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After the Wars: Survey of Iraq and Afghanistan Active Duty Soldiers and Veterans

March 30, 2014 Comments off

After the Wars: Survey of Iraq and Afghanistan Active Duty Soldiers and Veterans
Source: Kaiser Family Foundation

This partnership poll from The Washington Post and the Kaiser Family Foundation explores the views and experiences of adults who served in the Iraq or Afghanistan wars as members of the U.S. military in the period after the terrorist attacks of Sept. 11, 2001. The majority of veterans of these conflicts say that Americans appreciate their service and that gestures of support are genuine, but many report a number of challenges, including economic struggles, worse physical and mental health than prior to their engagement, and feeling disconnected from civilian life. The survey also includes findings on attitudes towards the government and the military, views on women serving in combat roles, and insight into the physical and mental toll the war has taken on these soldiers.

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The Numbers Behind “Young Invincibles” and the Affordable Care Act

December 19, 2013 Comments off

The Numbers Behind “Young Invincibles” and the Affordable Care Act
Source: Kaiser Family Foundation

As enrollment statistics in the new health insurance marketplaces start to become available, there is a growing focus on whether the enrollment of so-called “young invincibles” will be sufficient to keep insurance markets stable. Enrollment of young adults is important, but not as important as conventional wisdom suggests since premiums are still permitted to vary substantially by age. Because of this, a premium “death spiral” is highly unlikely.

The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid

December 3, 2013 Comments off

The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid
Source: Kaiser Family Foundation

The expansion of Medicaid eligibility to nearly all low-income adults is a core component of the coverage provisions in the 2010 Affordable Care Act (ACA). The ACA Medicaid expansion provides a link between new private coverage options available through either Health Insurance Marketplaces or employers and the existing Medicaid program, which previously had many gaps in coverage for adults. Historically, Medicaid eligibility generally was restricted to low income individuals in a specified category, such as children, their parents, the aged, or individuals with disabilities. In most states, adults without dependent children were not eligible for Medicaid. Further, eligibility levels for parents were generally set very low and varied greatly across states. As a result, only 30% of poor nonelderly adults had Medicaid coverage in 2012, compared to 70% of poor children, and uninsured rates for poor adults (42%) were well over twice the national average (18%).

The expansion of Medicaid, effective in January 2014, fills in historical gaps in Medicaid eligibility for low-income adults and has the potential to extend health coverage to millions of currently uninsured individuals. This expansion essentially sets a national Medicaid income eligibility level of 138% of poverty (about $27,000 for a family of three) for adults. The expansion was intended to be national and to be the vehicle for covering low-income individuals, with premium tax credits for Marketplace coverage serving as the vehicle for covering people with higher incomes. However, the June 2012 Supreme Court ruling made the expansion of Medicaid optional for states, and as of October 2013, 25 states did not plan to implement the expansion.

In states that do not expand Medicaid, nearly five million poor uninsured adults have incomes above Medicaid eligibility levels but below poverty and may fall into a “coverage gap” of earning too much to qualify for Medicaid but not enough to qualify for Marketplace premium tax credits. Most of these people have very limited coverage options and are likely to remain uninsured. This brief describes the coverage gap and presents estimates of the population that falls into this situation. An overview of the methodology underlying the analysis can be found in the Methods box at the end of the report, and more detail is available in the accompanying Technical Appendices.

Medicaid in a Historic Time of Transformation: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2013 and 2014

November 4, 2013 Comments off

Medicaid in a Historic Time of Transformation: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2013 and 2014
Source: Kaiser Family Foundation

The dominant forces shaping Medicaid during FY 2013 and heading into FY 2014 were the implementation of the Affordable Care Act (ACA) and the development and implementation of an array of delivery and payment system reforms. These changes represent some of the most significant changes to Medicaid since its enactment in 1965, and taken together, are transforming the role of Medicaid in the health care system in each state. At this time, the intensity of fiscal pressures and the focus on cost Medicaid containment were somewhat lessened as the economy slowly recovers; however, controlling costs and improving program administration are still important priorities for Medicaid program. The findings in this report are drawn from the 13th annual budget survey of Medicaid officials in all 50 states and the District of Columbia conducted by the Kaiser Commission on Medicaid and the Uninsured and Health Management Associates (HMA). The report highlights trends in Medicaid spending, enrollment and policy initiatives for FY 2013 and FY 2014 with an intense focus on eligibility and enrollment changes tied to the implementation of the ACA as well as payment and delivery system changes. The report provides detailed appendices with state-by-state information and a more in-depth look at four case study states: Arizona, Florida, Kentucky and Washington

2013 Employer Health Benefits Survey

September 16, 2013 Comments off

2013 Employer Health Benefits Survey
Source: Kaiser Family Foundation

This annual survey of employers provides a detailed look at trends in employer-sponsored health coverage, including premiums, employee contributions, cost-sharing provisions, and other relevant information. The 2013 survey included almost three thousand interviews with non-federal public and private firms.

Annual premiums for employer-sponsored family health coverage reached $16,351 this year, up 4 percent from last year, with workers on average paying $4,565 towards the cost of their coverage, according to the Kaiser Family Foundation/Health Research & Educational Trust (HRET) 2013 Employer Health Benefits Survey.

An Early Look at Premiums and Insurer Participation in Health Insurance Marketplaces, 2014

September 9, 2013 Comments off

An Early Look at Premiums and Insurer Participation in Health Insurance Marketplaces, 2014 (PDF)
Source: Kaiser Family Foundation

Under the Affordable Care Act (ACA), individuals and families may purchase private insurance coverage through new state-based exchanges (or “Marketplaces”), which are set to open in October of this year for coverage beginning January 1, 2014. In states that decide against operating their own exchanges, the federal government will either run the exchange or work in partnership with the state to create an exchange. Regardless of whether an exchange is state-run or federally-facilitated, enrollees with family incomes from one to four times the federal poverty level (about $24,000 to $94,000 for a family of four) may qualify for tax credits that will lower the cost of coverage through reduced premiums and, in some cases, also be eligible for subsidies to reduce their out-of-pocket costs. This report presents an early look at insurer participation and exchange premiums –both before and after tax credits –for enrollees in the 17 states plus the District of Columbia that have publicly released comprehensive data on rates or the rate filings submitted by insurers. These include eleven states operating their own exchanges and seven defaulting to a federally-facilitated exchange. Plan availability and premiums for all states are expected to be available by October 1.

Employer-Sponsored Family Health Premiums Rise a Modest 4 Percent in 2013, National Benchmark Employer Survey Finds

August 20, 2013 Comments off

Employer-Sponsored Family Health Premiums Rise a Modest 4 Percent in 2013, National Benchmark Employer Survey Finds
Source: Kaiser Family Foundation

Annual premiums for employer-sponsored family health coverage reached $16,351 this year, up 4 percent from last year, with workers on average paying $4,565 toward the cost of their coverage, according to the Kaiser Family Foundation/Health Research & Educational Trust (HRET) 2013 Employer Health Benefits Survey released today. During the same period, workers’ wages and general inflation were up 1.8 percent and 1.1 percent respectively.

This year’s rise in premiums remains moderate by historical standards. Since 2003, premiums have increased 80 percent, nearly three times as fast as wages (31 percent) and inflation (27 percent).

Quantifying Tax Credits for People Now Buying Insurance on Their Own

August 15, 2013 Comments off

Quantifying Tax Credits for People Now Buying Insurance on Their Own
Source: Kaiser Family Foundation

A number of states have recently released information on what premiums will be in the individual insurance market in 2014, when significant changes in that market take effect due to the Affordable Care Act (ACA). In some cases, states have provided estimates of how those premiums compare to what people buying their own insurance are paying today.

However, these premiums are in effect “sticker prices” that many people will not pay because they will be eligible for federal tax credits under the ACA to offset the cost of insurance. In this data note, we explain how the tax credits will work and estimate how much premium assistance people now buying their own insurance will be eligible for in 2014.

State Decisions on Health Insurance Exchanges and the Medicaid Expansion, as of June 20, 2013

July 16, 2013 Comments off

State Decisions on Health Insurance Exchanges and the Medicaid Expansion, as of June 20, 2013
Source: Kaiser Family Foundation

Data are as of June 20, 2013. It is important to note that per CMS guidance, there is no deadline for states to implement the Medicaid expansion. Requirements for legislation to implement the Medicaid expansion vary across states; some state will require authorizing language and/or budgetary authority to implement the expansion while others will not.

Coverage through the exchanges will begin in every state on January 1, 2014, with enrollment beginning October 1, 2013. States can elect to build a fully state-based exchange, enter into a state-federal partnership exchange, or default into a federally-facilitated exchange. The Affordable Care Act (ACA) directs the Secretary of Health and Human Services (HHS) to establish and operate a federally-facilitated exchange in any state that is not able or willing to establish a state-based exchange. In a federally-facilitated exchange, HHS will perform all exchange functions. States entering into a state-federal partnership exchange may administer plan management functions, in-person consumer assistance functions, or both, and HHS will perform the remaining exchange functions.

The ACA expands Medicaid coverage for most low-income adults to 138% of the federal poverty level (FPL) ($15,415 for an individual or $26,344 for a family of three in 2012). Following the June 2012 Supreme Court decision, states face a decision about whether to adopt the Medicaid expansion.

The HPV Vaccine: Access and Use in the U.S.

July 16, 2013 Comments off

The HPV Vaccine: Access and Use in the U.S.
Source: Kaiser Family Foundation

Vaccination rates have slowly been increasing for the two vaccines that protect young people against infection by certain strains of the human papillomavirus (HPV), the most common sexually transmitted infection (STI) in the United States. The vaccines were originally recommended only for girls and young women and were subsequently broadened to include the recommendations for boys and young men. This factsheet discusses HPV and related cancers, use of the HPV vaccines for both females and males, and insurance coverage and access to the vaccines.

State Spending On Consumer Assistance Could Have ‘Huge Impact’ On Marketplace Enrollment

May 6, 2013 Comments off

State Spending On Consumer Assistance Could Have ‘Huge Impact’ On Marketplace Enrollment
Source: Kaiser Health News

Florida is on course to spend $6 million to reach out to nearly 4 million uninsured people and help them sign up for coverage in the federal health law’s online marketplace this fall.

Maryland will spend more than four times as much, or about $24.8 million, to help about 730,000 uninsured. The District of Columbia expects to spend about $9 million assisting 42,000 uninsured.

The wide variation in spending to hire and train people to provide consumer assistance in the first year of the new marketplaces could have a major impact on how many people actually get coverage under Obamacare, experts say.

Yet states with some of the nation’s highest uninsured rates, such as Florida and Texas, are getting far less federal money per uninsured resident than states with low rates, such as Maryland, Vermont and Rhode Island, according to a Kaiser Health News analysis.

Ensuring the Health Care Needs of Women: A Checklist for Health Exchanges

March 7, 2013 Comments off

Ensuring the Health Care Needs of Women: A Checklist for Health Exchanges

Source: Kaiser Family Foundation

To inform the development of the state health insurance Exchanges under the Affordable Care Act, this checklist identifies key coverage, affordability and access issues that are important for women. Based on lessons learned from women’s health research and the Massachusetts experience, the checklist considers essential health benefits, implementation of no-cost preventive services including contraception, provider networks and affordability, outreach and enrollment efforts, and the importance of including gender and other demographic characteristics in data collection and reporting standards. It was jointly authored by policy experts at the Kaiser Family Foundation, The Connors Center for Women’s Health and Gender Biology at the Brigham and Women’s Hospital and the Jacobs Institute of Women’s Health at The George Washington University.

The Cost and Coverage Implications of the ACA Medicaid Expansion: National and State-by-State Analysis

December 18, 2012 Comments off

The Cost and Coverage Implications of the ACA Medicaid Expansion: National and State-by-State Analysis

Source: Kaiser Family Foundation

A central goal of the Patient Protection and Affordable Care Act (ACA) is to significantly reduce the number of uninsured by providing a continuum of affordable coverage options through Medicaid and new Health Insurance Exchanges. Following the June 2012 Supreme Court decision, states face a decision about whether to adopt the Medicaid expansion. These decisions will have enormous consequences for health coverage for the low-income population.

This analysis uses the Urban Institute’s Health Insurance Policy Simulation Model (HIPSM) to provide national as well as state-by-state estimates of the impact of ACA on federal and state Medicaid costs, Medicaid enrollment, and the number of uninsured. The analysis shows that the impact of the ACA Medicaid expansion will vary across states based on current coverage levels and the number of uninsured. This analysis shows that by implementing the Medicaid expansion with other provisions of the ACA, states could significantly reduce the number of uninsured. Overall state costs of implementing the Medicaid expansion would be modest compared to increases in federal funds, and some states are likely to see small net budget savings.

After The Election: A Consumer’s Guide To The Health Law

November 12, 2012 Comments off

After The Election: A Consumer’s Guide To The Health Law
Source: Kaiser Family Foundation

Now that President Barack Obama has won a second term, the Affordable Care Act is back on a fast track.

Some analysts argue that there could be modifications to reduce federal spending as part of a broader deficit deal; for now, this is just speculation. What is clear is that the law will have sweeping ramifications for consumers, state officials, employers and health care providers, including hospitals and doctors.

While some of the key features don’t kick in until 2014, the law has already altered the health care industry and established a number of consumer benefits.

Here’s a primer on parts of the law already up and running, what’s to come and ways that provisions could still be altered.

Hat tip: PW

Medicaid Today; Preparing for Tomorrow — A Look at State Medicaid Program Spending, Enrollment and Policy Trends Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2012 and 2013

November 9, 2012 Comments off

Medicaid Today; Preparing for Tomorrow — A Look at State Medicaid Program Spending, Enrollment and Policy Trends Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2012 and 2013

Source: Kaiser Family Foundation

After the worst economic downturn since the Great Depression, state policy makers were finally beginning to see signs of economic recovery at the end of state fiscal year (FY) 2012 and heading into FY 2013. Growth in total Medicaid spending and enrollment slowed substantially in FY 2012 as the economy began to improve. Relatively slow spending and enrollment growth are expected to continue in FY 2013.

Cost pressure and cost containment were still dominant themes, but states were also able to consider program changes, payment and delivery system reforms and continue efforts to re-orient long-term care programs to community-based care models. Eligibility rules for Medicaid remained stable due to the maintenance of eligibility (MOE) protections that were part of health reform legislation, and a number of states adopted targeted eligibility expansions or simplified enrollment procedures.

States are also preparing for the new role for Medicaid in the implementation of the Affordable Care Act (ACA). Under the June 2012 Supreme Court ruling, the Secretary’s authority to enforce the ACA Medicaid expansion requirement is limited, and state policy makers will decide whether or when to implement the Medicaid expansion.

The findings in this report are drawn from the 12th consecutive year of the Kaiser Commission on Medicaid and the Uninsured (KCMU) and Health Management Associates (HMA) budget survey of Medicaid officials in all 50 states and the District of Columbia. This survey reports on trends in Medicaid spending, enrollment and policy initiatives for FY 2012 and FY 2013. The report describes policy changes in reimbursement, eligibility, benefits, delivery systems and long-term care, as well as detailed appendices with state-by-state information, and a more in-depth look through four state-specific case studies of the Medicaid budget and policy decisions in Massachusetts, Ohio, Oregon and Texas.

A Guide to the Supreme Court’s Affordable Care Act Decision

July 6, 2012 Comments off

A Guide to the Supreme Court’s Affordable Care Act Decision

Source: Kaiser Family Foundation

This policy brief describes the Supreme Court’s decision on the Affordable Care Act and looks ahead to the implementation of health reform now that questions about the constitutionality of the law have been resolved.

American’s Views on the Supreme Court Case Mirror Their Views on the Health Reform Law; The Public Expects Parts Of The Affordable Care Act To Continue Whatever The Court Rules

March 21, 2012 Comments off
Source:  Kaiser Family Foundation
The requirement that nearly everyone obtain health insurance or pay a fine has long been Americans’ least favorite part of the health reform law, and their views on what the Supreme Court should do about that key provision, known as the “individual mandate,” mirror that sentiment, according to a new Kaiser Family Foundation poll.
The poll finds that half of all Americans (51%) think the Court should rule the mandate unconstitutional and about the same number (53%) expect the justices to do so. Those views about what the Court should do reflect public opinion about the Affordable Care Act (ACA) more generally. Those who favor the law say two-to-one (50% to 26%) that the Court should uphold the mandate, and those who oppose the law say twelve-to-one (83% to 7%) that it should strike the mandate down. Americans have not yet tuned in to the high court case, with more than six in ten saying they are not following it closely. And many are confused — 42 percent either think the Court has overturned the law or do not know whether it has.
The public also does not see the mandate as the linchpin of the entire law. Sixty-two percent say other parts of the law still will be implemented if the Court rules the mandate unconstitutional, compared to 28 percent who say such a ruling will scuttle the whole effort. The poll also finds substantial public skepticism towards the Court; about as many people say the justices’ ideological views will play a major role in their decision (51%) as say their analysis and interpretation of the law (54%) will play a major role.
These and other findings of the March Kaiser Health Tracking Poll come just weeks before the Court is set to hear oral arguments in the legal challenges to the health reform law, which turns two years old on March 23rd and over which public opinion has been chronically divided. At the two year mark the public is almost perfectly split: 41 percent of Americans hold a favorable view of the law this month, while 40 percent hold an unfavorable one — not terribly different from the 46 percent who favored it and 40 percent who did not in April 2010. Opinions divide sharply along partisan lines, with Republicans disliking the law (75% have an unfavorable view this month), Democrats favoring it (66% favorable) and independents more divided (40% favorable vs. 42% unfavorable).

Kaiser Health Tracking Poll — March 2012

Moving Ahead Amid Fiscal Challenges: A Look at Medicaid Spending, Coverage and Policy Trends Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2011 and 2012

November 3, 2011 Comments off

Moving Ahead Amid Fiscal Challenges: A Look at Medicaid Spending, Coverage and Policy Trends
Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2011 and 2012

Source: Kaiser Family Foundation

The 11th annual 50-State Medicaid budget survey from the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured finds that Medicaid officials in virtually every state are enacting a variety of cost cutting measures as states’ spending for Medicaid is projected to increase 28.7 percent in fiscal year 2012 to make up for the loss of federal stimulus money.

The temporary increase in the federal share of Medicaid spending under the American Recovery and Reinvestment Act (ARRA) brought about the only declines in state spending on Medicaid in the program’s history, even as the recession increased Medicaid enrollment and overall Medicaid spending. With that money having expired in June 2011, however, states must ramp up their own spending to replace the lost funds, even though states project total spending in the Medicaid program – which is jointly financed by the federal government and the states — to increase on average by 2.2 percent in FY 2012.

The survey finds cost containment actions ranging from restrictions on payments to providers and benefits, to new copayments for beneficiaries and additional efforts to contain the costs of prescription drugs. States also are trying to make their programs more efficient by increasing their reliance on Medicaid managed care, moving long-term care toward community-based care models, and streamlining enrollment procedures.

The state focus on cutting costs occurs as deficit reduction efforts in Washington could reduce federal support for Medicaid and shift costs to states and at a time when states, still coping with a weak economy, also must prepare for the expansion of Medicaid under the health reform.

Employer Health Benefits 2011 Annual Survey

September 27, 2011 Comments off

Employer Health Benefits 2011 Annual Survey
Source: Kaiser Family Foundation
From press release:

After several years of relatively modest premium increases, annual premiums for employer-sponsored family health coverage increased to $15,073 this year, up 9 percent from last year, according to the Kaiser Family Foundation/Health Research & Educational Trust 2011 Employer Health Benefits Survey released today. On average, workers pay $4,129 and employers pay $10,944 toward those annual premiums.

Premiums increased significantly faster than workers’ wages (2.1 percent) and general inflation (3.2 percent). Since 2001, family premiums have increased 113 percent, compared with 34 percent for workers’ wages and 27 percent for inflation.

The 13th annual Kaiser/HRET survey of small and large employers provides a detailed picture of trends in private health insurance costs and coverage. This year’s survey also looked at employers’ experiences with several already implemented provisions of the 2010 health reform law affecting employer coverage.

In particular, the survey estimates that employers added 2.3 million young adults to their parents’ family health insurance policies as a result of the health reform provision that allows young adults up to age 26 without employer coverage on their own to be covered as dependents on their parents’ plan. Young adults historically are more likely to be uninsured than any other age group.

The study also finds 31 percent of covered workers are in high-deductible health plans, facing deductibles for single coverage of at least $1,000, including 12 percent facing deductibles of at least $2,000. Covered workers in smaller firms (3-199 workers) are more likely to face such high deductibles, with half of workers in smaller firms facing deductibles of at least $1,000, including 28 percent facing deductibles of $2,000 or more.

These numbers in part reflect the rise of consumer-driven plans, which are high-deductible plans that include a tax-preferred savings options such as a Health Savings Account or Health Reimbursement Arrangement. Over the past two years, more firms have started to offer these plans, and the share of covered workers enrolled in this type of plan has doubled, from 8 percent in 2009 to 17 percent in 2011. Plans that can be used with a Health Savings Account have lower premiums than other plan types, but must have annual deductibles of at least $1,200 for an individual and $2,400 for a family this year.

Establishing Health Insurance Exchanges: An Update on State Efforts

July 28, 2011 Comments off

Establishing Health Insurance Exchanges: An Update on State Efforts
Source: Kaiser Family Foundation

This issue brief examines states’ progress in setting up the state-based health insurance exchanges through which millions of Americans are expected to purchase coverage under The Patient Protection and Affordable Care Act (ACA) beginning in 2014.

The exchanges, a key component of the law, are expected to enable consumers to compare a selection of qualified health insurance options in order to find the plan that best meets their needs and budget. The federal government will provide subsidies to certain low- and moderate-income individuals to make such coverage more affordable.

The brief reviews states’ progress, examines the choices and challenges they face, and summarizes the early trends that have emerged in terms of the governance, structure and financing of the new exchanges. The law requires states to demonstrate sufficient progress towards establishing a “fully operational” exchange by January 2013.

+ Full Document (PDF)

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