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Map: How Many Americans Could Lose Subsidies If the Supreme Court Rules for the Plaintiffs in King vs. Burwell?

November 20, 2014 Comments off

Map: How Many Americans Could Lose Subsidies If the Supreme Court Rules for the Plaintiffs in King vs. Burwell?
Source: Kaiser Family Foundation

This map based on Foundation analysis of Congressional Budget Office estimates of Marketplace enrollment provides a state-level breakdown of the number of Americans who in 2016 could be denied financial assistance to help pay insurance premiums for plans purchased in the Affordable Care Act’s federally operated insurance exchanges.

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What Do We Know About Health Care Access and Quality in Medicare Advantage Versus the Traditional Medicare Program?

November 13, 2014 Comments off

What Do We Know About Health Care Access and Quality in Medicare Advantage Versus the Traditional Medicare Program?
Source: Kaiser Family Foundation

While the majority of Medicare beneficiaries still receive their benefits through the traditional Medicare program, 30 percent now obtain them through private health plans participating in Medicare Advantage. As the number of Medicare Advantage enrollees continues to climb, there is growing interest in understanding how the care provided to Medicare beneficiaries in Medicare Advantage plans differs from the care received by beneficiaries in traditional Medicare.

Despite the interest, the last comprehensive review of research evidence on health care access and quality in Medicare Advantage and traditional Medicare is more than 10 years old and did not focus exclusively on Medicare (Miller and Luft 2002). That study found that health maintenance organizations (HMOs) provide care that is roughly comparable in quality to the care provided by non-HMOs (mainly traditional indemnity insurance), and that quality varied across health plans. It also found that HMOs used somewhat fewer hospital and other expensive resources in delivering care, with enrollees rating them worse on many measures of access and satisfaction. However, the market has changed substantially over the last decade, making it important that policymakers have available more current analysis, particularly on Medicare health plans.

This literature review synthesizes the findings of studies that focus specifically on Medicare and have been published between the year 2000 and early 2014. Forty-five studies met the criteria for selection, including 40 that made direct comparisons between Medicare health plans and traditional Medicare. An additional five studies are included, even though they have no traditional Medicare comparison group, because they include a comparison of health care access and quality in different types of Medicare Advantage plans. A full list of the studies included in this analysis is found in the Works Cited.

Analysis of 2015 Premium Changes in the Affordable Care Act’s Health Insurance Marketplaces

November 12, 2014 Comments off

Analysis of 2015 Premium Changes in the Affordable Care Act’s Health Insurance Marketplaces
Source: Kaiser Family Foundation

With the second open enrollment period of the health insurance marketplaces approaching, this analysis provides an initial look at premium changes for marketplace plans for individuals in 15 states and the District of Columbia that have publicly released comprehensive data on rates or rate filings for all insurers.

The analysis examines premium changes for the lowest-cost bronze plan and the two lowest-cost silver plans in 16 major cities. The second-lowest cost silver plan in each state is of particular interest as it acts as a benchmark that helps determine how much assistance eligible individuals can receive in the form of federal tax credits. The findings show that in general, individuals will pay slightly less to enroll in the second-lowest cost plan in 2015 than they did in 2014, prior to the application of tax credits.

Although premium changes vary substantially across and within states, premium changes for 2015 in general are modest when looking at the low-cost insurers in the marketplaces, where enrollment is concentrated. While the analysis provides an early look at how competitive dynamics may be influencing health insurance premiums, it is important to bear in mind that the overall picture may change as comprehensive data across all fifty states becomes available.

Data Note: Gearing Up For Round 2 of Open Enrollment: Some Lessons From Round 1

November 8, 2014 Comments off

Data Note: Gearing Up For Round 2 of Open Enrollment: Some Lessons From Round 1
Source: Kaiser Family Foundation

As the second round of open enrollment approaches, policy makers, journalists, insurers and enrollment groups may want to keep in mind what health insurance shoppers told us about their experiences during the first open enrollment period. Two Kaiser Family Foundation surveys conducted last spring after the first open enrollment came to a close explored the shopping experience among two key groups impacted by the ACA: non-group health insurance purchasers and the previously uninsured in California, the state with the largest number of uninsured in the country prior to the ACA. This data note examines selected findings from each of these surveys that shed light on how people navigated the new options and choices available under the ACA during last fall’s open enrollment, with the hope of informing our understanding of individuals needs during this second open enrollment period.

Four key takeaways emerge from these surveys:

  1. The websites were just one way people got information and enrolled in health plans – many also got help in person or over the phone.
  2. Costs, including the monthly premiums, deductible, and copays, were important factors in plan choice.
  3. Outreach efforts that reached individuals directly helped to boost enrollment
  4. Both those who successfully enrolled in coverage as well as those who remained uninsured expressed some trouble with the process, such as difficulty finding health insurance information, figuring out if their income qualified them for financial assistance, and comparing coverage and costs across plans.

ACA Advertising in 2014 – Insurance and Political Ads

October 31, 2014 Comments off

ACA Advertising in 2014 – Insurance and Political Ads
Source: Kaiser Family Foundation

Since the passage of the Affordable Care Act (ACA) in 2010, the law has been an often potent and divisive political issue, and has sparked an unprecedented amount of political and campaign advertising, particularly from candidates and groups that oppose the law. According to Kantar Media’s Campaign Media Analysis Group (CMAG), no other federal program or policy has resulted in the kind of advertising the ACA has caused, namely the combination of new insurance “product” advertising and sustained political advertising across multiple election cycles.

This year, Americans saw the launch of the ACA’s insurance market reforms, the implementation of the state and federal exchanges where people can shop for coverage and access subsidies, and the expansion of Medicaid in many states. Alongside these policy changes, new stakeholders began to advertise to encourage participation in the new coverage options, including state and federal governments, non-profit groups looking to boost enrollment, and health insurance companies seeking new customers. The mid-term elections have also brought a new collection of political advertising with ACA messaging. These two distinct types of advertising have different goals and aims; some encourage people to take advantage of new options under the ACA, while others encourage people to vote a certain way. With both of these types of advertising making their way into American living rooms in 2014, this analysis describes the full spectrum of ads that the American public is being exposed to regarding health care, both in the context of health insurance coverage, and as a political issue in the mid-term elections.

Explaining Health Care Reform: Questions About Health Insurance Subsidies

October 29, 2014 Comments off

Explaining Health Care Reform: Questions About Health Insurance Subsidies
Source: Kaiser Family Foundation

Good health insurance can be expensive, and is therefore often out of reach for lower and moderate income families, particularly if they are not offered health benefits at work. To make coverage obtainable for families that otherwise could not afford it and to encourage broad participation in health insurance, the Affordable Care Act (ACA) includes provisions to lower premiums and out-of-pocket costs for people with low and modest incomes. The adequacy of this assistance will be a key determinant of how many people ultimately gain coverage and whether or not lower-income people will be able to use the health insurance they obtain.

This brief provides an overview of the financial assistance provided under the ACA for people purchasing coverage on their own through health insurance Marketplaces (also called exchanges). In addition to offering financial assistance to some people purchasing their own private coverage, the ACA also gives states the option to bolster public coverage by expanding their Medicaid programs to cover people with incomes under 138% of the Federal Poverty Level (FPL). While this brief focuses on the premium tax credit and cost-sharing subsidies for marketplace enrollees, expanded coverage for low income people through Medicaid and new tax credits for small businesses are addressed in other reports.

Implementing The ACA: Medicaid Spending & Enrollment Growth For FY 2014 And FY 2015

October 16, 2014 Comments off

Implementing The ACA: Medicaid Spending & Enrollment Growth For FY 2014 And FY 2015 (PDF)
Source: Kaiser Family Foundation

Medicaid spending and enrollment growth are affected by both the economy and policy decisions determining who is covered under the program, the services provided and payments for care. For more than a decade, economic conditions, including two major recessions, were the primary driver of changes in Medicaid spending and enrollment. In FY 2014 and in budgets adopted for FY 2015, enrollment and spending have grown with implementation of the major coverage provisions in the Affordable Care Act (ACA), including the federally financed Medicaid expansion. This report provides an overview of Medicaid spending and enrollment growth with a focus on state fiscal years 2014 and 2015 (FY 2014 and FY 2015) and an overview of Medicaid financing. Findings are based on interviews and data provided by state Medicaid directors as part of the 14th annual survey of Medicaid directors in all 50 states and the District of Columbia conducted by the Kaiser Commission on Medicaid and the Uninsured (KCMU) with Health Management Associates (HMA). Findings examine changes in overall enrollment and spending growth and compare expansion and non-expansion states.

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