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Uninsured/Uncompensated Care

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The Implications of a Supreme Court Finding for the Plaintiff in King vs. Burwell: 8.2 Million More Uninsured and 35% Higher Premiums (Policy Briefs/Timely Analysis of Health Policy Issues)
Linda J. Blumberg, Matthew Buettgens, John Holahan

The Supreme Court will hear the King v. Burwell case, in which the plaintiff argues that the ACA prohibits payment of premium tax credits and cost-sharing reductions to people in states without state-managed Marketplaces. We estimate that a victory for the plaintiff would increase the number of uninsured by 8.2 million people and eliminate $28.8 billion in tax credits and cost-sharing reductions in 2016 ($340 billion over 10 years) for 9.3 million people. With lower cost individuals leaving the market, average nongroup premiums in 34 states would increase by 35 percent, affecting those purchasing inside and outside those Marketplaces.

Posted to Web: January 08, 2015Publication Date: January 08, 2015

Realign Physician Payment Incentives in Medicare to Achieve Payment Equity among Specialties, Expand the Supply of Primary Care Physicians, and Improve the Value of Care for Beneficiaries (Research Report)
Stephen Zuckerman, Katie Merrell, Robert A. Berenson, Nicole Cafarella Lallemand, Jonathan Sunshine

This report includes a number of studies related to promoting primary care access, addressing rising health care costs and improving value in the Medicare Physician Fee Schedule. One study showed that alternative methods for allocating Relative Value Units (RVUs) related to practice expenses would not result in a major payment shift to primary care providers. A second study examined the introduction of new codes and the effects of physician productivity changes on the distribution of work RVUs across services. The final study examined approaches promoting primary care services through payment reform, outside of the Medicare Resource Based Relative Value Scale.

Posted to Web: January 05, 2015Publication Date: January 05, 2015

An Early Look at Changes in Employer-Sponsored Insurance under the Affordable Care Act (Article)
Fredric Blavin, Adele Shartzer, Sharon K. Long, John Holahan

Critics frequently characterize the ACA's Medicaid expansion and Marketplace subsidies as a threat to the survival of employer-sponsored insurance. This article takes advantage of timely data from the Health Reform Monitoring Survey for June 2013 through September 2014 to examine, from the perspective of workers, early changes in offer, take-up, and coverage rates for employer-sponsored insurance under the ACA. We find no evidence that these rates have declined under the ACA, either overall or for workers in small firms with lower incomes. Economic incentives for workers to obtain coverage from employers remain strong.

Posted to Web: December 23, 2014Publication Date: December 23, 2014

Monitoring the Impact of Health Reform on Americans 50-64: Medicaid Expansion and Marketplace Implementation Increased Health Coverage (Policy Briefs/Health Policy Briefs)
Adam Weiss, Timothy Waidmann, Kyle Caswell

This paper is part of a series that looks at the experience of 50- to 64-year-olds during the first open enrollment period of the Affordable Care Act. A survey conducted by the Urban Institute and AARP shows that the share of 50- to 64-year-olds without health insurance fell between December 2013 and March 2014. In states that expanded their Medicaid programs, a greater share of previously uninsured adults gained coverage, particularly among groups that have traditionally faced barriers to obtaining it. The survey also found that the newly insured differed in key ways from those who reported being insured for all of the past 12 months. On average, more were low income, and more reported that they had had trouble paying medical bills.

Posted to Web: December 23, 2014Publication Date: December 23, 2014

Monitoring the Impact of Health Care Reforms on Americans 50-64: Awareness and Coverage Expectations (Policy Briefs/Health Policy Briefs)
Gerry Smolka, Olivia Dean, Kyle Caswell, Timothy Waidmann, Adam Weiss

This paper is part of a series that looks at the experiences of 50- to 64-year-olds during the Affordable Care Act (ACA)'s first open enrollment period. An Urban Institute and AARP survey conducted in December 2013 found widespread awareness among Americans ages 50 to 64 about the new health insurance Marketplace that had been created by the ACA. Those with the most to gain from the ACA—the uninsured and those with nongroup (individual) insurance—expressed the greatest interest in using the Marketplace to learn about new coverage options. Most of those already insured expected to keep their same source of coverage in 2014, whereas the uninsured had mixed expectations.

Posted to Web: December 23, 2014Publication Date: December 23, 2014

Racial/Ethnic Differences in Uninsurance Rates under the ACA (Research Report)
Lisa Clemans-Cope, Matthew Buettgens, Hannah Recht

This report is the first state-level projection of ACA coverage gains for racial/ethnic groups. Absent ACA coverage provisions, Latinos, blacks, and American Indian/Alaska Natives are overrepresented among the uninsured. With the ACA and current state Medicaid expansion decisions, uninsurance rates are projected to fall for each racial/ethnic group, narrowing coverage differences between whites and each minority group, except for blacks. If all states were to expand their Medicaid programs, we project that uninsurance rates would fall further for all racial/ethnic groups, with blacks experiencing a marked reduction. Effective outreach can further reduce uninsurance rates for all racial/ethnic groups

Posted to Web: December 16, 2014Publication Date: December 16, 2014

The ACA's Basic Health Program Option: Federal Requirements and State Trade-Offs (Policy Briefs/Health Policy Briefs)
Stan Dorn, Jennifer Tolbert

Starting in 2015, the ACA gives states the option to implement a Basic Health Program (BHP) that covers low-income residents through state-contracting plans outside the health insurance marketplace. Some view BHPs as an effective strategy for improving affordability of coverage and reducing churning between Medicaid and marketplace plans. This paper reviews BHP's federal legal requirements and funding mechanisms. It also analyzes key policy issues, including BHP's implications for state costs and marketplace viability.

Posted to Web: December 12, 2014Publication Date: December 12, 2014

Estimating Federal Payments and Eligibility for Basic Health Programs: An Illustrative Example (Policy Briefs/Health Policy Briefs)
Stan Dorn, Jennifer Tolbert

Some states are considering adoption of the Basic Health Program (BHP) to make coverage more affordable to low income consumers. This paper provides detailed information about the characteristics of BHP-eligible residents in each state. It explains how policymakers can use that information to estimate average federal BHP payments per BHP-eligible resident, both overall and within various age and income bands. The paper also explains in detail how federal BHP payments are calculated.

Posted to Web: December 12, 2014Publication Date: December 12, 2014

Public Education, Outreach and Application Assistance (Research Report)
Stan Dorn

Using the Health Reform Monitoring Survey and state-level interviews, this paper identifies effective strategies to educate uninsured consumers about available health coverage assistance and to help them enroll. Researchers describe promising state practices, such as Kentucky insurance brokers' targeting of firms that do not offer coverage, enrolling workers at those companies into Marketplace plans; 46 percent of America's subsidy-eligible uninsured work for similar employers that do not offer insurance. The report emphasizes the importance of continuing to fund hands-on application assistance.

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

Marketplace Enrollment Procedures: Early Barriers to Participation and Options for Surmounting Them (Research Report)
Stan Dorn

This report examines three barriers experienced during the 2014 open enrollment period in Marketplaces: Medicaid backlogs, procedural challenges facing disadvantaged populations, and difficulty with plan selection. It also explains promising strategies states have used to overcome those barriers, including using Medicaid computer systems to make eligibility determinations for the Marketplace and simplifying consumer choices by standardizing plan designs within each metal tier. These and other practices suggest directions to pursue in improving Marketplace enrollment for 2015 and beyond.

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

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