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Opportunities under the Affordable Care Act for Human Services Programs to Modernize Eligibility Systems and Expedite Eligibility Determination (Research Report)
Stan Dorn, Rebecca Peters

Human services programs can benefit from 90 percent federal funding for information technology investments that are complete by the end of 2015 and that: 1) build a service that helps both Medicaid and human services; or 2) build an interface that helps Medicaid use human services records to verify eligibility or "fast track" enrollment. Once the Affordable Care Act is fully phased in, Medicaid will be the country's most widely-used need-based program. Human services programs can use Medicaid records to streamline eligibility determination, despite limits on information sharing and differences between Medicaid and human services program rules, including household definitions.

Posted to Web: September 15, 2014Publication Date: July 21, 2014

A First Look at Children's Health Insurance Coverage under the ACA in 2014 (Policy Briefs/Health Policy Briefs)
Genevieve M. Kenney, Joan Alker, Nathaniel Anderson, Stacey McMorrow, Sharon K. Long, Douglas A. Wissoker, Lisa Clemans-Cope, Lisa Dubay, Michael Karpman, Tricia Brooks

Beginning in June 2013, the Urban Institute's Health Reform Monitoring Survey (HRMS), which was designed to provide early feedback on implementation of the Affordable Care Act (ACA), has been tracking changes in health insurance coverage and other outcomes for children under the ACA. In contrast to adults, uninsured rates for children had been declining in the decade before the ACA's passage, largely because of the expansion of public coverage (Medicaid and the Children's Health Insurance Program) which is substantially generous and draws high participation among children. Estimates derived from HRMS children's supplement suggest that uninsured rates for children had not changed by June 2014 from their pre-ACA levels, though there are reasons to expect that children's coverage will grow in future years.

Posted to Web: September 09, 2014Publication Date: September 09, 2014

Taking Stock: Health Insurance Coverage for Parents under the ACA in 2014 (Policy Briefs/Health Policy Briefs)
Genevieve M. Kenney, Nathaniel Anderson, Sharon K. Long, Lisa Dubay, Stacey McMorrow, Lisa Clemans-Cope, Michael Karpman, Douglas A. Wissoker

In this brief, we use data from the June 2014 Health Reform Monitoring Survey (HRMS) to examine changes in health insurance coverage for parents since September 2013. 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. We find that the uninsurance rate declined by 14.4 percent for parents nationally between September 2013 and June 2014 and by 33.3 percent for parents in states that expanded Medicaid. As the ACA moves forward, it will be important to assess (1) whether these coverage gains translate into improvements in access to care, health status, and financial well-being for parents and (2) the extent of positive spillover effects on parents' children.

Posted to Web: September 09, 2014Publication Date: September 09, 2014

QuickTake: Nonelderly Workers with ESI Are Satisfied with Nonfinancial Aspects of Their Coverage but Less Satisfied with Financial Aspects (Policy Briefs/In Brief)
Adele Shartzer, Sharon K. Long

The Urban Institute's Health Reform Monitoring Survey has been tracking health insurance coverage, including employer-sponsored insurance coverage (ESI), since the first quarter of 2013. This QuickTake reports on nonelderly (ages 18–64) workers' ESI in June 2014. In June 2014, most workers were insured and, among those who were insured, most had ESI. When asked to assess their ESI, workers were generally satisfied with available health care services, choice of doctors and other providers, and the quality of the care available under their ESI plan. However, satisfaction levels are much lower for the financial aspects of coverage, with workers more concerned about premiums, co-payments, and their potential financial risk from high medical bills.

Posted to Web: September 04, 2014Publication Date: September 04, 2014

Little Evidence of the ACA Increasing Part-Time Work So Far (Policy Briefs/Timely Analysis of Health Policy Issues)
Bowen Garrett, Robert Kaestner

This brief examines whether the Affordable Care Act (ACA) has increased part-time work using recent Current Population Survey data. We find a small increase in part-time work in 2014 beyond what would be expected at this point in the economic recovery, attributable to an increase in involuntary part-time work. The increase is not specific to part-time work as defined by the ACA (less than 30 hours per week). Moreover, job transition patterns suggest that the increase in part-time work in 2014 is more likely due to a slow recovery of full-time jobs following the Great Recession than the ACA.

Posted to Web: September 03, 2014Publication Date: September 03, 2014

State Variation in Hospital Use and Cost of Firearm Assault Injury, 2010 (Research Report)
Embry M. Howell, Samuel Bieler, Nathaniel Anderson

Hospital use and hospital mortality related to firearm-assault injuries varies considerably across demographic groups and states, as does the percentage of firearm-assault injury hospital costs borne by the public. Healthcare data from six states--Arizona, California, Maryland, New Jersey, North Carolina, and Wisconsin--show that hospital use for firearm-assault injury is disproportionately concentrated among young males, particularly young black males. Additionally, uninsured victims have higher hospital mortality rates for firearm-assault injury. Across all six states, the public pays a substantial portion of the hospital cost for injuries caused by firearm assault.

Posted to Web: August 25, 2014Publication Date: August 25, 2014

Physician Network Transparency (Research Report)
Linda J. Blumberg, Rebecca Peters, Erik Wengle, Rachel Arnesen

Urban Institute researchers studied nine marketplace websites (California, Colorado, Connecticut, District of Columbia, Massachusetts, Minnesota, Oregon, Rhode Island and Washington) and healthcare.gov, and offer recommendations on how to improve the transparency of the marketplace sites. Recommendations include creating clear and accurate "hover over" definitions of plan and network types and sizes for consumers scrolling over specific plans, and creating fully functional physician directories for each plan within the marketplace website.

Posted to Web: August 22, 2014Publication Date: August 22, 2014

Marketplace Competition & Insurance Premiums in the First Year of the Affordable Care Act (Research Report)
John Holahan, Linda J. Blumberg

The Affordable Care Act has resulted in considerable competition. In a large number of markets, this has resulted in lower premiums than expected, though there is considerable variability within each metal tier. This analysis assesses the variation in premiums within markets and the effects of competition in 10 states: Alabama, Arkansas, Colorado, Maryland, Massachusetts, New York, Oregon, Rhode Island, Virginia, and West Virginia. Four of the states have fairly limited competition, while the other six were very competitive, especially in urban, more populated markets.

Posted to Web: August 14, 2014Publication Date: August 14, 2014

Early 2014 Stakeholder Experiences with Small-Business Marketplaces in Eight States (Survey Brief)
Linda J. Blumberg, Shanna Rifkin

Participation of employers in the small group Marketplaces, or Small Business Health Options Program (SHOP), has started very slowly. The reasons for this are largely consistent across the states, and many of them lend themselves to reversal or improvement. Significant challenges remain, but it would be inappropriate to judge the long term prospects of SHOP merely on its first-year experiences. This analysis of early implementation experiences is based on case study interviews in eight states: Colorado, Illinois, Maryland, Minnesota, New Mexico, New York, Oregon, and Rhode Island. Interviews were conducted with a broad array of stakeholders in each state.

Posted to Web: August 14, 2014Publication Date: August 14, 2014

What is the Result of States Not Expanding Medicaid? (Policy Briefs/Timely Analysis of Health Policy Issues)
Stan Dorn, Megan McGrath, John Holahan

In states not expanding Medicaid, 6.7 million residents will remain uninsured in 2016 as a result. These states are foregoing $423.6 billion in federal Medicaid funds from 2013 to 2022, lessening economic activity and job growth. Their hospitals are also losing $167.8 billion in Medicaid revenue. Every comprehensive state-level fiscal analysis that we could find concluded that expansion helps state budgets, generating savings and revenues that exceed increased Medicaid costs. Future federal cuts to ACA's high federal match rate are unlikely. Of more than 100 federal Medicaid cuts since 1980, just one lowered the federal share of Medicaid spending.

Posted to Web: August 07, 2014Publication Date: August 07, 2014

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