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Affordability of Marketplace Coverage: Challenges to Enrollment and State Options to Lower Consumer Costs (Research Report)
Stan Dorn

The most frequent reason that uninsured adults who visited a health insurance marketplace gave for not enrolling in marketplace coverage was unaffordability, even with subsidies. This report examines how several states appeared to overcome this obstacle. For example, Minnesota uses a Medicaid waiver to provide more affordable coverage outside the marketplace to consumers with incomes up to 200 percent of the federal poverty level, planning to transition to the Basic Health Program in 2015. Vermont supplements federal subsidies inside the marketplace to improve affordability for consumers with incomes up to 300 percent of poverty.

Posted to Web: December 11, 2014Publication Date: December 11, 2014

Reversing the Medicaid Fee Bump: How Much Could Medicaid Physician Fees for Primary Care Fall in 2015?: Evidence from a 2014 Survey of Medicaid Physician Fees (Policy Briefs/Health Policy Briefs)
Stephen Zuckerman, Laura Skopec, Kristen McCormack

Under the Affordable Care Act, Medicaid fees for primary care services were increased to Medicare levels from January 1, 2013 through December 31, 2014. This paper uses data from the Urban Institute's 2014 survey of Medicaid physician fees to estimate how large a reduction in Medicaid primary care fees will occur on January 1, 2015, if the ACA's Medicaid primary care fee bump expires. We estimate that, in the 49 states studied and in the District of Columbia, expiration of the Medicaid primary care fee bump would lead to an average 42.8 percent reduction in fees for primary care services for eligible providers.

Posted to Web: December 10, 2014Publication Date: December 10, 2014

Medicaid on the Eve of the Affordable Care Act: What are the Research Priorities? (Research Report)
Indiana University, Urban Institute

The School of Public and Environmental Affairs (SPEA) at Indiana University and the Urban Institute cosponsored a conference in November 2013 to identify high-priority research questions and gaps in our knowledge related to changes in the Medicaid program occurring under the Affordable Care Act (ACA). This summary of the conference proceedings includes a status report on the major policy changes that occurred around the country in Medicaid under the ACA and during the 2013 open enrollment period, and an assessment of pressing research questions on topics related to Medicaid, including opportunities in enrollment and coverage; quality of care and outcomes; access to care; and cost impacts.

Posted to Web: December 08, 2014Publication Date: December 08, 2014

Taking Stock: Health Insurance Coverage under the ACA as of September 2014 (Policy Briefs/Health Policy Briefs)
Sharon K. Long, Michael Karpman, Adele Shartzer, Douglas A. Wissoker, Genevieve M. Kenney, Stephen Zuckerman, Nathaniel Anderson, Katherine Hempstead

This brief examines continued changes in the uninsurance rate for nonelderly adults through September 2014, when the most recent round of the Health Reform Monitoring Survey (HRMS) was completed. Though the marketplace open enrollment period ended in April 2014, those who have since experienced a qualifying life event, such as marriage, divorce, birth of a child, or loss of coverage, have been eligible to apply for coverage through the marketplace during a special enrollment period. Also, coverage may change because enrollment in Medicaid is available to eligible adults any time during the year, and the nation's ongoing economic recovery may cause gains in private coverage. Moreover, states' continued processing of their Medicaid application backlogs may have led to increased Medicaid enrollment. Simultaneously, other factors may dampen coverage gains, such as a decline in coverage because some Marketplace plan enrollees failed to pay their premiums.

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

Marketplace Renewals: State Efforts to Maximize Enrollment into Affordable Health Plan Options (Research Report)
Sabrina Corlette, Jack Hoadley, Sandy Ahn

This report outlines efforts of six state-based insurance marketplaces (California, Colorado, Kentucky, Maryland, Rhode Island and Washington) to re-enroll consumers into coverage for 2015. The report highlights key changes that consumers need to be aware of, most importantly that 2014 plans may not be the same as those participating in 2015. Due to changes, many consumers could be auto-enrolled in a plan that does not maximize their premium tax credit. Researchers found, however, that some state-based marketplaces have used their flexibility under federal rules to improve consumers' experiences and ensure they get a more accurate determination of premium tax credits.

Posted to Web: December 02, 2014Publication Date: December 02, 2014

Diagnosis in 'Digital India' (Opinion)
Divvy Upadhyay, Additional Authors

Misdiagnosis is likely to be one of the bigger health-care safety challenges facing India and solutions are not simple or obvious. While resource-rich nations are still evaluating how to reduce misdiagnosis, the conversation needs to start in low and middle income countries in order to prepare doctors and the health-care policymakers of tomorrow. As we have learnt, even a single misdiagnosis — such as in the case of Ebola in Dallas — can have widespread public health consequences. The new Indian government preparing its new health policy agenda can recognize the role low-cost health IT innovations could play in improving diagnostic accuracy, including many that would be useful for rural India.

Posted to Web: December 01, 2014Publication Date: November 24, 2014

Health Insurance Coverage and Health Care Access and Affordability in Massachusetts: Holding Steady in 2013 (Research Report)
Sharon K. Long, Thomas H. Dimmock

The Massachusetts Health Reform Survey (MHRS) has been conducted since 2006 to monitor and understand the state's health care system. The 2013 MHRS, funded by the Robert Wood Johnson Foundation and the Blue Cross Blue Shield of Massachusetts Foundation, provides an important new baseline against which to compare the results of the implementation of the Affordable Care Act (ACA), whose major provisions began in 2014. Findings highlight the state's ongoing success at maintaining near universal health insurance coverage and high levels of health care use, as well as the continued need to address the burden of health care costs.

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

Literature Review in Brief: Healthcare Occupational Training and Support Programs under the Affordable Care Act (Research Brief)
Randall R. Bovbjerg, Shayne Spaulding

This brief highlights key points from the report Literature Review: Healthcare Occupational Training and Support Programs under the ACA—Background and Implications for Evaluating HPOG regarding the structure of and employment trends in the healthcare industry, implications of the Affordable Care Act (ACA) for entry-level employment in healthcare, and resulting challenges and opportunities for training and support programs. The brief was developed as part of the HPOG Implementation, Systems and Outcome Project, which is being led by Abt Associates in partnership with the Urban Institute.

Posted to Web: November 20, 2014Publication Date: November 20, 2014

Analyzing Different Enrollment Outcomes in Select States that Used the Federally Facilitated Marketplace in 2014 (Research Report)
Jane B. Wishner, Anna C. Spencer, Erik Wengle

This paper analyzes two pairs of states—North Carolina and South Carolina, and Wisconsin and Ohio—that achieved very different enrollment rates in the federally facilitated Marketplace (FFM) during the 2014 open enrollment period; North Carolina and Wisconsin exceeded enrollment projections, while South Carolina and Ohio fell short of FFM averages. Demographics, uninsurance rates and FFM premium rates did not appear to explain the significant enrollment differences. Intense anti-Affordable Care Act environments in the two states that did less well, however, and a coordinated coalition of diverse stakeholders in the states that performed better did appear to improve FFM enrollment outcomes.

Posted to Web: November 13, 2014Publication Date: November 13, 2014

California's Implementation of the Affordable Care Act: Implications for Immigrants in the State (Research Brief)
Julia Gelatt, Heather Koball, Juan Pedroza

The Immigrant Access to Health and Human Services project describes the legal and policy contexts that affect immigrant access to health and human services. The study aims to describe federal, state, and local program eligibility provisions related to immigrants, major barriers to immigrants’ access to health and human services for which they are legally eligible, and innovative or promising practices that can help states manage their programs. This brief, drafted in late 2013, describes how the implementation of the Patient Protection and Affordable Care Act of 2010 (ACA) in California might affect immigrants’ access to health care in the state.

Posted to Web: November 13, 2014Publication Date: November 13, 2014

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