Affordable Care Act
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U.S. Navy photo by Photographer's Mate 1st Class Shane T. McCoy. [Public domain], via Wikimedia Commons
U.S. Navy photo by Photographer's Mate 1st Class Shane T. McCoy. [Public domain], via Wikimedia Commons
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Issue: Since 2001, long before the passage of the Affordable Care Act (ACA), the Commonwealth Fund Biennial Health Insurance Survey has examined health coverage and consumers' experiences buying insurance and using health care. Goals: To examine long-term trends and to make comparisons before and after passage of health reform. Methods: Analysis of the Commonwealth Fund Biennial Health Insurance Survey, 2016. Findings and Conclusions: There have been dramatic improvements in people's ability to buy health plans on their own following the passage of the ACA. For adults with family incomes less than $48,500, uninsured rates dropped about 17 percentage points below their 2010 peak. Lower-income whites, blacks, and Latinos have experienced drops this large, though Latinos are uninsured at higher rates. Among working-age adults who had shopped for plans in the individual market and ACA marketplaces over the prior three years, the percentage who reported it was very difficult to find affordable plans fell by nearly half from 2010, prior to the ACA reforms, to 2016. Coverage gains are helping working-age Americans get the care they need: the number of adults who reported problems getting needed health care and filling prescriptions because of costs fell from a high of 80 million in 2012 to an estimated 63 million in 2016.
With its recent adoption of the Affordable Care Act (ACA) Medicaid expansion to adults, Louisiana became the 32nd state to move forward with the expansion, and the 7th of the 17 states that make up the American South to expand. However, within the South, which has high rates of chronic disease and poor health outcomes, the majority of states still have not adopted the Medicaid expansion. The ACA and its Medicaid expansion offer important opportunities to expand access to health coverage, particularly in the South, where Medicaid and CHIP eligibility levels across groups have lagged behind other regions for many years.1 While many factors contribute to chronic disease and poor health outcomes, expanding health coverage can provide an important step in improving health by supporting individuals' ability to access preventive and primary care and ongoing treatment of health conditions. This brief provides key data on the South and the current status of health and health coverage in the South to provide greater insight into the health needs in the region and the potential coverage gains that may be achieved through the ACA. State specific data for the indicators presented in the brief are available in Tables 1 through 6.
This analysis compares access to affordable health care across U.S. states after the first year of the Affordable Care Act's major coverage expansions. It finds that in 2014, uninsured rates for working-age adults declined in nearly every state compared with 2013. There was at least a three-percentage-point decline in 39 states. For children, uninsured rates declined by at least two percentage points in 16 states. The share of adults who said they went without care because of costs decreased by at least two points in 21 states, while the share of at-risk adults who had not had a recent checkup declined by that same amount in 11 states. Yet there was little progress in expanding access to dental care for adults, which is not a required insurance benefit under the ACA. Wide variation in insurance coverage and access to care persists, highlighting many opportunities for states to improve.
Objective: To examine racial and ethnic disparities in health care access and utilization after the Affordable Care Act (ACA) health insurance mandate was fully implemented in 2014.Research Design: Using the 2011-2014 National Health Interview Survey, we examine changes in health care access and utilization for the nonelderly US adult population. Multivariate linear probability models are estimated to adjust for demographic and sociodemographic factors.Results: The implementation of the ACA (year indicator 2014) is associated with significant reductions in the probabilities of being uninsured (coef=-0.03, P
This report takes a close look at access to care under Medi-Cal for nonelderly adults and children on the eve of Affordable Care Act (ACA) implementation. Using data from the 2012 and 2013 California Health Interview Surveys (CHIS), the research examines a total of 49 measures (45 on realized and potential access and 4 on health status and health behaviors) for nonelderly adults and 31 measures (28 on realized and potential access and 3 on health status and behaviors) for children.For adults, access under Medi-Cal is compared to access under employer-sponsored insurance (ESI) overall; among Medi-Cal enrollees, access is compared across subgroups defined by region, race/ethnicity, language, and other dimensions. For children, access under Medi-Cal and Healthy Families together (referred hereafter simply as "Medi-Cal") is compared against access under ESI. To account for differences in health status and socioeconomic status between those with Medi-Cal and those with ESI, for each measure, three sets of analyses are presented: unadjusted percentages, predicted percentages adjusted for health care need, and predicted percentages adjusted for both health care need and socioeconomic status. The same approach is used in the analysis of regional and subgroup differences within the Medi-Cal population.
This paper focuses on the ways in which women in the United States are impacted by the 2010 passage of the Patient Protection and Affordable Care Act (usually referred to as ACA or 'Obamacare'). The ACA's three main goals of expanding access, increasing consumer protections and reducing costs while increasing quality of services will improve coverage, access to services and types of services that benefit women (and men). However, universal coverage remains illusive due to employer-based insurance coverage that allows firms to make decisions about coverage type. This patchwork universalism is the result of political decisions to extend rather than transform the current health-care system and as such reproduces many of the previously existing problems of uneven costs and coverage. The paper argues the ACA is consistent with other sets of US social welfare and labour market regimes that stratify access to social protections by income, race/ethnicity and gender as well as provide individual states with administrative and policy authority. The paper concludes that the passage of ACA will vastly improve health-care coverage in the United States, however, will continue to leave millions of people uninsured. This paper was produced for UN Women's flagship report Progress of the World's Women 2015-2016 and is released as part of the UN Women discussion paper series.
The Patient Protection and Affordable Care Act (ACA), enacted in 2010, held great promise for expanding insurance coverage to millions of uninsured Americans. Starting in 2014, it expanded Medicaid eligibility to low-income adults with family income below 138 percent of the federal poverty level. It also offered premium subsidies to people with income up to four times the poverty level so they could purchase private insurance through federal or state health insurance exchanges. While most of those expected to gain insurance coverage for the first time are adults, children stand to gain as well, since children are more likely to have health care coverage when their parents do too (DeVoe et al. 2015). In 2014, about 3.9 million children were estimated to be eligible but not enrolled in Medicaid or the Children's Health Insurance Program (CHIP), representing roughly two-thirds of all uninsured children (Kaiser Family Foundation 2015). This brief looks at the KidsWell Campaign, a multilevel effort designed to ensure access to health insurance for all children. It summarizes evaluation findings on two research questions: (1) to what extent has state grantees' participation in KidsWell strengthened advocacy networks and capacities so far? and (2) which advocacy activities do grantees believe to be most effective in securing policy advances for children's health care coverage?
This article reviews studies that explore the relationship between access to medical care and children's health. The authors find that, on the whole, policies to improve access indeed improve children's health, with the caveat that context plays a big role. Focusing on studies that can plausibly show a causal effect between policies to increase access and better health for children, and starting from an economic framework, they consider both the demand for and supply of health care. On the demand side, they examine what happens when the government expands public insurance programs (such as Medicaid), or when parents are offered financial incentives to take their children to preventive appointments. On the supply side, they look at what happens when public insurance programs increase the payments they offer to health care providers, or when health care providers are placed directly in schools where children spend their days. They also examine how the Affordable Care Act is likely to affect children's access to medical care.
Across the country's four largest states, uninsured rates vary for adults ages 19 to 64: 12 percent of New Yorkers, 17 percent of Californians, 21 percent of Floridians, and 30 percent of Texans lacked health coverage in 2014. Differences also extend to the proportion of residents reporting problems getting needed care because of cost, which was significantly lower in New York and California compared with Florida and Texas. Similarly, lower percentages of New Yorkers and Californians reported having a medical bill problem in the past 12 months or having accrued medical debt compared with Floridians and Texans. These differences stem from a variety of factors, including whether states have expanded eligibility for Medicaid, the state's uninsured rate prior to the Affordable Care Act taking effect, differences in the cost protections provided by private health insurance, and demographics.
This report tells how four tax-preparation programs are breaking the mold and tackling the world of health care enrollment. Readers will learn the challenges and opportunities associated with such a move, which has the potential to help millions of low-income Americans take a critical first step toward a healthier future.
Most of the discussion of the Affordable Care Act (ACA) has focused on the extent to which it has extended health insurance coverage to the formerly uninsured. This is certainly an important aspect of the law. However by allowing people to buy insurance through the exchanges and extending Medicaid coverage to millions of people, the ACA also largely ends workers' dependence on their employer for insurance. This gives tens of millions of people the option to change their job, to work part-time, or take time off to be with young children or family members in need of care, or to retire early.
Families USA spearheaded formation of Enroll America in 2010 to identify newly eligible adults for enrollment in expanded health insurance coverage made possible by the Affordable Care Act. Mathematica is conducting a rigorous evaluation that includes qualitative and quantitative assessments. For its first outreach campaign, Enroll America built infrastructure in 11 states (Arizona, Florida, Georgia, Illinois, Michigan, New Jersey, North Carolina, Ohio, Pennsylvania, Tennessee, and Texas), training staff and engaging volunteers and local partners in outreach to consumers. Areas of recommendation for the second enrollment period include:Expand the number of consumer assistance counselors.Reconsider how resources are allocated in states that have geographically dispersed uninsured.Continue to place a high priority on seeking partnerships, especially with groups connected to key uninsured constituencies.