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Publications by Shanna Rifkin for Health Policy Center

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Monitoring the Impact of the Affordable Care Act on Employers (Research Report)
Fredric Blavin, Bowen Garrett, Linda J. Blumberg, Matthew Buettgens, Sarah Gadsden, Shanna Rifkin

In this report, we analyze recent trends in the employer health insurance market and the anticipated effects of the Affordable Care Act on employers, with a particular focus on small firms with fewer than 50 workers. We first present a detailed picture of the employer market by identifying preexisting trends in key outcomes that could be incorrectly attributed to the Affordable Care Act. We also analyze the literature to identify economic factors that are important in current employer and employee decisions regarding health coverage.

Posted: October 23, 2014Availability: HTML | PDF

Early 2014 Stakeholder Experiences with Small-Business Marketplaces in Eight States (Survey Brief)
Linda J. Blumberg, Shanna Rifkin

Participation of employers in the small group Marketplaces, or Small Business Health Options Program (SHOP), has started very slowly. The reasons for this are largely consistent across the states, and many of them lend themselves to reversal or improvement. Significant challenges remain, but it would be inappropriate to judge the long term prospects of SHOP merely on its first-year experiences. This analysis of early implementation experiences is based on case study interviews in eight states: Colorado, Illinois, Maryland, Minnesota, New Mexico, New York, Oregon, and Rhode Island. Interviews were conducted with a broad array of stakeholders in each state.

Posted: August 14, 2014Availability: HTML | PDF

The Launch of the Affordable Care Act in Selected States: Small Group Marketplaces (Research Report)
Linda J. Blumberg, Shanna Rifkin, Erik Wengle

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.

Posted: March 05, 2014Availability: HTML | PDF

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.

Posted: March 05, 2014Availability: HTML | PDF

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.

Posted: November 19, 2013Availability: HTML | PDF

Implementation of Small Business Exchanges in Six States (Research Report)
Linda J. Blumberg, Shanna Rifkin

The Affordable Care Act includes Small Business Health Options Programs (SHOP) exchanges, intended to provide administrative relief and affordable coverage options to small employers across the country. This paper provides an overview of SHOP exchange development in six states. The six state based exchanges studied are all intending to offer employee choice in 2014 and report an encouraging amount of carrier interest. Specific policy decisions in design tend to reflect prior state differences in small group markets. State contacts note that employer education is one of the major challenges they face, and outreach efforts to small businesses are just beginning.

Posted: June 27, 2013Availability: HTML | PDF

State Level Progress in Implementation of Federally Facilitated Exchanges: Findings in Three Case Study States (Research Report)
Linda J. Blumberg, Shanna Rifkin

This paper focuses on states' roles in implementation of FFEs. We start by providing an overview of recent regulations issued by CCIIO that describes the possible roles both for states and the federal government in the FFEs. We then provide in-depth descriptions of each of the specific FFE options as implemented in three states-Alabama, Michigan, and Virginia-with an eye to each state's role in developing mechanisms to carry out their new responsibilities and progress in creating relationships with the federal government in order to ensure successful implementation of the three types of federally facilitated exchanges.

Posted: June 14, 2013Availability: HTML | PDF

State Progress in Implementing Health Insurance Exchanges: Results from 10 State Analyses (Occasional Paper)
Linda J. Blumberg, Shanna Rifkin

This paper describes the status of health insurance exchange development and design choices in the 10 states participating in the Robert Wood Johnson Foundation health reform implementation monitoring and tracking project. We found state policy-makers, their staffs, stakeholders, and consumer advocates to be highly engaged in exchange policy discussions and development processes. By all accounts, each state was making concerted efforts to engage with a broad-swath of stakeholder and consumer interests and allowing all perspectives to be heard. However, many state policy environments remain politically contentious, and progress in exchange development has been slow for some as a result.

Posted: September 10, 2012Availability: HTML | PDF

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.

Posted: April 19, 2012Availability: HTML | PDF

ACA Implementation-Monitoring and Tracking: Rhode Island Site Visit Report (Research Report)
John Holahan, Shanna Rifkin, Additional Authors

With financial support from the Robert Wood Johnson Foundation, the Urban Institute is undertaking a comprehensive monitoring and tracking project to examine the implementation efforts and effects of the Affordable Care Act on 10 states—Alabama, Colorado, Maryland, Michigan, Minnesota, New Mexico, New York, Oregon, Rhode Island, and Virginia. The second case study report draws on a site visit and key informant interviews, to provide an in-depth description of Rhode Island's efforts to implement health reform. The report chronicles Rhode Island's successes thus far, with a special look at exchange establishment, private market reforms, and preparations for Medicaid expansion.

Posted: February 14, 2012Availability: HTML | PDF


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