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Federal Budgets and Fiscal Policy

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The Federal New Starts Program: What Do New Regulations Mean for Metropolitan Areas? (Research Report)
Kate Lowe, Sandra Rosenbloom

On January 9, 2013, the Federal Transit Administration (FTA) published a new final rule for evaluating the applications submitted by metropolitan areas seeking major capital grants under the New Starts program. Despite the old guidelines, it appears that local characteristics, particularly local financial commitment, better explained the New Starts funding decisions between 1999 and 2011 than did Congressional influence or project justification. This new rule provides an opportunity to revisit the program’s design and grant evaluation process.

Posted to Web: April 01, 2014Publication Date: April 01, 2014

Congress Should Phase Out the Mortgage Interest Deduction (Article)
Eric Toder

The mortgage interest deduction is one of the most expensive federal tax preferences. Supporters claim it stimulates homeownership, which creates broad benefits to society beyond the benefits received by owners. But the case for these external benefits is unproven and the deduction is an ineffective way to promote homeownership. Instead, it provides an incentive for middle-income and upper income people to acquire larger and more expensive homes than they otherwise would. A uniform credit for interest or first home purchases would be a more effective subsidy for homeownership. The deduction, however, should be phased out gradually to minimize market disruption.

Posted to Web: March 28, 2014Publication Date: March 28, 2014

The Launch of Health Reform in Eight States: State Flexibility Is Leading to Very Different Outcomes (Research Report)
John Holahan, Linda J. Blumberg, Teresa A. Coughlin, Brigette Courtot, Ian Hill, Rebecca Peters, Shanna Rifkin, Margaret Wilkinson, Sabrina Corlette, Kevin Lucia

This paper provides a review of a series of papers that examine early implementation of the Affordable Care Act in 8 states. These states – Alabama, Colorado, Maryland, Michigan, Minnesota, New York, Oregon, and Virginia – have made very different design choices in implementing the law. We examine 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. We conclude that different design choices made by states will lead to different results. 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.

Posted to Web: March 05, 2014Publication Date: March 05, 2014

The Launch of the Affordable Care Act in Selected States: Coverage Expansion and Uninsurance (Research Report)
John Holahan

This brief examines the impacts of the Affordable Care Act on health insurance coverage and the uninsured. The brief concludes that states will benefit from the establishment of marketplaces and income-related subsidies. Employer coverage is not expected to change significantly. States that are expanding Medicaid will have larger gains in insurance coverage than those states that do not and will see very large reductions in the number of uninsured. Those states that have not expanded Medicaid will see less impact on the uninsured. These states have more uninsured to begin with, thus current disparities in coverage will increase, at least in the early years.

Posted to Web: March 05, 2014Publication Date: March 05, 2014

The Launch of the Affordable Care Act in Selected States: The Financial Impact on States from the Affordable Care Act (Research Report)
John Holahan

This brief examines the financial impacts of the Affordable Care Act on (ACA) selected states. The brief concludes that states expanding Medicaid will receive significantly larger inflows of federal dollars than those that do not. Medicaid expansion will bring in large amounts of federal dollars that will offset cuts in the ACA to Medicare provider payment rates and Medicaid and Medicare disproportionate share hospital payments. States that do not expand Medicaid will experience the ACA cuts but will have much smaller inflows of federal revenues. All states will experience some new spending but much can be offset by savings in other parts of state budgets.

Posted to Web: March 05, 2014Publication Date: March 05, 2014

The Launch of the Affordable Care Act in Selected States: Building ACA-Compliant Eligibility and Enrollment Systems (Research Report)
Brigette Courtot, Teresa A. Coughlin, Divvy Upadhyay

Arguably among the biggest tasks facing the health insurance marketplaces established by the Affordable Care Act (ACA) has been the creation of an information technology (IT) system (including a self-service enrollment web site) that determines eligibility for and facilitates enrollment into health coverage. This paper examines the development and performance of ACA-compliant eligibility and enrollment systems for health insurance marketplaces in eight states. Some of these states’ IT systems are operating smoothly while others have struggled to overcome technical glitches for months. These early successes and stumbles are reflected in marketplace-based enrollment numbers during the ACA’s first months of open enrollment.

Posted to Web: March 05, 2014Publication Date: March 05, 2014

The Launch of the Affordable Care Act in Eight States: Outreach, Education, and Enrollment Assistance (Research Report)
Ian Hill, Margaret Wilkinson, Brigette Courtot

The Affordable Care Act's success depends on whether eligible, uninsured persons can enroll in health coverage. Meeting enrollment goals partially hinges on the effectiveness of marketing campaigns to raise public awareness, and application assistance programs that help consumers enroll. This brief examines ACA-related marketing, outreach, and application assistance efforts in eight states: five that have aggressively participated in ACA implementation and three states that have taken a limited approach. Differences in the intensity of efforts across states are stark—with some launching multi-pronged marketing campaigns and funding community-based organizations and providers to lend hands-on assistance with enrollment, and others investing much less energy and resources in such efforts. These differences may ultimately contribute to noticeably different enrollment experiences during early ACA implementation.

Posted to Web: March 05, 2014Publication Date: March 05, 2014

The Launch of the Affordable Care Act in Selected States: Insurer Participation, Competition, and Premiums (Research Report)
John Holahan, Rebecca Peters, Kevin Lucia

This brief provides considerable data on insurer participation and premiums in several markets in 8 study states. The brief concludes that plan participation is less a function of whether states have state-based (SBM) or federally-facilitated (FFM) health insurance marketplaces and more a function of the pre-Affordable Care Act (ACA) insurance market, as well as the managed competition framework in the ACA. In both SBM and FFM states there are a large number of participants in most markets, including large and small commercial insurers and some new entrants such as Medicaid plans and Co-Ops. In most markets, premiums are lower than expected, although in markets with few plans and little competition, the ACA has had much less impact.

Posted to Web: March 05, 2014Publication Date: March 05, 2014

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