The Patient Protection and Affordable Care Act—health care reform—fundamentally changed health insurance and access to health care. Our researchers are unpacking the landmark law, studying the challenges of implementation, and using our Health Insurance Policy Simulation Model to estimate how its proposals will affect children, seniors, and families, as well as doctors, small businesses, and the national debt.
The Urban Institute also studies cost, coverage, and reform options for Medicare and Medicaid and analyzes trends and underlying causes of changes in health insurance coverage, access to care, and Americans’ use of health care services. Read more.
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.
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.
In fall 2013, media reported consumer discontent over "cancellation" notices of health insurance policies not meeting new minimum standards under the Affordable Care Act (ACA), but it's difficult to determine exactly how many were affected. Findings from the December 2013 Health Reform Monitoring Survey (HRMS) show that nearly 1 in 5 (18.6 percent) with nongroup health insurance at the time of the survey report the plan they had in 2013 will no longer be offered to them because it did not meet the ACA's standards. Over half are likely to be eligible for coverage assistance under the ACA.
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.
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.