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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The Children’s Health Insurance Program: Why CHIP is Still the Best Deal for Kids

April 18, 2018

CHIP covers those who earn too much to qualify for Medicaid but not enough to be able to purchase health insurance coverage on their own. CHIP's supporters recognized the value of investing in children's coverage to make sure that all children have access to the medical care they need to grow up to become healthy and productive adults.CHIP has a long history of bipartisan support from lawmakers on both sides of the aisle who recognize that providing health coverage for our nation's children is a critical investment in America and its future. If funding for CHIP is not extended beyond FY 2017, the remarkable trend toward universal coverage for children would most certainly be reversed and significant numbers of children would become uninsured.

Tracking Section 1332 State Innovation Waivers

December 12, 2017

Through Section 1332 of the Affordable Care Act (ACA), states may apply for innovation waivers to alter key ACA requirements in the individual and small group insurance markets. States can use the flexibility granted by 1332 waiver authority to shore up fragile insurance markets, address unique state insurance market issues, or experiment with alternative models of providing coverage to state residents. With Congressional efforts to repeal and replace the ACA on hold, attention will likely turn to 1332 waivers as states explore ways to address access and affordability issues in their individual and small group markets.While the ACA provides states with some flexibility to alter certain provisions using 1332 waiver authority, it establishes guardrails that limit the extent of the changes states may make. The current statutory language requires that state waiver applications must demonstrate that the innovation plan will provide coverage that is at least as comprehensive in covered benefits; at least as affordable (taking into account premiums and excessive cost sharing); cover at least a comparable number of state residents; and not increase the federal deficit. The ACA requirements states may seek to waive using Section 1332 authority include:Individual and employer mandates;Essential health benefits (EHBs);Limits on cost sharing for covered benefits;Metal tiers of coverage;Standards for health insurance marketplaces, including requirements to establish a website, a call center, and a navigator program; andPremium tax credits and cost-sharing reductions.Additionally, states may request an aggregate payment of what residents would otherwise have received in premium tax credits and cost-sharing reductions, referred to as subsidy pass-through funding. States may not waive certain provisions through section 1332, including guaranteed issue, age rating, and prohibitions on health status and gender rating. While states can submit ACA innovation waivers in conjunction with Medicaid waivers (under Sec. 1115 of the Social Security Act), innovation waivers cannot be used to change Medicaid program requirements.

Medicaid Works: No Work Requirement Necessary

December 1, 2017

Several states have submitted proposals for Medicaid waivers to the Centers for Medicare and Medicaid Services that include work requirements. While work requirements are new to health programs, we have decades of experience with such requirements in other safety net programs, specifically cash assistance under Temporary Assistance for Needy Families and the Supplemental Nutrition Assistance Program. Ideas and language put forth by states in their Medicaid waivers are clearly drawn from these programs. We know from these programs that the main effect of work requirements is to discourage enrollment, with little effect on employment outcomes. This document translates many of the lessons learned from TANF and SNAP to Medicaid.

The Affordable Care Act Repeal Bill Would Put Affordable Health Coverage Out of Reach For Many Women

March 20, 2017

The American Health Care Act, the budget reconciliation proposal to repeal the Affordable Care Act (ACA), restructures the health care system in favor of wealthier individuals and companies. At the same time, it takes away critical financial assistance that has helped individuals afford health insurance and health care, and it imposes financial penalties on those least able to afford it. These changes come at the expense of women, who will lose access to health care and health insurance, jeopardizing their health and economic security.

Facts and Figures on the ACA in California: What We've Gained and What We Stand to Lose

November 1, 2016

The 2016 election of Donald Trump as president, combined with a Republican-controlled Congress, could result in a partial or complete repeal of the Affordable Care Act (ACA). Here is a reminder of what has been achieved under the ACA -- and what California now stands to lose.Nationally, the uninsured rate is at a historic low:20 million Americans are covered as a result of the ACA.Close to 90% of all Americans are now covered: The uninsured rate fell from 16.6% in 2013 to a historic low of 10.5% in 2015.Some of the ACA's biggest gains have been in California:Over 5 million Californians have insurance as a result of the ACA -- roughly a quarter of all Americans covered under the law.91% of Californians are now insured. The uninsured rate in California fell from 17.2% in 2013 to a historic low of 8.6% in 2015.In California, the uninsured rate dropped across all racial/ethnic groups, with the greatest gains seen among Latinos. Between 2013 and 2015, 1.5 million additional Latinos gained coverage, and the uninsured rate in this population fell from 23% to 12%.The sources of coverage for the more than 5 million Californians insured under the ACA include:1.4 million bought insurance on Covered California.3.7 million Californians enrolled in Medi-Cal under the ACA expansion -- representing more than a quarter of the 13.6 million Californians now covered under Medi-Cal.Hundreds of thousands of young adults under the age of 26 were able to stay on their parents' plan.Over 1 million Californians receive financial assistance to afford coverage through Covered California:Of Covered California's 1.4 million consumers, 1.2 million receive federal subsidies to help them pay their monthly premiums.The average federal premium subsidy per household is $438/month.The California Health Care Foundation will work to protect the coverage and access to care that millions of Californians have gained under the ACA. We remain committed to building a health care system that works for all Californians.

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 Reform in Translation: Individual Coverage Before and After ACA

August 22, 2013

The Affordable Care Act (ACA) will bring major changes to the individual market for health insurance and will extend new protections, opportunities, and obligations to consumers. The table compares market and regulatory features affecting California's individual purchasers before and after January 2014.

Improving Quality of Care; Increasing Access to Care; Making the Transition

Health Reform in Translation: Small Group Coverage Before and After ACA

August 22, 2013

Premium tax credits (PTC) are a new mechanism that will be available beginning in January 2013 to help people purchase health insurance in Covered California under the federal Affordable Care Act (ACA). Premium tax credits will be determined on a sliding scale 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.

Increasing Access to 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