View Research by Author - Michael Karpman
Taking Stock at Mid-Year: Health Insurance Coverage under the ACA as of June 2014 (Policy Briefs/Health Policy Briefs)
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The Affordable Care Act (ACA) has brought major changes to the US health insurance system: In January 2014, Medicaid was expanded to nearly all adults with family incomes at or below 138 percent of the federal poverty level in 24 states and the District of Columbia, and enrollment under the new health insurance Marketplaces officially began in all states and the District of Columbia. We use the June 2014 Health Reform Monitoring Survey (HRMS) to examine changes in health insurance coverage since the beginning of the previous year for nonelderly adults. The HRMS was designed to provide early feedback on ACA implementation to complement the more robust assessments that will be possible when the federal surveys release their estimates of changes in health insurance coverage later in 2014 and in 2015.
Navigating the Marketplace: How Uninsured Adults Have Been Looking for Coverage (Policy Briefs/Health Policy Briefs)
|Posted to Web: July 29, 2014||Publication Date: July 29, 2014|
A growing body of evidence shows that the number of uninsured adults declined significantly since the Affordable Care Act’s open enrollment period started in October 2013. Although the vast majority of people turned to websites for information on the federal or state Marketplaces, many consumers used, and will likely continue to use, other sources for health insurance plan information. In this brief, we focus on adults who were uninsured for some or all of the 12 months before June 2014. We consider the share who looked for information on health plans in the Marketplaces, comparing the approaches used by those who obtained coverage with those who remained uninsured as of June 2014. Our objective is to identify which approaches to obtaining Marketplace information are more likely to be associated with gaining insurance coverage.
QuickTake: Number of Uninsured Adults Continues to Fall under the ACA: Down by 8.0 Million in June 2014 (Fact Sheet / Data at a Glance)
|Posted to Web: July 29, 2014||Publication Date: July 29, 2014|
The Urban Institute's Health Reform Monitoring Survey (HRMS) has been tracking insurance coverage since the first quarter of 2013. This QuickTake reports on how the uninsurance rate changed through early June 2014. These results track changes in coverage following the Affordable Care Act's first open enrollment period, which ended on March 31, 2014.
Increase in Medicaid under the ACA Reduces Uninsurance, According to Early Estimates (Policy Briefs/Health Policy Briefs)
|Posted to Web: July 10, 2014||Publication Date: July 10, 2014|
An important strategy for increasing health insurance coverage under the Affordable Care Act (ACA) is expanded enrollment in Medicaid, which provides free or very low cost health insurance to low-income people. Over 6 million individuals enrolled in Medicaid or the Children’s Health Insurance Program between October 2013 and April 2014 despite the fact that only about half of the states have expanded Medicaid and the early problems with the federal health insurance website. This brief takes advantage of new data from the Health Reform Monitoring Survey to examine how much of the increase in Medicaid coverage is a net gain in insurance coverage rather than a shift to Medicaid from other coverage, as well as whether there are differences in the patterns of Medicaid changes across states and among different population subgroups.
Obtaining Information on Marketplace Health Plans: Websites Dominate but Key Groups Also Use Other Sources (Policy Briefs/Health Policy Briefs)
|Posted to Web: June 26, 2014||Publication Date: June 26, 2014|
After the highly publicized troubled start, enrollment in the Affordable Care Act's health insurance Marketplaces exceeded 8 million. Despite many early problems, the vast majority of people who looked for Marketplace information had either used or tried to use a website to find it, and most had found the website they used very or somewhat easy to navigate. But not everyone used a website to obtain information on Marketplace health insurance plans. In this brief, we explore how different groups relied on many sources—website, direct assistance (e.g., call center, navigator, insurance broker, Medicaid agency office), the media, or indirect or informal channels—to find information on Marketplace plans. While Healthcare.gov and the state-based Marketplace websites are often viewed as the cornerstone of the ACA, consumers have used, and will likely continue to use, other sources of information on health insurance plans.
Early Estimates Indicate Rapid Increase in Health Insurance Coverage under the ACA: A Promising Start (Policy Briefs/Health Policy Briefs)
|Posted to Web: June 24, 2014||Publication Date: June 09, 2014|
By the end of March, enrollment in Marketplace plans created by the Affordable Care Act (ACA) was reported at just over 7 million and the Centers for Medicare and Medicaid Services (CMS) reported that Medicaid enrollment increased between the beginning of October 2013 and the end of February 2014. However, neither the Marketplace enrollment figures nor the CMS Medicaid report provide an accurate picture of how many uninsured people have gained coverage since open enrollment began, because both sets of enrollment figures may include newly insured people as well as those who had other sources of coverage before 2014. We use the March 2014 Health Reform Monitoring Survey (HRMS) to examine changes in health insurance coverage in early March 2014 relative to coverage over the prior year, including more disaggregated information on coverage changes and additional details on the statistical precision of the estimates.
QuickTake: Number of Uninsured Adults Falls by 5.4 Million since 2013 (Policy Briefs/Health Policy Briefs)
|Posted to Web: April 15, 2014||Publication Date: April 15, 2014|
The Urban Institute's Health Reform Monitoring Survey (HRMS) has been tracking insurance coverage since the first quarter of 2013. Today, we report the first estimate of how the uninsurance rate has changed through early March 2014. These results track changes through most of the first Affordable Care Act's (ACA) open-enrollment period, which ended on March 31, 2014. Analysis of data from the March 2014 HRMS shows the uninsurance rate for nonelderly adults (age 18–64) was 15.2 percent for the nation, a drop of 2.7 percentage points since September 2013, the month before ACA open enrollment began. This represents a gain in coverage for about 5.4 million adults.
Looking Behind Opinion Polling on the Affordable Care Act (Policy Briefs/Health Policy Briefs)
|Posted to Web: April 07, 2014||Publication Date: April 03, 2014|
This brief looks in detail at what different groups of nonelderly adults think about the ACA. Public opinion across several polls has been unfavorable toward the ACA and grew increasingly so in the wake of the troubled roll out of the new Marketplaces. The analysis draws on data collected in September 2013 from the Health Reform Monitoring Survey (HRMS), reflecting opinions prior to the first open enrollment period, which began on October 1. Because the sample includes almost 8,000 adults, we are able to probe more deeply than prior efforts, assessing (1) how opinions about the ACA vary with the person's demographic, health, and socioeconomic characteristics and (2) whether experience with the early provisions of the law has shaped their perceptions.
Who Has Been Looking for Information in the ACA Marketplaces? Why? And How? (Policy Briefs/Health Policy Briefs)
|Posted to Web: March 11, 2014||Publication Date: February 26, 2014|
As of February 25, 2014, approximately 4 million people have enrolled in a health plan through the health insurance Marketplaces established by the Affordable Care Act (ACA) and approximately 1.85 million people have enrolled since January 1st alone. While the low October–December 2013 enrollment likely reflects a lack of awareness of the ACA combined with early technical problems with the federal eligibility and enrollment system (i.e., HealthCare.gov) and the state-based Marketplaces, the most recent estimates provide some optimism on the viability of the Marketplaces. This brief complements Marketplace enrollment data by providing information about who looked or was planning to look for health coverage in the Marketplaces during the first two to three months of the rollout, as well as why and how they looked for information.
Uninsured Adults Eligible for Medicaid and Health Insurance Literacy (Policy Briefs/Health Policy Briefs)
|Posted to Web: March 11, 2014||Publication Date: March 05, 2014|
A key question is how successful enrollment efforts under the ACA will be at reaching uninsured adults who will become newly eligible for Medicaid. Historically, enrollment in Medicaid coverage has been lower for adults than for children, with substantial variation across states. Approximately two-thirds of nonelderly adults without private coverage who currently qualify for Medicaid are enrolled. This brief explores prior experiences with Medicaid among low-income, uninsured adults targeted by Medicaid under the ACA and assesses this population's understanding of basic health insurance terms and the sources of information they would use for making health insurance decisions.
|Posted to Web: February 06, 2014||Publication Date: January 01, 2014|
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