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.
Enacted against a background of growing public- and private-sector interest in integrating enrollment, retention, and eligibility determination for health and human services programs, the Affordable Care Act included provisions specifically calling for an expansion of such efforts, using 21st-century information technology (IT) to improve consumer experience and streamline enrollment while lowering administrative costs and protecting program integrity. This report, which summarizes a multi-faceted research project sponsored by the Assistant Secretary for Planning and Evaluation, describes integration efforts to date and explores promising strategies for the future.
This study analyzes the state budgetary effects of Medicaid expansion in Connecticut, New Mexico, and Washington State. Researchers interviewed state budget staff and officials and reviewed state budget documents. Early evidence shows state savings, within and outside Medicaid, and revenue gains alongside limited costs resulting from expansion. Researchers also analyze findings from Kentucky, another expansion state, noting that the two states able to compare overall costs and savings (Kentucky and Washington) both found that expansion yielded net state budget gains. This includes projections for future years when states pay 10 percent of Medicaid expansion costs.
The coming months will be important in determining the framework for children’s health insurance coverage. The future availability of tax credits for marketplace coverage under the Affordable Care Act (ACA) in 34 states is in the hands of the Supreme Court, while the fate of the Children’s Health Insurance Program (CHIP) and future Medicaid coverage for children rests with Congress. This brief projects how these decisions would affect the number of uninsured children. Up to 3.3 million children could become uninsured if states scale back coverage of Medicaid for children and tax credits are not available in 34 states.
We examine marketplace premium changes between 2014 and 2015 in all rating regions in all states and the District of Columbia. We provide premium data on the lowest-cost silver plan within each rating region for a 40-year-old individual who does not use tobacco. We calculate that the population-weighted national average premium increase in the lowest-cost silver plan offered in each year was 2.9 percent. Increases varied considerably both across rating regions within states and across states. We also provide data on premium increases in 40 cities and in 38 rural areas that could be separately identified.
The Medicaid and CHIP Payment and Access Commission (MACPAC) commissioned the Urban Institute to updates its model to consider the alternative health insurance options that would be available to children enrolled in separate CHIP programs were separate CHIP coverage to be discontinued. Chapter 1, “Sources of Coverage for Children if CHIP Funding Is Exhausted,” of the March 2015 MACPAC report to Congress presents key findings from our simulation modeling. This report provides additional detail on the methodology used to develop the estimates and includes supplemental tables that support the estimates included in chapter 1 of the March 2015 MACPAC report.