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Gaining Ground: Americans’ Health Insurance Coverage and Access to Care After the Affordable Care Act’s First Open Enrollment Period

July 14, 2014 Comments off

Gaining Ground: Americans’ Health Insurance Coverage and Access to Care After the Affordable Care Act’s First Open Enrollment Period
Source: Commonwealth Fund

A new Commonwealth Fund survey finds that in the wake of the Affordable Care Act’s first open enrollment period, significantly fewer working-age adults are uninsured than just before the sign-up period began, and many have used their new coverage to obtain needed care.

The uninsured rate for people ages 19 to 64 declined from 20 percent in the July-to-September 2013 period to 15 percent in the April-to-June 2014 period. An estimated 9.5 million fewer adults were uninsured. Young men and women drove a large part of the decline: the uninsured rate for 19-to-34-year-olds declined from 28 percent to 18 percent, with an estimated 5.7 million fewer young adults uninsured. By June, 60 percent of adults with new coverage through the marketplaces or Medicaid reported they had visited a doctor or hospital or filled a prescription; of these, 62 percent said they could not have accessed or afforded this care previously.

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Raising Expectations 2014: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers

June 23, 2014 Comments off

Raising Expectations 2014: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers
Source: AARP and Commonwealth Fund

This report by AARP’s Public Policy Institute, The Commonwealth Fund and The SCAN Foundation shows some states significantly out-perform others in the delivery of long-term services and supports (LTSS) to older adults and people with disabilities.

While states are making measureable progress in improving long term services and supports (LTSS) – which includes home care services, family caregiver supports, and residential services such as nursing homes – widespread disparities still exist across the country, with even top performing states requiring improvement. Further, the pace of change remains slow, threatening states’ ability to meet the needs of the aging population.

The LTSS Scorecard evaluates performance in five key dimensions: (1) affordability and access, (2) choice of setting and provider, (3) quality of life and quality of care, (4) support for family caregivers, and (5) effective transitions. New indicators this year include length of stay in nursing homes and use of anti-psychotic drugs by nursing homes, raising serious concerns about the quality of institutionalized care.

Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally

June 16, 2014 Comments off

Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally
Source: Commonwealth Fund

The United States health care system is the most expensive in the world, but this report and prior editions consistently show the U.S. underperforms relative to other countries on most dimensions of performance. Among the 11 nations studied in this report—Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States—the U.S. ranks last, as it did in the 2010, 2007, 2006, and 2004 editions of Mirror, Mirror. Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last or near last on dimensions of access, efficiency, and equity. In this edition of Mirror, Mirror, the United Kingdom ranks first, followed closely by Switzerland .

Aiming Higher: Results from a Scorecard on State Health System Performance, 2014

June 13, 2014 Comments off

Aiming Higher: Results from a Scorecard on State Health System Performance, 2014
Source: Commonwealth Fund

The Commonwealth Fund’s Scorecard on State Health System Performance, 2014, assesses states on 42 indicators of health care access, quality, costs, and outcomes over the 2007–2012 period, which includes the Great Recession and precedes the major coverage expansions of the Affordable Care Act. Changes in health system performance were mixed overall, with states making progress on some indicators while losing ground on others. In a few areas that were the focus of national and state attention—childhood immunizations, hospital readmissions, safe prescribing, and cancer deaths—there were widespread gains. But more often than not, states exhibited little or no improvement. Access to care deteriorated for adults, while costs increased. Persistent disparities in performance across and within states and evidence of poor care coordination highlight the importance of insurance expansions, health care delivery reforms, and payment changes in promoting a more equitable, high-quality health system.

The mixed performance of states’ health systems over the five years preceding implementation of the Affordable Care Act’s major reforms sends a clear message that states and the nation are still a long way from becoming places where everyone has access to high-quality, affordable care and an equal opportunity for a long and healthy life. In tracking 42 measures of health care access, quality, costs, and outcomes between 2007 and 2012 for the 50 states and the District of Columbia, The Commonwealth Fund’s Scorecard on State Health System Performance, 2014, finds that, on a significant majority of measures, the story is mostly one of stagnation or decline. In most parts of the country, performance worsened on nearly as many measures as it improved.

New State-by-State Analysis: 32 Million Were Underinsured in 2012, Including 4 Million Middle-Income People; Nearly 80 Million in Total Lacked Health Insurance or Were Underinsured, Ranging from 14 Percent in Massachusetts to 38 Percent in New Mexico and Texas

April 11, 2014 Comments off

New State-by-State Analysis: 32 Million Were Underinsured in 2012, Including 4 Million Middle-Income People; Nearly 80 Million in Total Lacked Health Insurance or Were Underinsured, Ranging from 14 Percent in Massachusetts to 38 Percent in New Mexico and Texas
Source: Commonwealth Fund

Thirty-two million people under age 65 were underinsured in the U.S. in 2012, meaning they had health coverage but it provided inadequate protection against high health care costs relative to their income, a new Commonwealth Fund report finds. The first report to examine the underinsured at the state level, it finds that the rate of underinsured ranged from a low of 8 percent in New Hampshire to highs of 16 percent in Mississippi and Tennessee and 17 percent in Idaho and Utah.

Low- and middle-income families were most likely to be affected: 13 percent—4 million—of the underinsured were middle-income, earning between about $47,000 and $95,000 for a family of four, and 81 percent—26 million—were low-income, earning less than 200 percent of the federal poverty level, or under $47,000 a year for a family of four.

In addition, 47 million people were uninsured in 2012—a decline of nearly 2 million from 2010, likely due in large part to the Affordable Care Act’s early provision to expand dependent coverage for young adults.

Before the major expansions of the ACA began to be implemented this year, a total of 79 million people under 65 were uninsured or underinsured, and therefore at risk for not being able to afford needed health care or for facing debt from medical bills in 2012. Nationally, nearly one of three (29%) people were uninsured or underinsured, ranging from 14 percent in Massachusetts to 36 to 38 percent in Florida, Idaho, Nevada, New Mexico, and Texas.

The Affordable Care Act’s Medicaid expansion and health insurance reforms are appropriately targeted to those Americans who are most likely to be unable to afford insurance or needed health care, according to the report, America’s Underinsured: A State-by-State Look at Health Insurance Affordability Prior to the New Coverage Expansions. Based on their incomes alone, 20 million of the underinsured in 2012, as well as 24 million of the uninsured, would qualify for Medicaid under the Affordable Care Act.

However, millions who are poor will not have any new coverage options. In states choosing not to expand Medicaid, more than 15 million underinsured and uninsured people have incomes below poverty—earning less than $23,550 a year for a family of four

Implementing the Affordable Care Act: Key Design Decisions for State-Based Exchanges

September 12, 2013 Comments off

Implementing the Affordable Care Act: Key Design Decisions for State-Based Exchanges
Source: Commonwealth Fund

The Affordable Care Act requires the establishment of new health insurance marketplaces—known as exchanges—in every state by October 1, 2013. This report examines key design decisions made by the 17 states and the District of Columbia that chose to establish a state-based exchange. The analysis finds that states made significant progress in structuring their exchanges, with states varying in their design decisions. Many states expect to exceed some federal requirements—to collect and display quality data, for instance—for 2014. These findings suggest that states capitalized on the flexibility provided by the Affordable Care Act to tailor their exchanges to their unique needs and made decisions with an eye towards outcomes, such as enrollment, consumer experience, and sustainability. These findings also suggest that states’ initial decisions will inform future exchange implementation and that states will adjust their decisions while continuing to adopt innovative approaches to accomplish policy goals.

Covering Young Adults Under the Affordable Care Act: The Importance of Outreach and Medicaid Expansion

August 21, 2013 Comments off

Covering Young Adults Under the Affordable Care Act: The Importance of Outreach and Medicaid Expansion (PDF)
Source: Commonwealth Fund

There is concern that many young adults (ages 19–29) will remain without health insurance in 2014 despite the Affordable Care Act’s reforms, including subsidized private coverage offered in new state marketplaces and expanded Medicaid eligibility. How things turn out will likely depend on outreach efforts and states’ decisions on expanding Medicaid. Commonwealth Fund Health Insurance Tracking Survey data from 2011 and 2013 show increasing awareness among young adults of the 2010 requirement that health plans cover children under age 26. Of the estimated 15 million young adults enrolled in a parent’s plan in the prior 12 months, 7.8 million would not likely have been eligible to enroll prior to the law. Still, only 27 percent of 19-to-29-year-olds are aware of the marketplaces. Meanwhile, most uninsured young adults living below poverty will not have access to subsidized public or private insurance in states opting out of the Medicaid expansion.

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