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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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.

Kaiser Health  Tracking Poll – February 2018 : Health Care  and the 2018 Midterms, Attitudes Towards Proposed  Changes to Medicaid

February 27, 2018

With still a few months until the midterm elections are in full swing, the latest Kaiser Health Tracking Poll finds health care costs as the top health care issue mentioned by voters when asked what they want to hear 2018 candidates discuss. When asked to say in their own words what health care issue they most want to hear the candidates talk about during their upcoming campaigns, one-fifth (22 percent) of registered voters mention health care costs. This is followed by a series of other health care issues, such as Medicare/senior concerns (8 percent), repealing or opposition to the Affordable Care Act (7 percent), improve how health care is delivered (7 percent), increasing access/decreasing the number of uninsured (6 percent), or a single-payer system (5 percent). Health care costs is the top issue mentioned by Democratic voters (16 percent) and independent voters (25 percent), as well as one of the top issues mentioned by Republican voters (22 percent), followed by repealing or opposing the ACA (17 percent).

Older Americans Were Sicker and Faced More Financial Barriers to Health Care Than Counterparts in Other Countries

November 15, 2017

An international survey of older adults finds that seniors in the United States are sicker than their counterparts in 10 other high-income countries and face greater financial barriers to health care, despite the universal coverage that Medicare provides. Across all the countries, few elderly adults discuss mental health concerns with their primary care providers. Moreover, nearly a quarter are considered "high need" — meaning they have three or more chronic conditions or require help with basic tasks of daily living.

Who Are the Remaining Uninsured and Why Haven't They Signed Up for Coverage? Findings from the Commonwealth Fund Affordable Care Act Tracking Survey, February–April 2016

August 18, 2016

The number of uninsured people in the United States has declined by an estimated 20 million since the Affordable Care Act went into effect in 2010. Yet, an estimated 24 million people still lack health insurance. Goal: To examine the characteristics of the remaining uninsured adults and their reasons for not enrolling in marketplace plans or Medicaid. Methods: Analysis of the Commonwealth Fund ACA Tracking Survey, February–April 2016. Key findings and conclusions: There have been notable shifts in the demographic composition of the uninsured since the law's major coverage expansions went into effect in 2014. Latinos have become a growing share of the uninsured, rising from 29 percent in 2013 to 40 percent in 2016. Whites have become a declining share, falling from half the uninsured in 2013 to 41 percent in 2016. The uninsured are very poor: 39 percent of uninsured adults have incomes below the federal poverty level, twice the rate of their overall representation in the adult population. Of uninsured adults who are aware of the marketplaces or who have tried to enroll for coverage, the majority point to affordability concerns as a reason for not signing up.

Realizing Health Reform's Potential: Factors Affecting Health Insurance Enrollment Through the State Marketplace - Observations on the ACA's Third Open Enrollment Period

July 22, 2016

Nearly 12.7 million individuals signed up for coverage in the Affordable Care Act's (ACA) health insurance marketplaces during the third open enrollment period, and by the end of March there were 11.1 million consumers with active coverage. States that operate their own marketplaces posted a year-to-year enrollment gain of 8.8 percent. To maintain membership and attract new consumers, the statebased marketplaces must sponsor enrollment assistance programs and conduct consumer outreach. These marketplaces relied heavily on such efforts during the third enrollment period, despite declining funding. Goal: To learn which outreach strategies, assistance programs, and other factors marketplace officials viewed as having exerted the greatest influence on enrollment. Methods: Survey of officialsrepresenting each of the 17 state-based marketplaces (15 responses). Key findings andconclusions: The cost of coverage and low health insurance literacy pose significantbarriers to enrollment for many consumers. Marketplaces sought to overcome themby encouraging consumers to obtain in-person enrollment assistance from ACAcreatedassistance programs and from insurance brokers, and by partnering with community organizations for outreach activities. Many marketplaces also enhanced their web portals to make them easier to navigate and to give consumers better tools with which to evaluate their coverage options.

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

Health Care Coverage and Access in the Nation's Four Largest States: Results from the Commonwealth Fund Biennial Health Insurance Survey, 2014

April 10, 2015

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.

Improving Quality of Care; Increasing Access to Care

Monitoring the Impact of Health Reform on Americans 50-64: Use of Insurance Marketplaces

December 21, 2014

This survey found that 9 out of 10 Americans ages 50 to 64 were aware of the new health insurance Marketplace that had been created by the Affordable Care Act (ACA). The survey found that, despite widespread awareness of the Marketplace among this age group, relatively few who knew about the Marketplace were interested in using it to acquire new coverage. The survey also found that 50- to 64-year-olds' use of the Marketplace varied widely by health insurance status and income. This paper is part of a series that looks at the experiences of 50- to 64-year-olds during the ACA's first open enrollment period.

Implications for Medicaid/Medicare; Making the Transition

Monitoring the Impact of Health Care Reforms on Americans 50-64: Awareness and Coverage Expectations

December 21, 2014

This survey found widespread awareness among Americans ages 50 to 64 about the new health insurance Marketplace that had been created by the Affordable Care Act (ACA). Those with the most to gain from the ACA -- the uninsured and those with nongroup (individual) insurance -- expressed the greatest interest in using the Marketplace to learn about new coverage options. Most of those already insured expected to keep their same source of coverage in 2014, whereas the uninsured had mixed expectations. This paper is part of a series that looks at the experiences of 50- to 64-year-olds during the ACA's first open enrollment period.

Making the Transition; The Uninsured

Monitoring the Impact of Health Reform on Americans 50-64: Medicaid Expansion and Marketplace Implementation Increased Health Coverage

December 21, 2014

This survey shows that the share of 50- to 64-year-olds without health insurance fell between December 2013 and March 2014. In states that expanded their Medicaid programs, a greater share of previously uninsured adults gained coverage, particularly among groups that have traditionally faced barriers to obtaining it. The survey also found that the newly insured differed in key ways from those who reported being insured for all of the past 12 months. On average, more were low income, and more reported that they had had trouble paying medical bills. This paper is part of a series that looks at the experience of 50- to 64-year-olds during the first open enrollment period of the Affordable Care Act (ACA).

Implications for Medicaid/Medicare; Making the Transition; The Uninsured

Health Care Opinion Leaders' Views on Vulnerable Populations in the U.S. Health System

August 8, 2011

Presents survey responses from healthcare experts about the equity of the health system; healthcare reform's potential effects on safety-net institutions, access, and financial protection; and strategies for improving quality of care.

Implications for Medicaid/Medicare; Making the Transition; The Uninsured

Health Care Opinion Leaders' Views on Health Reform and the Role of States

May 23, 2011

Presents findings of a survey of experts about the relative authority of states and the federal government over the individual mandate, health insurance exchanges, provider payment methods, and other reform provisions and barriers to implementation.

Making the Transition