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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Insurers Remaining in Affordable Care Act Markets Prepare for Continued Uncertainty in 2018, 2019

March 19, 2018

A new report, supported by the Robert Wood Johnson Foundation and authored by Georgetown CHIR and Urban Institute researchers, examines how uncertainty over the long-term future of the ACA have affected insurers' participation and premium setting decisions for the 2018 and 2019 plan years. We interviewed 10 insurance companies participating in the individual market in 28 states and D.C. and a few key takeaways include:The rollback of the ACA's individual mandate led insurers to implement higher premiums in 2018 and will likely drive premiums even higher in 2019. However, insurers' views differed on the impact of repealing the individual mandate. Some felt it would ultimately lead to a collapse of the market and are considering further retrenchment; others felt confident that a market for highly subsidized, low-income consumers would continue.The midyear loss of the ACA's cost-sharing reduction plan reimbursements drove 2018 premium increases ranging from 10 percent to 20 percent. However, several insurers noted that proposed federal legislation to restore cost-sharing reduction funding could result in significant disruption and sticker shock for consumers receiving premium tax credits.All insurers had concerns regarding an expansion of short-term and association health plans under the President's October 12, 2017 executive order. Insurers worry that an expansion of these plans could siphon healthy people away from the individual market, leaving a sicker, costlier population.Insurers with narrow provider networks reported concerns about the potential exit of competing insurers, noting that their network providers lacked capacity to take an influx of new, often sicker enrollees. They further noted that unexpected insurer exits can produce considerable disruption, particularly if remaining insurers lack sufficient time or ability to readjust their pricing.A worsening of the risk pool will likely cause many insurers to reduce their market presence, will cause all insurers to raise their premiums, and may lead to more exits.

Why Does Medicare Advantage Work Better Than Marketplaces?

January 30, 2018

Medicare Advantage (MA) markets are significantly more robust, with higher private insurer participation and lower average premium growth than the Affordable Care Act (ACA) marketplaces. The programs differ in insurer participation, the risk-adjustment system, and provider payments.Key FindingsBased on MA's success relative to the ACA marketplaces in terms of marketplace strength and long-term stability, there are five policies that could be useful for the ACA marketplaces:Raise enrollment in marketplace plans by increasing premium and cost-sharing subsidies and eliminating short-term plans;Cap provider payment rates at Medicare rates or a fixed percentage above them;Standardize cost-sharing within metal tiers, or limit the number of plan designs available;Lift the budget neutrality requirement for risk adjustment in the marketplaces; andUse a higher benchmark than the second-lowest-cost silver plan for calculating premium tax credits. ConclusionMA's success lays out a possible model for the ACA marketplaces. By adopting policies geared towards increasing enrollment in marketplace plans as well as insurer participation, the ACA marketplaces could become stronger and more stable.

How Has the ACA Changed Finances for Different Types of Hospitals? Updated Insights from 2015 Cost Report Data

April 1, 2017

The American Health Care Act, which was considered by Congress, would have repealed the state option to expand Medicaid under the ACA. However, with the ACA remaining intact, states that did not expand Medicaid now have the chance to reconsider.Key FindingsUsing data through fiscal year 2015:In states that expanded Medicaid through the ACA, hospitals had $5.0 million in increased Medicaid revenue and $3.2 million decreased uncompensated care costs, on average per hospital. Hospitals in states that expanded Medicaid through the ACA improved average operating margins by 2.5 percentage points.Small hospitals, for-profit and non-federal-government-operated hospitals, and those in non-metropolitan areas saw the strongest gains in profit margins.ConclusionFor states still considering Medicaid expansion, experts say that expansion likely would improve hospitals' payer mix and overall financial outlook, particularly for hospitals in non-metro areas.

ACA Implementation Monitoring and Tracking: New York Site Visit Report

April 19, 2012

Examines New York's progress in implementing the 2010 federal healthcare reform, including an executive order to establish a health insurance exchange, legislation to enact insurance reforms, and the debate over implementing the Basic Health Program.

Making the Transition

ACA Implementation Monitoring and Tracking Site Visit Report: Colorado

April 12, 2012

Assesses Colorado's progress in implementing federal healthcare reform legislation, including ongoing planning for the health insurance exchange, enrollment and subsidy determination, and Medicaid expansion, as well as work remaining on insurance reforms.

Making the Transition

The Individual Mandate in Perspective

March 27, 2012

Estimates the number and percentage of Americans who are exempt from the healthcare reform law's requirement to have insurance coverage; those who are subject to it but already have coverage; and those who are required to purchase coverage or pay a fine.

Lowering Costs of Care; The Uninsured

Federal Health Expenditures on Children on the Eve of Health Reform: A Benchmark for the Future

March 19, 2012

Analyzes trends in federal spending on children's health in 2010, changes over the past fifty years, factors that affect Medicaid and Children's Health Insurance Program coverage under the Affordable Care Act, and implications for federal spending.

Lowering Costs of Care

Will the Affordable Care Act Move Patient-Centeredness to Center Stage?

March 7, 2012

Outlines the evolution of ethical, economic, and clinical concepts of the patient's role in health care; efforts to develop a measurement infrastructure; and provisions in the healthcare reform law aimed at integrating and aligning measures.

Making the Transition

A Decade of Coverage Losses: Implications for the Affordable Care Act

February 24, 2012

Examines 2000-10 trends in employer-sponsored health insurance and Medicaid/CHIP coverage by income group; contributing factors, including a growing low-income population; and projected coverage among low-income adults under the 2010 healthcare reform.

Increasing Access to Care

ACA Implementation Monitoring and Tracking: Maryland Site Visit Report

February 20, 2012

Assesses Maryland's progress in implementing the 2010 federal healthcare reform, including legislation to establish an insurance exchange, information technology development to facilitate enrollment and eligibility determinations, and insurance reforms.

Making the Transition

ACA Implementation Monitoring and Tracking: Rhode Island Site Visit Report

February 13, 2012

Assesses Rhode Island's progress in implementing the 2010 federal healthcare reform, including earlier reforms that facilitate Medicaid expansion, advances in establishing a health insurance exchange, and efforts to pass private market reform legislation.

Making the Transition

ACA Implementation Monitoring and Tracking: Oregon Site Visit Report

February 7, 2012

Assesses Oregon's progress in implementing the 2010 federal healthcare reform, including establishing a health insurance exchange, amending the state insurance code, and planning for seamless eligibility and enrollment processes across state programs.

Making the Transition