Health Policy Center Authors
Publications by Sabrina Corlette for Health Policy Center
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The Launch of Health Reform in Eight States: State Flexibility Is Leading to Very Different Outcomes (Research Report)
John Holahan, Linda J. Blumberg, Teresa A. Coughlin, Brigette Courtot, Ian Hill, Rebecca Peters, Shanna Rifkin, Margaret Wilkinson, Sabrina Corlette, Kevin Lucia
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.
The Launch of the Affordable Care Act in Eight States: Reforming Insurance Markets and Protecting Consumers (Research Report)
Sabrina Corlette, Kevin Lucia
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.
Stabilizing Premiums Under the Affordable Care Act: State Efforts to Reduce Adverse Selection (Research Report)
Linda J. Blumberg, Shanna Rifkin, Sabrina Corlette, Additional Authors
As a consequence of the ACA's reformed nongroup insurance market, some have raised concerns about short-term "rate shock" — an increase in premiums as a result of enhanced consumer protections and more risk-sharing compared with the pre-reform market – as well as longer-term instability due to adverse selection, the phenomenon by which particular insurance plans or markets attract an enrollment with higher than average health care risks. While the ACA includes strategies intended to mitigate these effects, some states are introducing additional strategies to strengthen the protections. This paper explores policies designed to address these concerns being implemented in 11 states.
Moving to High Quality, Adequate Coverage: State Implementation of New Essential Health Benefits Requirements (Research Report)
Sabrina Corlette, Christine Monahan, Kevin Lucia
The Affordable Care Act attempts to improve the adequacy of health insurance by establishing a minimum standard for "essential health benefits" (EHB). This paper documents challenges faced by insurance companies and state officials in the development and oversight of new plans that meet the new EHB requirements. We find that most people will see little change in the number of benefits covered by plans, but some will gain benefits, such as maternity care, mental health, and prescription drugs, that have often not been covered. The study also finds that insurers are taking limited advantage of their flexibility to add and subtract benefits through substitution.
The Affordable Care Act: Improving Incentives for Entrepreneurship and Self-Employment (Policy Briefs/Timely Analysis of Health Policy Issues)
Linda J. Blumberg, Sabrina Corlette, Kevin Lucia
Research evidence of pre-reform job lock and empirical research demonstrating a significant increase in self-employment under health care reforms or availability of Medicare benefits, strongly suggests that self-employment will increase as a consequence of full implementation of the Affordable Care Act (ACA). Taking into account the most recent findings in the economic literature on this topic, we make a rough estimate that the number of self-employed people will be 1.5 million higher under the ACA than it would otherwise have been. Relative increases in self-employment will vary across states as a function of pre-ACA market reforms already in place.
Factors Affecting Self-Funding by Small Employers: Views from the Market (Research Report)
Kevin Lucia, Christine Monahan, Sabrina Corlette
Policy experts predict that small employers, especially those with younger and healthier employees, will increasingly establish “self-funded” health plans, leaving the traditional fully insured market to obtain lower premiums and avoid market reforms under the Affordable Care Act. Through interviews with stakeholders in 10 study states, this paper describes factors that may in¬fluence whether and how extensively this change occurs. It also shows that states have minimal data on this potentially growing market, but they would be well served to improve their monitoring efforts so they can identify any increases in small group self-funding and resulting adverse selection, and respond appropriately.
Monitoring State Implementation of the Affordable Care Act in 10 States: Early Market Reforms (Research Report)
Kevin Lucia, Sabrina Corlette, Katie Keith
The ten states participating in the Robert Wood Johnson Foundation's monitoring and tracking project have taken significant steps to implement the early market reforms of the ACA. Each state took action to require or encourage insurers to comply with these reforms. Although some challenges were noted, insurers are generally complying with them; regulators are hearing few consumer concerns, and premiums have not risen substantially because of these reforms. Compliance was largely facilitated through the efforts of state regulators, insurers, and consumer advocates. The actions taken by these states reflect the diversity of approaches that exist among states nationwide.
Monitoring State Implementation of the Affordable Care Act in 10 States: Rate Review (Research Report)
Sabrina Corlette, Kevin Lucia, Katie Keith
The ten states participating in the Robert Wood Johnson Foundation’s monitoring and tracking project have enhanced their health insurance rate review programs in response to the Affordable Care Act. Although there has been significant variation among the states, all have taken steps to improve their processes to ensure that health insurance rates are justified. They have also increased transparency and expanded efforts to educate consumers about the factors underlying rate increases and involve them in the process. To a large extent, the actions taken by these states reflect the diversity of approaches to rate review that exist among states nationwide.
ACA Implementation-Monitoring and Tracking: New York Site Visit Report (Research Report)
Teresa A. Coughlin, Randall R. Bovbjerg, Shanna Rifkin, Sabrina Corlette
In this fifth of a series of ten briefs on state implementation efforts of the Affordable Care Act, researchers from the Urban Institute and Georgetown University provide a recap of their findings from a New York site visit conducted in December 2011. The findings in the report are based off of extensive interviews with state government officials, health care stakeholders and policy experts. New York's ACA implementation successes and challenges thus far relating to the health insurance exchange, Medicaid expansion, and private insurance market reforms, are discussed throughout the report. Current political difficulties and the state's history of involvement in insurance regulation and Medicaid eligibility expansion are also considered as New York moves ahead in implementing national health reform.
ACA Implementation-Monitoring and Tracking: Oregon Site Visit Report (Research Report)
Teresa A. Coughlin, Sabrina Corlette
Many of the provisions to expand health coverage in the Affordable Care Act must be implemented by the states. With support from the Robert Wood Johnson Foundation, the Urban Institute is undertaking a comprehensive monitoring and tracking project to examine the implementation and effects of the ACA in ten of the states: Alabama, Colorado, Maryland, Michigan, Minnesota, New Mexico, New York, Oregon, Rhode Island and Virginia. This first report is a case study analysis of Oregon’s efforts to advance health care reform. Derived from a site visit and extensive interviews with state officials and state stakeholders, it documents Oregon's considerable progress in establishing an exchange, implementing insurance reforms, and preparing for an expansion of Medicaid, all within a challenging fiscal environment.