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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How the Affordable Care Act Has Improved Americans' Ability to Buy Health Insurance on Their Own: Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2016

February 2, 2017

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.

Increasing Access to Care; Lowering Costs of Care

Health Care Costs 101: ACA Spurs Modest Growth

May 4, 2016

After five years of slow growth, national health spending grew by 5.3% in 2014, up from 2.9% in 2013. The faster growth was due in part to coverage expansion under the Affordable Care Act (ACA) and increased spending on prescription drugs. US health spending reached $3.0 trillion in 2014, or $9,523 per capita, and accounted for 17.5% of gross domestic product (GDP).Health Care Costs 101: ACA Spurs Modest Growth, which relies on the most recent data available, details how much is spent on health care in the US, which services are purchased, and who pays.Key findings include:Federal subsidies for ACA Marketplace premiums and cost sharing totaled $18.5 billion, accounting for 12% of the $151 billion in new health spending in 2014.Federal spending on Medicaid increased 18.4% (compared to 0.9% for states), as the federal government fully funded the ACA's expansion of Medicaid eligibility in participating states.Spending on prescription drugs increased by $32.4 billion, or 12.2%, much faster than recent years. New hepatitis C drugs accounted for $11.3 billion, more than one-third of the increase in all prescription drug spending.Household spending on direct purchase insurance rose only 2.2% (more slowly than overall spending at 5.3% and similar to overall household spending at 2.0%) despite a 19.5% increase in enrollment levels for direct purchase insurance.The growth rate in per capita spending more than doubled from 2.1% in 2013 to 4.5% in 2014.

Lowering Costs of Care

Small Employers and the Small Business Health Options Program (SHOP): Results from a National Study of Employers with 50 or Fewer Employees about Health Insurance

December 1, 2015

The Affordable Care Act (ACA) has several implications for small businesses, but one opportunity is the Small Business Health Options Program or SHOP, an online marketplace for small businesses with features designed to offer flexibility to both employers and employees. The Robert Wood Johnson Foundation commissioned a national study of small employers, conducted by PerryUndem Research/Communication and GMMB, to understand their feelings about offering health insurance. In particular, the study explored awareness of and interest in SHOP. It also tested its features and identified messengers to learn how best to communicate with small employers about the benefits of using SHOP.This report presents findings from focus groups held in Baltimore and Salt Lake City, as well as a national survey of 821 small employers with two to 50 employees. Focus groups were held in August 2015. The survey fielded September 18 through September 29. The margin of error for the survey is +/- 3.4 percentage points. Methodology, survey toplines, and the full public use data set are also available.

Lowering Costs of Care

The Affordable Care Act, Medicare Costs, and Retirement Security

November 1, 2015

Rising Medicare costs have been a major contributor to projected long-run budget deficits, and rising outof-pocket costs have become an increasing challenge to individuals' retirement security. The 2010 Patient Protection and Affordable Care Act (ACA) made substantial changes to Medicare, designed both to improve the program's finances and to reduce the outof-pocket costs faced by retirees. However, the Office of the Actuary (OACT) at the Centers for Medicare & Medicaid Services (CMS) warns that the assumed impact of the ACA may be overly optimistic and that realized savings may be far more muted. As a result, since 2010, OACT each year has released a set of alternative projections to illustrate Medicare expenditures if current-law payment reductions are not sustained.This brief compares the baseline projections in the annual Medicare Trustees Report with OACT's alternative projections.

Implications for Medicaid/Medicare; Lowering Costs of Care; Making the Transition

Getting the Coverage You Deserve: What to Do if You Are Charged a Co-Pay, Deductible, or Co-Insurance for a Preventive Service

April 3, 2014

The health care law requires new health plans to cover certain preventive services. This means that, as an increasing number of health plans come under the law's reach over the next few years, more and more people will have access to a wide range of preventive services without co-payments, deductibles, or co-insurance. This is especially important to women, who are more likely than men to avoid needed health care, including preventive care, because of cost. This requirement is a huge step forward for women's health.The National Women's Law Center has been working hard to make sure women and their families know about the preventive coverage provided through the health care law. We've heard from many women about how much this coverage has helped them but we've also heard about some women encountering problems while trying to get these services without cost sharing. This toolkit is designed to provide women with information on the coverage of preventive services in the health care law and tools they can use if they encounter problems with this coverage. We have also provided detailed instructions on how to file an appeal with insurance companies and draft appeal letters on a range of preventive services

Lowering Costs of Care

America's Underinsured: A State-by-State Look at Health Insurance Affordability Prior to the New Coverage Expansions

March 25, 2014

The Affordable Care Act insurance reforms seek to expand coverage and to improve the affordability of care and premiums. Before the implementation of the major reforms, data from U.S. census surveys indicated nearly 32 million insured people under age 65 were in households spending a high share of their income on medical care. Adding these "underinsured" people to the estimated 47.3 million uninsured, the state share of the population at risk for not being able to afford care ranged from 14 percent in Massachusetts to 36 percent to 38 percent in Idaho, Florida, Nevada, New Mexico, and Texas. Nationally, more than half of people with low incomes and 20 percent of those with middle incomes were either underinsured or uninsured in 2012. The report provides state baselines to assess changes in coverage and affordability and compare states as insurance expansions and market reforms are implemented.

Improving Quality of Care; Lowering Costs of Care

Arranged Marriages: The Evolution of ACO Partnerships in California

September 18, 2013

In response to the federal Patient Protection and Affordable Care Act of 2010 (ACA), hospitals, physicians, and other providers across the country are collaborating with public and private payers on new delivery system and payment reforms intended to slow health care spending growth and to improve quality of care. Among these, Medicare initiatives to develop accountable care organizations (ACOs) - groups of providers that take responsibility for the cost and quality of care of a defined patient population - have spurred interest in similar, commercial ACO contracting arrangements.

Implications for Medicaid/Medicare; Improving Quality of Care; Lowering Costs of Care

Health Care Costs 101: Slow Growth: A New Trend?

September 1, 2013

The United States continues to spend a greater percentage of its wealth on health care than any other industrialized nation, but a smaller overall increase in 2011 spending was in notable contrast to historical trends. The 3.9% rise was on pace with the growth rate in the economy as a whole and with inflation. Whether this signals a change in the cost trend line or is simply a result of lowered spending during the recession is hard to know. With sweeping changes to the health care system around the corner, these latest figures may indicate a more favorable climate for the rollout of the Affordable Care Act. Relying on the latest data available, this report - part of CHCF's California Health Care almanac, details how much is spent on health care in the US; which services are purchased; and what proportions are financed by households, government, and business.

Lowering Costs of Care

Health Reform in Translation: What is the Premium Tax Credit?

August 22, 2013

Premium tax credits (PTC) are a new mechanism that will be available beginning in January 2014 to help people purchase health insurance in Covered California under the Affordable Care Act (ACA). Premium tax credits will be determined on a sliding scaled based on income, and will operate as an offset against federal income taxes. Unlike many tax credits, the PTC will be available as soon as a consumer enrolls in an insurance plan - they won't have to wait until tax filing to claim the benefit. The PTC can be paid directly to the health insurance carrier to be applied against the premium.

Lowering Costs of Care

The Affordable Care Act: A Hidden Jobs Killer?

July 23, 2013

Opponents of the ACA have labeled the health care bill a jobs killer. It seems implausible that the bill could be expected to have much impact on employment except among the relatively small number of firms that are near the 50-worker cutoff. However the bill does provide a clear incentive to reduce workers' hours below 30 per week and many employers claim to be making such reductions in hours. This issue brief looks at data from the Current Population Survey and finds only a small number (0.6 percent of the workforce) of workers report working just below the 30-hour cutoff in the range of 26-29 hours per week. Furthermore, the number of workers who fall in this category was actually lower in 2013 than in 2012, the year before the sanctions would have applied.

Lowering Costs of Care

The Price of Being Uninsured

April 26, 2013

This interactive resource provides key findings on the costs of being uninsured. All information is from The Commonwealth Fund Biennial Health Insurance Survey (2012).

Lowering Costs of Care; The Uninsured

California Employer Health Benefits Survey: Fewer Covered, More Cost

April 23, 2013

Employer-based coverage is the leading source of health insurance in California as well as nationally. This report of selected findings from the 2012 California employer Health Benefits Survey provides a snapshot of the employer-based coverage landscape in the lead-up to implementation of the affordable Care act (aCa) in 2014. The percentage of employers reporting that they offer coverage continues its decline, with only 60% now offering insurance to employees. More than one-third of surveyed firms said they are increasing the premium cost to their workers in the coming year, and almost one-fourth plan to increase employees' deductibles.

Lowering Costs of Care; Making the Transition; The Uninsured