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Issue Brief of the Commonwealth Fund

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https://www.readbyqxmd.com/read/28880062/following-the-aca-repeal-and-replace-effort-where-does-the-u-s-stand-on-insurance-coverage-findings-from-the-commonwealth-fund-affordable-care-act-tracking-survey-march-june-2017
#1
Sara R Collins, Munira Z Gunja, Michelle M Doty
Issue: After Congress's failure to repeal and replace the Affordable Care Act, some policy leaders are calling for bipartisan approaches to address weaknesses in the law’s coverage expansions. To do this, policymakers will need data about trends in insurance coverage, reasons why people remain uninsured, and consumer perceptions of affordability. Goal: To examine U.S. trends in insurance coverage and the demographics of the remaining uninsured population, as well as affordability and satisfaction among adults with marketplace and Medicaid coverage...
September 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28836751/reducing-racial-and-ethnic-disparities-in-access-to-care-has-the-affordable-care-act-made-a-difference
#2
Susan L Hayes, Pamela Riley, David C Radley, Douglas McCarthy
ISSUE: Prior to the Affordable Care Act (ACA), blacks and Hispanics were more likely than whites to face barriers in access to health care. GOAL: Assess the effect of the ACA’s major coverage expansions on disparities in access to care among adults. METHODS: Analysis of nationally representative data from the American Community Survey and the Behavioral Risk Factor Surveillance System. FINDINGS AND CONCLUSIONS: Between 2013 and 2015, disparities with whites narrowed for blacks and Hispanics on three key access indicators: the percentage of uninsured working-age adults, the percentage who skipped care because of costs, and the percentage who lacked a usual care provider...
August 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28829534/how-medicaid-expansion-affected-out-of-pocket-health-care-spending-for-low-income-families
#3
Sherry Glied, Ougni Chakraborty, Therese Russo
ISSUE. Prior research shows that low-income residents of states that expanded Medicaid under the Affordable Care Act are less likely to experience financial barriers to health care access, but the impact on out-of-pocket spending has not yet been measured. GOAL. Assess how the Medicaid expansion affected out-of-pocket health care spending for low-income families compared to those in states that did not expand and consider whether effects differed in states that expanded under conventional Medicaid rules vs...
August 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28805362/how-the-affordable-care-act-has-helped-women-gain-insurance-and-improved-their-ability-to-get-health-care-findings-from-the-commonwealth-fund-biennial-health-insurance-survey-2016
#4
Munira Z Gunja, Sara R Collins, Michelle M Doty, Sophie Beautel
ISSUE: Prior to the Affordable Care Act (ACA), one-third of women who tried to buy a health plan on their own were either turned down, charged a higher premium because of their health, or had specific health problems excluded from their plans. Beginning in 2010, ACA consumer protections, particularly coverage for preventive care screenings with no cost-sharing and a ban on plan benefit limits, improved the quality of health insurance for women. In 2014, the law’s major insurance reforms helped millions of women who did not have employer insurance to gain coverage through the ACA’s marketplaces or through Medicaid...
August 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28745476/extending-marketplace-tax-credits-would-make-coverage-more-affordable-for-middle-income-adults
#5
Jodi Liu, Christine Eiber
ISSUE: Affordability of health coverage is a growing challenge for Americans facing rising premiums, deductibles, and copayments. The Affordable Care Act's tax credits make marketplace insurance more affordable for eligible lower-income individuals. However, individuals lose tax credits when their income exceeds 400 percent of the federal poverty level, creating a steep cliff. GOALS: To analyze the effects of extending eligibility for tax credits to individuals with incomes above 400 percent of the federal poverty level...
July 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28700190/getting-to-the-root-of-high-prescription-drug-prices
#6
Henry Waxman, Bill Corr, Kristi Martin, Sophia Duong
ISSUE: Historic increases in prescription drug prices and spending are contributing to unsustainable health care costs in the United States. There is widespread public support for elected officials to address the problem. GOAL: To document the drivers of high U.S. prescription drug prices and offer a broad range of feasible policy actions. METHODS: Interviews with experts and organizations engaged with prescription drug development and utilization, pricing, regulation, and clinical practice. Review of policy documents, proposals, and position statements from a variety of stakeholders...
July 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28641364/access-to-coverage-and-care-for-people-with-preexisting-conditions-how-has-it-changed-under-the-aca
#7
Sherry Glied, Adlan Jackson
ISSUE: Prior to the Affordable Care Act (ACA), people with preexisting health conditions could be denied insurance coverage or charged higher rates. If the law is repealed, these protections could be diluted or lost altogether. GOALS: Assess the ACA's impact on coverage and access for people with preexisting conditions and compare their coverage gains with state high-risk-pool enrollment pre-ACA. METHODS: Analysis of Behavioral Risk Factor Surveillance System data for the period 2011–13 to 2015. KEY FINDINGS AND CONCLUSIONS: Between 2013 and 2015, 16...
June 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28613067/the-american-health-care-act-economic-and-employment-consequences-for-states
#8
Leighton Ku, Erika Steinmetz, Erin Brantley, Nikhil Holla, Brian K Bruen
ISSUE: The American Health Care Act (AHCA), passed by the U.S. House of Representatives, would repeal and replace the Affordable Care Act. The Congressional Budget Office indicates that the AHCA could increase the number of uninsured by 23 million by 2026. GOAL: To determine the consequences of the AHCA on employment and economic activity in every state. METHODS: We compute changes in federal spending and revenue from 2018 to 2026 for each state and use the PI+ model to project the effects on states’ employment and economies...
June 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28613066/balance-billing-by-health-care-providers-assessing-consumer-protections-across-states
#9
Kevin Lucia, Jack Hoadley, Ashley Williams
ISSUE: Privately insured consumers expect that if they pay premiums and use in-network providers, their insurer will cover the cost of medically necessary care beyond their cost-sharing. However, when obtaining care at emergency departments and in-network hospitals, patients treated by an out-of-network provider may receive an unexpected "balance bill" for an amount beyond what the insurer paid. With no explicit federal protections against balance billing, some states have stepped in to protect consumers from this costly and confusing practice...
June 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28591975/an-overview-of-home-based-primary-care-learning-from-the-field
#10
Sarah Klein, Martha Hostetter, Douglas McCarthy
ISSUE: Homebound and functionally limited individuals are often unable to access office-based primary care, leading to unmet needs and increased health care spending. GOAL: Show how home-based primary care affects outcomes and costs for Medicare and Medicaid beneficiaries with complex care needs. METHODS: Qualitative synthesis of expert perspectives and the experiences of six case-study sites. FINDINGS AND CONCLUSIONS: Successful home-based primary care practices optimize care by: fielding interdisciplinary teams, incorporating behavioral care and social supports into primary care, responding rapidly to urgent and acute care needs, offering palliative care, and supporting family members and caregivers...
June 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28574235/how-arizona-medicaid-accelerated-the-integration-of-physical-and-behavioral-health-services
#11
Deborah Bachrach, Patricia M Boozang, Hailey E Davis
ISSUE: In most states, one agency has responsibility for Medicaid enrollees' physical health services and at least one other agency has responsibility for their behavioral health services. Apportioning responsibility for the physical and behavioral health of Medicaid beneficiaries into different agencies inevitably leads to different--and sometimes misaligned--policy goals, program priorities, and purchasing strategies, thereby impeding the delivery of integrated care. GOAL: To describe the rationale, process, and impact of Arizona's 2015 consolidation of its physical and behavioral health services agencies into its Medicaid agency...
May 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28574234/effect-of-the-affordable-care-act-on-health-care-access
#12
Sherry Glied, Stephanie Ma, Anais A Borja
ISSUE: The Affordable Care Act's (ACA) coverage provisions have extended health insurance coverage to millions of Americans. While the effects of the Medicaid expansion and marketplace establishments on coverage have been well studied, the resulting effects of coverage on access to health care remain unclear. GOAL: To examine how the 2014 coverage expansions affected health care access following the first open enrollment period of October 2013 to March 2014. METHODS: Analysis of data from the National Health Interview Survey (NHIS) and the Behavioral Risk Factor Surveillance System (BRFSS)...
May 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28574233/the-impact-of-the-aca-s-medicaid-expansion-on-hospitals-uncompensated-care-burden-and-the-potential-effects-of-repeal
#13
David Dranove, Craig Gartwaite, Christopher Ody
ISSUE: By increasing health insurance coverage, the Affordable Care Act's Medicaid eligibility expansion was also expected to lessen the uncompensated care burden on hospitals. The expansion currently faces an uncertain future. GOAL: To compare the change in hospitals' uncompensated care burden in the 31 states (plus the District of Columbia) that chose to expand Medicaid to the changes in states that did not, and to estimate how these expenses would be affected by repeal or further expansion. METHODS: Analysis of uncompensated care data from Medicare Hospital Cost Reports from 2011 to 2015...
May 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28498650/medicare-beneficiaries-high-out-of-pocket-costs-cost-burdens-by-income-and-health-status
#14
Cathy Schoen, Karen Davis, Amber Willink
ISSUE: Fifty-six million people--17 percent of the U.S. population--rely on Medicare. Yet, its benefits exclude dental, vision, hearing, and long-term services, and it contains no ceiling on out-of-pocket costs for covered services, exposing beneficiaries to high costs. GOAL: To inform discussion of possible changes to Medicare, this issue brief looks at beneficiaries’ out-of-pocket costs by income and health status. METHODS: Spending estimates based on the Medicare Current Beneficiary Survey. FINDINGS AND CONCLUSION: More than one-fourth of all Medicare beneficiaries--15 million people--spend 20 percent or more of their incomes on premiums plus medical care, including cost-sharing and uncovered services...
May 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28448109/how-medicaid-enrollees-fare-compared-with-privately-insured-and-uninsured-adults-findings-from-the-commonwealth-fund-biennial-health-insurance-survey-2016
#15
Munira Z Gunja, Sara R Collins, David Blumenthal, Michelle M Doty, Sophie Beutel
ISSUE: The number of Americans insured by Medicaid has climbed to more than 70 million, with an estimated 12 million gaining coverage under the Affordable Care Act’s Medicaid expansion. Still, some policymakers have questioned whether Medicaid coverage actually improves access to care, quality of care, or financial protection. GOALS: To compare the experiences of working-age adults who were either: covered all year by private employer or individual insurance; covered by Medicaid for the full year; or uninsured for some time during the year...
April 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28351118/how-will-repealing-the-aca-affect-medicaid-impact-on-health-care-coverage-delivery-and-payment
#16
Sara Rosenbaum, Sara Rothenberg, Sara Schmucker, Rachel Gunsalus, J. Zoë Beckerman
ISSUE: The Affordable Care Act enhanced Medicaid's role as a health care purchaser by expanding eligibility and broadening the range of tools and strategies available to states. All states have embraced delivery and payment reform as basic elements of their programs. GOAL: To examine the effects of reducing the size and scope of Medicaid under legislation to repeal the ACA. FINDINGS AND CONCLUSIONS: Were the ACA's Medicaid expansion to be eliminated and were federal Medicaid funding to experience major reductions through block grants or per capita caps, the effects on system transformation would be significant...
March 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28350430/insurance-coverage-access-to-care-and-medical-debt-since-the-aca-a-look-at-california-florida-new-york-and-texas
#17
Munira Z Gunja, Sara R Collins, Michelle McEvoy Doty, Sophie Beutel
ISSUE: The Affordable Care Act has significantly increased health insurance coverage and access to care among U.S. adults nationwide. However, the law gives states flexibility in implementing certain provisions, leading to wide variations between states in consumers’ experiences. GOAL: To examine the differences in insurance coverage, access to care, and medical bill problems in the four largest states—California, Florida, New York, and Texas—all of which have made different choices in implementing the law...
March 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28233972/evidence-from-the-private-option-the-arkansas-experience
#18
Bethany Maylone, Benjamin D Sommers
Issue: Arkansas was the first state to receive approval to expand Medicaid under the Affordable Care Act through a Section 1115 waiver. This approach, known as the "private option," uses Medicaid funds to purchase private health plans on the state’s marketplace. It is intended to promote market competition, continuity of coverage, and greater access to care. Goal: To describe the key features of the private option and evaluate its impact on health care for low-income adults in the state after two years. Methods: Survey data from 2013–2015 that assessed health insurance coverage, access to care, utilization, and self-reported health among low-income adults in Arkansas compared to adults in two other states...
February 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28211994/building-the-coverage-continuum-the-role-of-state-medicaid-directors-and-insurance-commissioners
#19
Joel Ario, Deborah Bachrach
Issue: The Affordable Care Act has expanded coverage to 20 million newly insured individuals, split between state Medicaid programs and commercially insured marketplaces, with limited integration between the two. The seamless continuum of coverage envisioned by the law is central to achieving the full potential of the Affordable Care Act, but it remains an elusive promise. Goals: To examine the historical and cultural differences between state Medicaid agencies and insurance departments that contribute to this lack of coordination...
February 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28182371/efforts-to-support-consumer-enrollment-decisions-using-total-cost-estimators-lessons-from-the-affordable-care-act%C3%A2-s-marketplaces
#20
Justin Giovannelli, Emily Curran
Issue: Policymakers have sought to improve the shopping experience on the Affordable Care Act’s marketplaces by offering decision support tools that help consumers better understand and compare their health plan options. Cost estimators are one such tool. They are designed to provide consumers a personalized estimate of the total cost--premium, minus subsidy, plus cost-sharing--of their coverage options. Cost estimators were available in most states by the start of the fourth open enrollment period. Goal: To understand the experiences of marketplaces that offer a total cost estimator and the interests and concerns of policymakers from states that are not using them...
February 2017: Issue Brief of the Commonwealth Fund
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