The passage of the Affordable Care Act represents an historic change in the way health insurance has been handled in the United States. With political discourse about the act continuing to occupy public policy debates and the news media, this collection attempts to shed light on the impact of the policy on citizens and providers as well as examine how the ACA is affecting quality, access, and costs of care.

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Insurers Remaining in Affordable Care Act Markets Prepare for Continued Uncertainty in 2018, 2019

March 19, 2018

A new report, supported by the Robert Wood Johnson Foundation and authored by Georgetown CHIR and Urban Institute researchers, examines how uncertainty over the long-term future of the ACA have affected insurers' participation and premium setting decisions for the 2018 and 2019 plan years. We interviewed 10 insurance companies participating in the individual market in 28 states and D.C. and a few key takeaways include:The rollback of the ACA's individual mandate led insurers to implement higher premiums in 2018 and will likely drive premiums even higher in 2019. However, insurers' views differed on the impact of repealing the individual mandate. Some felt it would ultimately lead to a collapse of the market and are considering further retrenchment; others felt confident that a market for highly subsidized, low-income consumers would continue.The midyear loss of the ACA's cost-sharing reduction plan reimbursements drove 2018 premium increases ranging from 10 percent to 20 percent. However, several insurers noted that proposed federal legislation to restore cost-sharing reduction funding could result in significant disruption and sticker shock for consumers receiving premium tax credits.All insurers had concerns regarding an expansion of short-term and association health plans under the President's October 12, 2017 executive order. Insurers worry that an expansion of these plans could siphon healthy people away from the individual market, leaving a sicker, costlier population.Insurers with narrow provider networks reported concerns about the potential exit of competing insurers, noting that their network providers lacked capacity to take an influx of new, often sicker enrollees. They further noted that unexpected insurer exits can produce considerable disruption, particularly if remaining insurers lack sufficient time or ability to readjust their pricing.A worsening of the risk pool will likely cause many insurers to reduce their market presence, will cause all insurers to raise their premiums, and may lead to more exits.

Why Does Medicare Advantage Work Better Than Marketplaces?

January 30, 2018

Medicare Advantage (MA) markets are significantly more robust, with higher private insurer participation and lower average premium growth than the Affordable Care Act (ACA) marketplaces. The programs differ in insurer participation, the risk-adjustment system, and provider payments.Key FindingsBased on MA's success relative to the ACA marketplaces in terms of marketplace strength and long-term stability, there are five policies that could be useful for the ACA marketplaces:Raise enrollment in marketplace plans by increasing premium and cost-sharing subsidies and eliminating short-term plans;Cap provider payment rates at Medicare rates or a fixed percentage above them;Standardize cost-sharing within metal tiers, or limit the number of plan designs available;Lift the budget neutrality requirement for risk adjustment in the marketplaces; andUse a higher benchmark than the second-lowest-cost silver plan for calculating premium tax credits. ConclusionMA's success lays out a possible model for the ACA marketplaces. By adopting policies geared towards increasing enrollment in marketplace plans as well as insurer participation, the ACA marketplaces could become stronger and more stable.

A Decade of Coverage Losses: Implications for the Affordable Care Act

February 24, 2012

Examines 2000-10 trends in employer-sponsored health insurance and Medicaid/CHIP coverage by income group; contributing factors, including a growing low-income population; and projected coverage among low-income adults under the 2010 healthcare reform.

Increasing Access to Care

ACA Implementation Monitoring and Tracking: Maryland Site Visit Report

February 20, 2012

Assesses Maryland's progress in implementing the 2010 federal healthcare reform, including legislation to establish an insurance exchange, information technology development to facilitate enrollment and eligibility determinations, and insurance reforms.

Making the Transition

ACA Implementation Monitoring and Tracking: Rhode Island Site Visit Report

February 13, 2012

Assesses Rhode Island's progress in implementing the 2010 federal healthcare reform, including earlier reforms that facilitate Medicaid expansion, advances in establishing a health insurance exchange, and efforts to pass private market reform legislation.

Making the Transition

How Will the Affordable Care Act Affect Jobs?

March 16, 2011

Examines the argument that the 2010 healthcare reform law will destroy jobs, including claims about the increase in federal spending and likely effect on business. Considers impact relative to the economy's size, offsets, and cost-containment effects.

Lowering Costs of Care; Making the Transition

America Under the Affordable Care Act

December 8, 2010

Provides an overview of how the 2010 healthcare reform law will change Americans' health insurance coverage, the number of uninsured, and overall spending on acute care for the non-elderly by households, employers, and the government.

Making the Transition

How Will the Patient Protection and Affordable Care Act Affect Seniors?

July 6, 2010

Summarizes how healthcare reform provisions including changes to Medicare premiums and drug benefits, preventive services, Medicare Advantage plans; reduced provider payment rates; and efforts to improve quality and system performance will affect seniors.

Increasing Access to Care; Lowering Costs of Care; Making the Transition

What Is the Impact of the Patient Protection and Affordable Care Act (PPACA) on the States?

June 21, 2010

Outlines how the 2010 healthcare reform law's Medicaid provisions will increase state spending on Medicaid but will reduce spending in other areas, such as uncompensated care and children's health insurance programs. Examines federal funding and offsets.

Making the Transition