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Issue Brief of the Commonwealth Fund

Leighton Ku, Erin Brantley, Erika Steinmetz, Brian K Bruen, Pillai Drishti
Issue: The Centers for Medicare and Medicaid Services approved Medicaid work requirement demonstration projects in four states, and other states also have applied. However, the future of these projects has been clouded by legal and policy challenges. Goal: To assess whether state Medicaid work requirement projects are designed for success in promoting employment among unemployed Medicaid beneficiaries. Methods: To examine the design of new work requirement projects, we reviewed the evidence, analyzed the overlap of Medicaid and Supplemental Nutrition Assistance Program (SNAP) work requirements, and convened a roundtable of seven experts who have research or implementation experience with work programs for Medicaid and public assistance recipients...
November 1, 2018: Issue Brief of the Commonwealth Fund
Sherry A Glied, Adlan Jackson
Issue: A current Republican legislative proposal would permit insurers to offer plans that exclude coverage of treatment for preexisting health conditions, even while the bill would maintain the Affordable Care Act’s rule prohibiting denial of coverage to people with a preexisting condition. Goal: Estimate patients’ out-of-pocket costs for five common preexisting conditions if the bill were to become law and assess any additional impact on out-of-pocket expenditures if spending on care for preexisting conditions no longer counted against plan deductibles...
November 1, 2018: Issue Brief of the Commonwealth Fund
Mark A Hall, Michael J McCue
Issue: There has been relatively little discussion about the small-group employer insurance market since the implementation of reforms under the Affordable Care Act. It is important to understand the condition of this market before the impact of recent regulatory changes from the Trump administration. Goal: To understand how the ACA’s market reforms have affected prices, enrollment, and competition in the small-group market. Methods: Analysis of financial data filed by small-group insurers with the federal government, along with relevant published literature...
October 1, 2018: Issue Brief of the Commonwealth Fund
Cathy Schoen, Karen Davis, Christine Buttorf, Amber Willink
Issue: Out-of-pocket expenses are capped for enrollees in Medicare Advantage (MA) plans but not for beneficiaries in traditional Medicare, which also requires a high deductible for hospital care. The need for supplemental Medigap coverage adds to traditional Medicare’s complexity and administrative costs. Shortfalls in financial protection also make it difficult to offer traditional Medicare as a choice for people under age 65, as some have proposed. Goals: Describe alternative benefit designs that would limit out-of-pocket costs for traditional Medicare’s core services, assess their cost, and illustrate financing mechanisms...
October 1, 2018: Issue Brief of the Commonwealth Fund
Sara R Collins, Sherry A Glied, Adlan Jackson
Issue: With encouragement from the Trump administration, 14 states have received approval for or are pursuing work requirements for nondisabled Medicaid beneficiaries. The requirements have sparked controversy, including two legal challenges. Goal: To predict the effect of work requirements on the insurance coverage of Medicaid enrollees over time. Methods: Analysis of the coverage patterns of a national cohort of nondisabled adults in the federal Medical Expenditure Panel Survey...
October 1, 2018: Issue Brief of the Commonwealth Fund
David Chase, John Arensmeyer
Issue: Small-business owners have seen significant gains in health care coverage for themselves and their employees thanks to the Affordable Care Act. Though efforts to repeal the law failed in 2017, the current administration continues to take steps that undermine the law’s progress. In recent months, new rules have been announced that allow more groups to establish association health plans and extend the length of short-term health insurance plans. These changes are likely to impact the stability of the marketplaces and coverage rates for the small-business community...
October 1, 2018: Issue Brief of the Commonwealth Fund
Anna L Goldman, Benjamin D Sommers
Issue: Kansas remains one of 17 states that have not expanded Medicaid. In 2017, the Kansas legislature voted to expand Medicaid, but former Governor Sam Brownback vetoed the measure. Goal: To examine evidence on health care coverage and access among low-income Kansans and to review the potential impact of expanding Medicaid with the possible addition of a work requirement as a condition of eligibility. Methods: Findings from a telephone survey of 1,000 low-income nonelderly adults in Kansas were compared with data on low-income adults in Ohio and Indiana, both of which expanded Medicaid...
September 1, 2018: Issue Brief of the Commonwealth Fund
Cathy Schoen, Karen Davis, Amber Willink, Christine Buttorf
Issue: An estimated 40 percent of low-income Medicare beneficiaries spend 20 percent or more of their incomes on premiums and health care costs. Low-income beneficiaries with multiple chronic conditions or high need are at particular risk of financial hardship. High cost burdens reflect Medicare premiums and cost-sharing, gaps in benefits, and limited assistance. Existing policies to help people with low incomes are fragmented — meaning that beneficiaries apply separately, sometimes to different offices — and require Medicare beneficiaries to navigate complex applications...
September 1, 2018: Issue Brief of the Commonwealth Fund
Jame C Robinson
Issue: Reference pricing is an emerging health insurance benefit design aimed at reducing health costs. In this model, an insurer establishes a maximum payment that it will contribute toward covering the price of a product or service in situations where there is wide price variation for therapeutically similar drugs, diagnostics, or procedures. Experiences to date indicate that reference pricing can influence patients and physicians to switch to less costly options within each therapeutic class, reducing overall drug prices...
September 1, 2018: Issue Brief of the Commonwealth Fund
Jodi Liu, Christine Eibner
Issue: Recent changes to the Affordable Care Act, including elimination of the individual mandate penalty, the halting of federal payments for cost-sharing reductions, and expanded access to short-term plans, may reduce enrollment in the individual market. Goal: Analyze options to increase enrollment, accounting for recent policy changes. Methods: RAND’s COMPARE microsimulation model is used to analyze six policies that would expand access to tax credits, increase their generosity, and fund a reinsurance program...
August 1, 2018: Issue Brief of the Commonwealth Fund
JoAnn Volk, Emily Curran, Justin Giovannelli
Issue: Health care sharing ministries (HCSMs) are a form of health coverage in which members--who typically share a religious belief--make monthly payments to cover expenses of other members. HCSMs do not have to comply with the consumer protections of the Affordable Care Act and may provide value for some individuals, but pose risks for others. Although HCSMs are not insurance and do not guarantee payment of claims, their features closely mimic traditional insurance products, possibly confusing consumers...
August 1, 2018: Issue Brief of the Commonwealth Fund
Karen Davis, Amber Willink, Ian Stockwell, Kaitlyn Whiton, Julia Burgdorf, Cynthia Woodcock
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June 1, 2018: Issue Brief of the Commonwealth Fund
Nathan D Shippee, Katherine D Vickery
Issue: Access to health care, use of services, and patient outcomes can be complicated by many medical and nonmedical factors. People facing complex challenges such as mental illness, housing insecurity, or substance use, however, are not a homogeneous group; different individuals have different needs. Goals: To understand the needs of people with very low income--no more than 75 percent of the federal poverty level--who enrolled in Medicaid under Minnesota’s expansion of the program prior to the Affordable Care Act...
May 1, 2018: Issue Brief of the Commonwealth Fund
Stan Dorn
Issue: Consumers' concerns about affordability limit participation in ACA marketplaces. Funded by local hospital systems and run by independent nonprofits, third-party payment (TPP) programs improve affordability for low-income consumers by paying premium costs not covered by tax credits. Goal: To assess the potential of TPP to make marketplace coverage more affordable, without harming insurance risk pools. Methods: Interviews in May and June 2016 with program administrators, hospital systems, carriers, and consumer groups in five localities and the Washington State marketplace...
May 1, 2018: Issue Brief of the Commonwealth Fund
Henry Waxman, Bill Corr, Kristi Martin, Sophia Duong
Issue: Prescription drug prices have been climbing, creating significant barriers for patients. Since becoming U.S. Food and Drug Administration (FDA) Commissioner, Scott Gottlieb announced an action plan and several policy changes to increase generic drug competition and transparency to address high prescription drug prices. Goal: This issue brief aims to explain the FDA's plan of action and assess its implementation to date. It also aims to assess whether FDA actions, if implemented, address the known problems leading to high drug pricing...
April 1, 2018: Issue Brief of the Commonwealth Fund
Sherry Glied, Ougni Chakraborti
Issue: The Affordable Care Act (ACA) regulates the price of health plans sold in the nongroup market. Premiums cannot be based on gender or health status, and price increases related to age are limited. These changes have lowered premiums for older, sicker people but raised them for younger, healthier ones--especially young men ineligible for premium subsidies. This has raised concerns that the latter have failed to gain coverage. Goal: Compare the impact of the ACA's rating rules on the number of insured young men, older adults, and others...
April 1, 2018: Issue Brief of the Commonwealth Fund
Stuart Guterman, Laura Skopec, Stephen Zuckerman
Issue: Medicare Advantage (MA) enrollment has grown significantly since 2009, despite legislation that reduced what Medicare pays these plans to provide care to enrollees. MA payments, on average, now approach parity with costs in traditional Medicare. Goal: Examine changes in per enrollee costs between 2009 and 2014 to better understand how MA plans have continued to thrive even as payments decreased. Methods: Analysis of Medicare data on MA plan bids, net of rebates...
March 1, 2018: Issue Brief of the Commonwealth Fund
Jon R Gabel, Heidi Whitmore, Matthew Green, Sam Stromber
Issue: In 2017, five states--Alabama, Alaska, Oklahoma, South Carolina, and Wyoming--had only one issuer participating in their health care marketplaces, limiting consumer choice and competition among insurers. Goal: Examine the history of participation in the individual market from 2010 (before the Affordable Care Act was enacted) to 2017, and analyze premium changes among marketplace plans. Methods: Robert Wood Johnson Foundation's HIX Compare, which provides national data on the marketplaces from 2014 to 2017...
March 1, 2018: Issue Brief of the Commonwealth Fund
Amber Willink, Cathy Shoen, Karen Davis
Issue: The Medicare program specifically excludes coverage of dental, vision, and hearing services. As a result, many beneficiaries do not receive necessary care. Those that do are subject to high out-of-pocket costs. Goal: Examine gaps in access to dental, vision, and hearing services for Medicare beneficiaries and design a voluntary dental, vision, and hearing benefit plan with cost estimates. Methods: Uses the Medicare Current Beneficiary Survey, Cost and Use File, 2012, with population and costs projected to 2016 values...
January 1, 2018: Issue Brief of the Commonwealth Fund
Ruben Amarashingham, Bin Xie, Albert Karam, Nam Nguyen, Bianca Kapoor
Issue: Our health care and social services delivery systems are not well-equipped to effectively manage patients with multiple chronic diseases and complex social needs such as food, housing, or substance abuse services. Community-level efforts have emerged across the nation to integrate the activities of disparate social service organizations with local health care delivery systems. Evidence on the experiences and outcomes of these programs is emerging, and there is much to learn about their approaches and challenges...
January 1, 2018: Issue Brief of the Commonwealth Fund
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