected to rise from 17.2 percent in 2012 to 19.3 percent in 2023.
 

Twenty-six states and the District of Columbia are now implementing health reform’s Medicaid expansion. Arkansas, Iowa, and Michigan have expanded through federally approved Medicaid demonstration projects, or “waivers.” This brief considers the guardrails the federal government has established so far around what is and is not permissible in a Medicaid expansion waiver, and provides useful lessons for policymakers in states considering whether to expand Medicaid.
 

This report series explains how expanding Medicaid would give uninsured Americans access to affordable health insurance, create a healthier workforce, and strengthen state economies. The series focuses on 10 states: Alabama, Florida, Indiana, Missouri, North Carolina, Pennsylvania, Tennessee, Texas, Utah, and Virginia. These reports show that, in these states, more than half of the residents who could benefit from Medicaid expansion are working adults, and that they work in occupations that make up the foundation of the state’s economy.
 

Going into the second open enrollment period for the health insurance marketplaces, the enrollment community must focus on both getting more uninsured consumers enrolled and also ensuring that those who are already enrolled retain coverage. It is crucial that the enrollment community organize around simple, unified messages for consumers, including those enrolling for the first time and those who are renewing coverage. This memo presents Enroll America’s suggestions for a simple consumer messaging framework in the months leading up to and during the second open enrollment period.
 

Under the ACA, the health insurance marketplaces can encourage improvements in health care quality by: allowing consumers to compare plans based on quality and value, setting common quality improvement requirements for qualified health plans, and collecting quality and cost data to inform improvements. This issue brief reviews actions taken by state-based marketplaces to improve health care quality in three areas: 1) using selective contracting to drive quality and delivery system reforms; 2) informing consumers about plan quality; and 3) collecting data to inform quality improvement.