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.
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.
States, whether or not they have decided to operate their own health insurance marketplaces, must navigate rapidly changing health insurance markets in which the ACA’s reforms are affecting insurers, businesses, and consumers. Under the ACA, states are primarily responsible for implementing significant insurance reforms that went into effect on January 1, 2014. This paper explores the responses of eight states to the ACA’s new rules and the creation of the new health insurance marketplaces.
This is one of a series of 9 briefs comparing the early implementation experiences of the ACA in eight states: five that have chosen to aggressively participate in all aspects of the Affordable Care Act (ACA; Colorado, Maryland, Minnesota, New York, and Oregon) and three that have taken only a limited or no participation approach (Alabama, Michigan, and Virginia). This brief focuses on the implementation of the Small Business Health Options Program (SHOP) Marketplaces, which are new structured markets for the employer purchase of small group insurance for their workers.
Much of the success of the Affordable Care Act (ACA) will hinge on issues surrounding access to care, particularly as millions of individuals become newly-insured and strain the capacity of provider systems. New service delivery reforms in state Medicaid programs and the private sector, as well as provisions in the ACA focused on increasing primary care reimbursement and provider supply, and increasing funding for Community Health Centers, hold promise to improve access to quality care. This brief describes the efforts taken by eight states—five that have aggressively participated in ACA implementation and three states that have taken a limited approach—in addressing provider capacity issues.
The expansion of Medicaid coverage under the ACA offers the potential for significant increases in health care access, use, and spending for uninsured nonelderly adults with chronic conditions. Using pooled data from the Medical Expenditure Panel Survey, we estimate the potential effects of Medicaid, controlling for individual and local community characteristics. We project significant gains in access and use, except outpatient Emergency Department use, for uninsured adults who enroll in Medicaid coverage and have chronic and mental health conditions. Annual per capita health care spending for newly insured individuals is projected to grow from $2,677 to $6,370 in 2013 dollars, while out-of-pocket spending drops by $921.
The Affordable Care Act (ACA) includes many changes to the health care system—some implemented as early as 2010 (e.g., allowing children to stay on a parent's health insurance plan until age 26), others to be implemented much later. Of particular relevance to the coverage provisions of the law are the rollout of the Marketplaces, which began in October 2013 with coverage starting in January 2014; the Medicaid expansion taking effect in January 2014 in those states that choose to expand eligibility; and the mandate on individuals to buy insurance beginning in 2014. This brief focuses on knowledge of the ACA coverage provisions among nonelderly adults overall and among those most likely to be affected by the different provisions of the law.
Concern about even modest disruption of existing health insurance coverage by the ACA regenerates the belief that "there's got to be a better way" to make coverage available, adequate and affordable. But this brief shows that disruption is inevitable in any health reform and that the ACA's disruption is remarkably limited—far less than single payer proposals on the left or market-based proposals on the right. Further, unlike even many narrowly targeted reform alternatives, the ACA improves the pooling of risk that is essential to effective insurance.
The Affordable Care Act (ACA) has created new opportunities for health and human services programs to integrate eligibility determination, enrollment, and retention. Using two large microsimulation models—the Transfer Income Model, Version 3, and the Health Insurance Policy Simulation Model—we find considerable overlaps between expanded eligibility for health coverage and current receipt of human services benefits, particularly with Earned Income Tax Credits, the Supplemental Nutrition Assistance Program, and the Low-Income Home Energy Assistance Program. In an appendix, we identify specific data sharing strategies that seek to increase participation, lower administrative costs, and prevent errors.
More than 74% of uninsured consumers who qualify for ACA health coverage file federal income tax returns. This includes over 90% of consumers under age 35 who qualify for subsidies in health insurance marketplaces. Most low-income taxpayers use tax preparers, including 64.6% of EITC claimants, more than 78% of whom file by March 31, the final day of open enrollment. State and federal officials and private leaders concerned about ACA enrollment should seriously explore partnering with commercial and nonprofit tax preparers to reach the eligible uninsured and move towards a healthy, balanced risk pool.