Strategic Planning & Timelines

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Latinos Have Made Coverage Gains but Millions Are Still Uninsured

May 2015

Since the ACA’s health insurance marketplaces opened and states began to expand Medicaid eligibility, uninsured rates among Latinos have begun to decline for the first time in decades. Studies of the effects of health insurance suggest that these higher coverage rates will contribute to better access to care, increased use of preventive services, better management of chronic illness and, eventually, longer and healthier lives for many Latinos. Despite these historic declines in the number of uninsured, the Commonwealth Fund Biennial Health Insurance Survey finds Latinos continue to have the highest uninsured rates among major U.S. racial or ethnic groups.


Health Insurance Coverage in 2013: Gains in Public Coverage Continue to Offset Loss of Private Insurance

Apr 2015

Since the Great Recession peaked in 2010, the economic picture has steadily improved, and in 2013, GDP increased relative to 2012 and the unemployment rate fell but remained fairly high at 7.4 percent. In addition, the uninsured rate decreased slightly (0.1 percentage point) in 2013, continuing the trend from 2011 and 2012. Despite these improvements, rates of coverage through employer sponsored insurance have declined since 2010, though more slowly in recent years than at the height of the recession. Gains in coverage since 2010 have been largely due to increases in coverage through public programs such as Medicaid and the Children’s Health Insurance Program (CHIP). This brief further examines coverage patterns for the nonelderly population from 2008 through 2013 using data from the American Community Survey.


Taking Stock: Gains in Health Insurance Coverage under the ACA as of March 2015

Apr 2015

Since the ACA’s first open enrollment period began in late 2013, there has been rapid enrollment growth in Medicaid and in private health insurance plans purchased through the new Marketplaces. However, administrative data on Medicaid enrollment and enrollment in Marketplace health plans do not show how health insurance coverage is changing under the ACA, because not all of those enrolling were previously uninsured. Household survey data are needed to track changes over time in the share of the population that is uninsured. This report uses the Urban Institute’s Health Reform Monitoring Survey (HRMS) to examine trends in health insurance coverage since the first quarter of 2013. According to HRMS data, the uninsurance rate among nonelderly adults has declined 7.5 percentage points between September 2013 and March 2015, representing 15 million fewer adults without health insurance.


State Innovations in Horizontal Integration: Leveraging Technology for Health and Human Services

Apr 2015

The ACA required states to make large-scale changes to their eligibility systems for Medicaid in order to create streamlined processing with the health plan coverage and subsidies that are available through health insurance marketplaces. To support these changes, the U.S. Department of Health and Human Services made enhanced federal Medicaid matching funds available for states to update or build their systems, and states have also been given the opportunity of a cost allocation waiver that allows them to temporarily use this enhanced funding to support technology and services improvements to eligibility systems shared by Medicaid and other health and human services programs. This issue brief highlights examples of technology and services innovations that states are implementing in support of integration among health and human services programs and discusses common themes across efforts.


Health Care Coverage and Access in the Nation's Four Largest States

Apr 2015

Across the country’s four largest states, uninsured rates vary for adults ages 19 to 64: 12 percent of New Yorkers, 17 percent of Californians, 21 percent of Floridians, and 30 percent of Texans lacked health coverage in 2014. Differences also extend to the proportion of residents reporting problems getting needed care because of cost, which was significantly lower in New York and California compared with Florida and Texas. These differences stem from a variety of factors, including whether states have expanded eligibility for Medicaid, the state’s uninsured rate prior to the Affordable Care Act taking effect, differences in the cost protections provided by private health insurance, and demographics.


Health Reform’s Impact on Charity Care

Mar 2015
The ACA is changing the traditional role of charity care programs as safety net providers. The ACA’s Medicaid expansion and subsidized marketplace plans are giving millions of uninsured Americans options instead of charity care. This brief explores how four charity care programs in different states – CareLink (TX), Portico Healthnet (MN), Ingham Health Plan (MI), and Kaiser Permanente’s Charitable Health Coverage program (multiple states) – are responding to the changing health care environment. It examines their benefit packages; membership and eligibility; outreach and enrollment strategies; financial models; and new roles in providing consumer assistance.

Integrating Health and Human Services Programs and Reaching Eligible Individuals Under the Affordable Care Act: Final Report

Mar 2015
Enacted against a background of growing public- and private-sector interest in integrating enrollment, retention, and eligibility determination for health and human services programs, the Affordable Care Act included provisions specifically calling for an expansion of such efforts, using 21st-century information technology (IT) to improve consumer experience and streamline enrollment while lowering administrative costs and protecting program integrity. This report, which summarizes a multi-faceted research project sponsored by the Assistant Secretary for Planning and Evaluation, describes integration efforts to date and explores promising strategies for the future.

Hospital Community Benefits after the ACA: State Law Changes and Promotion of Community Health

Mar 2015

Hospital community benefit policy is evolving differently by state. Since passage of the ACA in 2010 and subsequent rulemaking, state community benefit policy has increasingly moved beyond a focus on financial assistance policies to pursuing strategies that address the social determinants of health and promote community health. In this issue brief, Hilltop’s Hospital Community Benefit Program examines state-level community benefit oversight by studying specific changes to community benefit statutes, regulations, and policies in 5 select states – Colorado, Illinois, Minnesota, New Hampshire, and New York. The Hilltop Institute also has released an update of its interactive map detailing each state’s community benefit laws.


The Coverage Provisions in the Affordable Care Act: An Update

Mar 2015

The enactment of the Affordable Care Act (ACA) ushered in sweeping changes to the U.S. health care system. While the law touched almost every aspect of our health care system, the parts of the law that have garnered the most attention, and generated the most controversy, are those relating to the availability and affordability of health insurance coverage. The coverage provisions in the law were aimed at improving access to insurance, enhancing the quality of coverage by imposing minimum benefit standards, and increasing the affordability of coverage through expanded public programs and new subsidies for private coverage. This brief examines these coverage provisions, providing an update on how they have been implemented and assessing their impact. It also discusses key issues looking ahead.


How Will the Affordable Care Act Affect the Use of Health Care Services?

Mar 2015

In January 2014, the ACA extended access to health insurance coverage to an estimated 30 million previously uninsured people. This issue brief provides state-level estimates of the increased demand for physician and hospital services that is expected to result from expanded access and assesses the sufficiency of the existing supply of providers to accommodate the anticipated increase in demand. Increases of the magnitude likely to be generated by the Affordable Care Act will have modest effects on the demand for health services, and the existing supply of providers should be sufficient to accommodate this increased demand.

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