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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Percent of Children Covered by Medicaid/CHIP by County, 2012-2016

March 26, 2018

Notes: Children are defined as under 18 years of age. Children with two or more types of coverage are not included in the map. A dash indicates that the percent of children with Medicaid/CHIP coverage in the county are unreported on the map because there are fewer than 10 children residing in the county. Source: Georgetown University Center for Children and Families analysis of the five-year estimates of summary data from the 2016 American Community Survey (ACS). The U.S. Census Bureau publishes ACS summary data on American Fact Finder. Percent estimates were computed.

Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost Sharing Policies as of January 2018: Findings from a 50-State Survey

March 20, 2018

This 16th annual 50-state survey provides data on Medicaid and the Children's Health Insurance Program (CHIP) eligibility, enrollment, renewal and cost sharing policies as of January 2018. It takes stock of how the programs have evolved as the fifth year of implementation of the Affordable Care Act (ACA) begins, discusses policy changes made during 2017, and looks ahead to issues that may affect state policies moving forward. It is based on a survey of state Medicaid and CHIP officials conducted by the Kaiser Family Foundation and the Georgetown University Center for Children and Families.Key FindingsMedicaid and CHIP provide a robust base of coverage for low-income children. All but two states cover children with incomes up to at least 200% of the federal poverty level (FPL, $41,560 per year for a family of three in 2018), including 19 states that cover children with incomes at or above 300% FPL. The ten-year extension of federal funding for CHIP approved by Congress provides states stable funding to maintain children's coverage and continues protections for children's coverage moving forward.There have been major gains in Medicaid eligibility for parents and other adults under the Affordable Care Act (ACA) Medicaid expansion, but eligibility remains limited in the 19 states that have not implemented the expansion. Among non-expansion states, the median eligibility level for parents is 43% FPL ($8,935 for a family of three in 2018) and other adults generally are ineligible. Alabama and Texas have the lowest parent eligibility limits at 18% FPL or $3,740 per year for a family of three. Additional states may expand Medicaid for adults in the coming year, which would reduce the number of poor uninsured adults who fall into the coverage gap. States moving forward with expansion may seek waivers to add requirements or restrictions for adults as a condition of expanding.Through significant investments of time and resources, most states have transformed their Medicaid and CHIP enrollment and renewal processes to provide a modernized, streamlined experience as outlined in the ACA. With these processes, a growing number of states are processing real-time eligibility determinations and automated renewals through electronic data matches with trusted data sources. Looking ahead, waivers and other proposed changes for adults, including premiums and cost sharing, work requirements, and lockout periods, require complex documentation and costly administrative processes that run counter to the simplified enrollment and renewal processes states have implemented under the ACA.

Women’s Connections to the Healthcare Delivery System: Key Findings from the 2017 Kaiser Women’s Health Survey

March 13, 2018

Women's ability to access the care they need depends greatly on the availability of high quality providers in their communities as well as their own knowledge about maintaining their health through routine checkups, screenings, and provider counseling. This brief presents findings from the 2017 Kaiser Women's Health Survey, a nationally representative survey of women ages 18 to 64 on their health status, relationships to regular providers and sites of care, and the frequency at which they receive routine preventive care. The Kaiser Family Foundation has conducted surveys on women's health care in 2001, 2004, 2008, and 2013. This brief focuses on findings from the newest 2017 survey and presents some findings compared to earlier years.

State Health Compare

January 1, 2018

Analysis of healthcare access at the state level that goes beyond standard indicators of health insurance coverage.

Health Reform 2017: Regulation & Administrative Actions Georgia's Marketplace

October 13, 2017

Georgia's 2017 Marketplace Health Reform 2017.

Medicaid Long‐term Services and Supports in Maryland: FY 2011 to FY 2014 Volume 1

February 3, 2017

The Medicaid Long-Term Services and Supports in Maryland Chart Book, Volume 1, The Autism Waiver is the first in a series of three that explores service utilization and expenditures for Medicaid-funded long-term services and supports in Maryland. Volume 2 explores service utilization and expenditures for Maryland Medicaid's Brain Injury Waiver. Volume 3 provides information on the state's Medicaid Model Waiver.

Medicaid Long-Term Services and Supports in Maryland: FY 2011 to FY 2014, Volume 2

January 24, 2017

The Medicaid Long-Term Services and Supports in Maryland Chart Book, Volume 2, The Brain Injury Waiver is the second in a series of three that explores service utilization and expenditures for Medicaid-funded long-term services and supports in Maryland. Volume 1 explores service utilization and expenditures for Maryland Medicaid's Autism Waiver. Volume 3 provides information on the states' Medicaid Model Waiver.

California's Uninsured: As Coverage Grows, Millions Go Without

December 1, 2016

Since the implementation of the Affordable Care Act (ACA) in 2014, the uninsured rate in California dropped by nearly half, from 16% in 2013 to 9% in 2015. However, 2.9 million Californians remained uninsured.California's Uninsured: As Coverage Grows, Millions Go Without provides a look at the uninsured two years after full implementation of the ACA. There could be big changes in health insurance coverage ahead with the election of President Donald Trump.Key findings include:The drop in the uninsured rate was mainly due to a seven percentage point increase in individually purchased insurance coupled with a five percentage point increase in Medi-Cal enrollment.One in three of California's uninsured had annual incomes of less than $25,000. At this income level, people are potentially eligible for Medi-Cal.Of the state's remaining uninsured, one in four were age 25 to 34, one in three were noncitizens, and more than half were Latino.62% of the uninsured were employed. Of the 1.8 million uninsured workers, 44% worked in firms with fewer than 50 employees.Fewer Californians cited "lack of affordability" as the main reason for going without health insurance in 2015 compared to 2014.

Preliminary Regional Remaining Uninsured 2017 Data Book, California Simulation of Insurance Markets (CalSIM) version 2.0

August 11, 2016

This data book provides estimates of the remaining uninsured in California in 2017 by Covered California rating region and for large counties using a preliminary version of the California Simulation of Insurance Markets (CalSIM) model v 2.0.

Study of the Impact of the ACA Implementation in Kentucky - Quarterly Snapshot: January - March 2016

August 1, 2016

The Study of the Impact of the Affordable Care Act (ACA) on Health Coverage, Access, Quality, Cost, and Outcomes in Kentucky, funded by the Foundation for a Healthy Kentucky, is a three-year mixed methods study conducted by the State Health Access Data Assistance Center (SHADAC), a health policy research institute at the University of Minnesota. As part of the Study, the research team produces Quarterly Snapshots to track ACA implementation indicators in a timely way.

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

Health and Health Coverage in the South: A Data Update

February 1, 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.

Increasing Access to Care