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Marketplace competitionMarketplace Competition & Insurance Premiums in the First Year of the Affordable Care Act
Linda J. Blumberg, John Holahan

The Affordable Care Act has resulted in considerable competition. In a large number of markets, this has resulted in lower premiums than expected, though there is considerable variability within each metal tier. This analysis assesses the variation in premiums within markets and the effects of competition in 10 states: Alabama, Arkansas, Colorado, Maryland, Massachusetts, New York, Oregon, Rhode Island, Virginia, and West Virginia. Four of the states have fairly limited competition, while the other six were very competitive, especially in urban, more populated markets.

Early 2014 stakeholder experiencesEarly 2014 Stakeholder Experiences with Small-Business Marketplaces in Eight States
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.

crime_justice_homeHalbig v Burwell: Potential Implications for ACA Coverage and Subsidies
Linda J. Blumberg, John HolahanMatthew Buettgens

A ruling from the U.S. Court of Appeals for the D.C. Circuit on Halbig v. Burwell is imminent.  The plaintiff claims a phrase in the ACA prohibits residents of states where the federal government is administering the health insurance Marketplace from receiving subsidies for purchasing insurance. With 34 states having chosen to leave administration of their Marketplaces to the federal government, a decision for the plaintiff could have broad implications. In 2016, 7.3 million people in these states are estimated to receive federal subsidies totaling $36.1 billion, ranging up to $4.8 billion in Florida and $5.6 billion in Texas. Read more

innercityhousingThe ACA and America's Cities: Fewer Uninsured and More Federal Dollars
Matthew Buettgens, Jay Dev

This report estimated the effect of the Affordable Care Act (ACA) on 14 large and diverse cities: Los Angeles, Chicago, Houston, Philadelphia, Phoenix, Indianapolis, Columbus, Charlotte, Detroit, Memphis, Seattle, Denver, Atlanta, and Miami. For each city we estimated changes in health coverage under the ACA, particularly the resulting decline in the uninsured.  We also estimated the additional federal spending on health care that would flow into these cities.  For cities in states that have not expanded Medicaid eligibility, we provide estimates both with and without expansion. Read more

nurse-on-computerNarrow Provider Networks in New Health Plans: Balancing Affordability with Access to Quality Care
Sabrina Corlette, JoAnn Volk, Robert Berenson, Judy Feder

Consumers choosing health insurance plans inside and outside the new marketplaces may face a tradeoff: narrower provider networks may lower premiums, but they may also limit access to care or increase out-of-pocket costs. This policy brief assesses the benefits and risks of policy options open to federal and state policymakers now reviewing requirements for plans' network adequacy. The authors find that no single policy can achieve the appropriate balance between insurers' flexibility to negotiate with providers and consumers' confidence that plans will deliver on promised benefits. Accordingly, the authors call on policymakers to protect consumers with a combination of regulatory standards, up-to-date information to facilitate consumer choices, and active monitoring of plans' actual performance. Read more

smiling family with sonEligibility for Assistance and Projected Changes in Coverage Under the ACA: Variation Across States
May 2014 Update

Matthew Buettgens, Genevieve M. Kenney, Hannah Recht

The authors estimate that in 2014, 56 percent of the uninsured became eligible for financial assistance with health insurance coverage through Medicaid, CHIP, or subsidized marketplace coverage.  In states that expanded Medicaid eligibility, 68 percent of the uninsured became eligible for assistance, compared with only 44 percent in states that did not.  Because of this difference in eligibility, the ACA is projected to reduce the number of uninsured people by 56 percent in states that expanded Medicaid, compared with only 34 percent in states that did not.  The authors also provide estimates of what would happen if states that have not yet expanded Medicaid were to do so. Read more 

 

Immediate Issues
The Urban Institute has launched a powerful new research tool, the Health Reform Monitoring Survey (HRMS), to provide timely insights into the Affordable Care Act. From coverage to access to affordability, the HRMS delivers critical data before federal government surveys are available. Read more

Immediate Issues
The Urban Institute is undertaking a comprehensive monitoring and tracking project to examine the implementation and effects of the ACA in ten states. Derived from extensive interviews with state officials and health care stakeholders, this series of reports documents each state’s progress in establishing a health insurance marketplace, implementing insurance reforms, and preparing for an expansion of Medicaid. Read more

New interactive map shows wide local variation in numbers of poor uninsured Americans who would be eligible for Medicaid under the ACA

mapState plans for expanding Medicaid under the ACA

 
Immediate Issues
The reforms implemented in Massachusetts in 2006 became the template for the Affordable Care Act. The Urban Institute has conducted numerous studies of Massachusetts' ambitious effort to transform its health care system. Read more

Health Reform Modeling Capacity

The UI Health Policy Center staff has developed a sophisticated microsimulation model that is used to estimate the impacts of health reforms and to inform policy design choices at the state and national levels.  Learn more about the HIPSM model.
 
All HPC Research
 
What is the Result of States Not Expanding Medicaid? (Policy Briefs/Timely Analysis of Health Policy Issues)
Stan Dorn, Megan McGrath, John Holahan
Publication Date: August 07, 2014
In Pursuit of Health Equity: Comparing U.S. and EU Approaches to Eliminating Disparities (Policy Briefs/Timely Analysis of Health Policy Issues)
Elizabeth Docteur, Robert A. Berenson
Publication Date: June 24, 2014
 


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