This blog discusses Rhode Island's new program that will automatically enroll consumers determined ineligible for Medicaid into a qualified health plan offered through HealthSource RI, the state’s health insurance marketplace.
This blog reviews a report published by the task force on recommendations for creating a “Bridge Program” by using Section 1331 of the Affordable Care Act (ACA), which authorizes state-based Basic Health Programs (BHP).
Despite the changes brought about by the COVID-19 pandemic, California’s health insurance landscape remained relatively stable during 2021. This blog focuses exclusively on coverage trends for Californians under age 65.
This brief reviews California’s approach to expanding health coverage to all lower-income residents, regardless of immigration status, in an effort to help the state’s 3.2 million remaining uninsured, of which 65% are undocumented.
This toolkit includes resources developed for states to customize based on their unique needs, program eligibility criteria, and environments to support outreach and education efforts to drive enrollment in new or existing health coverage programs.
This report used data from the Urban Institute’s Health Reform Monitoring Survey to assess changes between 2019 and 2022 in the share of adults ages 18 to 64 reporting they were insured for the full 12 months before each survey.
This blog identifies strategies for state-based Marketplaces, in partnership with Medicaid agencies, departments of insurance, consumer assisters, and participating insurers, to help maintain continuity of care.
Amid rising healthcare costs, this blog explores how a public coverage option in the individual and small group Marketplace could help reduce costs and expand access to coverage for people with job-based insurance.
The Affordable Care Act (ACA) requires most insurers and employers to cover a set of preventive health services at no cost to enrollees. This blog analyzes a case pending in federal court that threatens to cut off consumers’ access to these services by allowing insurers to impose cost-sharing or, in some cases, cease covering them altogether.
On July 19, executives across the 19 state-based health insurance marketplaces sent a letter to Congressional leaders calling for the permanent extension of health insurance premium affordability measures slated to expire at the end of this year. This blog explores projections and analysis of how consumers may be impacted if ARPA’s affordability measures are left to expire.
With the premium tax credit expansion’s (PTC) sunset approaching, Congress has been considering passing an extension—first in the Build Back Better Act and more recently for potential inclusion in narrower reconciliation legislation. This blog explores cost and enrollment rates without an extension of the ARPA’s expanded PTC.
In this Health Affairs blog post, Nancy Archibald, MHA, MBA, CHCS’ Associate Director for Federal Integrated Care Programs, outlines perspectives from state Medicaid officials on the federal policies that have advanced Medicare-Medicaid integration, and areas where they believe additional federal policy actions are needed.
This update to the methodology documentation for the Urban Institute’s Health Insurance Policy Simulation Model explains how they estimated health coverage in 2023, taking into account major uncertain issues such as Medicaid enrollment after the HHS public health emergency and the potential expiration of enhanced premium tax credits for Marketplace coverage in 2023.
This page provides communications resources designed to support states as they prepare for the various stages of work needed to inform stakeholders and consumers about the upcoming end of the Medicaid continuous coverage requirement. The end of the Medicaid continuous coverage requirement presents states with tremendous opportunities to keep individuals enrolled in Medicaid or transition to another form of health coverage.
This blog post provide an analysis of the National Center for Health Statistics (NCHS) health insurance coverage estimates for 2021 from the National Health Interview Survey (NHIS) as part of the NHIS Early Release Program. The estimates captured in this report are some of the first available coverage estimates for 2021 from a federal survey.
This interactive map and chart summarize proposed and approved legislation since 2018, Medicaid waivers, financial estimates, and other initiatives designed to extend coverage during the postpartum period. (Under the Families First Coronavirus Response Act, Medicaid enrollees who typically lose coverage after 60 days postpartum cannot be disenrolled until the end of the month in which the public emergency period ends.)
This toolkit is designed to help state and local WIC agencies leverage data from Medicaid and SNAP to measure enrollment gaps and increase enrollment using tools to plan, launch, and/or strengthen data matching and targeted outreach to eligible families who are not receiving WIC benefits.
This brief presents benchmark premium data separated by urban versus rural rating regions and includes data on the differences between average benchmark premiums in 2019 and 2022 for all 50 states and the District of Columbia.
This blog answers questions about the ACA's "family glitch," a flawed regulatory interpretation that has created barriers to coverage. The current administration is currently working to correct this interpretation that prevents 4.8 to 5 million individuals from accessing more affordable health insurance.
This blog provides model comments developed to inform and support state responses to the Centers for Medicare & Medicaid Services' RFI to achieve substantial reforms on access to coverage–namely, the processes for enrollment and eligibility redeterminations.
This interactive map summarizes state Medicaid reimbursement policies for all types of midwives including certified nurse-midwives and midwives who pursue alternative pathways to licensure, often referred to as certified professional midwives, certified midwives, or direct entry midwives depending on state regulations.
This blog summarizes feedback from representatives of consumer advocates, insurers, and state agencies on CMS' proposed annual Notice of Benefits and Payment Parameters, which updates regulations governing the Affordable Care Act’s marketplaces.
This blog provides data and key findings that explain how that expiration of ARPA provisions will lead to significant premium increases for the majority of consumers enrolled in coverage through the state-based marketplaces.
This blog explores data on Health Care Sharing Ministries (HCSM) operating in Massachusetts, due to a state requirement to regularly report on enrollment, membership fees, and other information about HCSM operations and finances.
This brief analyzes data from the National Health Interview Survey, the Current Population Survey, and the Health Reform Monitoring Survey to explore trends in coverage status and type between early 2019 and early 2021.
This blog summarizes key takeaways laid out in the new CMS guidance related to timelines and operational strategies states can leverage to mitigate churn when the federal Medicaid continuous coverage requirement ends.
This report examines existing data and research to comprehensively describe the scope and prevalence of obesity and available obesity treatments in the US covered by fee-for-service Medicaid, Medicaid managed care, state employee health plans, and state essential health benefits benchmark plans.
This blog explores value-based, alternative payment models as employer-sponsored health insurance costs have increased by 6.3 percent in the United States since 2010, with additional increases projected.
This blog presents survey findings that show no significant changes in coverage type (public, private) or uninsured rate across all ages and income groups when compared in Q3 of 2021 compared to the Q3 of 2020.
This blog summarizes a phased set of priority measures and provides a model enrollment and retention dashboard template that states can use to monitor both the short-term impacts of phasing out public health emergency protections and continuous coverage requirements, as well as longer-term enrollment and retention trends.
This interactive map and chart summarize proposed and approved legislation since 2018, Medicaid waivers, financial estimates, and other initiatives designed to extend coverage during the postpartum period.
This blog examines the Centers for Medicare and Medicaid Services' newly released State Health Official letter providing guidance on the scope of and enhanced payments for qualifying community-based mobile crisis intervention services for Medicaid enrollees experiencing a mental health or substance use disorder crisis.
This blog analyzes the coverage landscape in California in 2020, highlighting both encouraging trends and persistent disparities that warrant attention, particularly as federal policies that protect coverage connected to the pandemic end or wind down.
This blog examines the Notice of Benefit and Payment Parameters for the 2023 plan year, released by the U.S. Department of Health and Human Services, that describes the annual regulation governing health insurance plans and marketplaces for the upcoming year.
This brief offers considerations for policymakers around the Children’s Health Insurance Program coverage as a method of enabling states to provide prenatal, labor and delivery, and postpartum services to pregnant individuals, regardless of immigration status.
This commentary presents strategies for state-based marketplaces to improve consumer outreach, provide enrollment assistant and clearly communicate with consumers with what health coverage options are available for them in 2022.
This brief aims to assist state and federal analysts with survey development and/or analysis of existing survey data to generate estimates of health insurance coverage and access to care across racial and ethnic groups and according to nativity and/or immigrant status.
This brief examines how New York is expanding changes to the race and ethnicity questions system-wide for the next open enrollment period and how the state is considering additional revisions in hopes of further enhancing the quality and completeness of its data.
This op-ed, authored by David Schaefer of the Georgia Budget Policy Institute, argues that closing the Medicaid coverage gap in Georgia will also increase access to health care and strengthen health infrastructure in rural communities.
This blog post outlines the potential coverage gains, state cost savings, and improved health outcomes that would occur if the remaining 12 nonexpansion states extending their Medicaid programs in accordance with the Affordable Care Act.
This brief examines how enrollment gains in public insurance helped offset declines in employer-sponsored insurance during the COVID-19 pandemic. Unlike previous recessions, the uninsurance rate did not change.
This series of policy briefs include evidence-based recommendations to help people through the immediate health and economic crises and longer-term recommendations to ensure a fair and just opportunity for health.
This commentary analyzes the indirect costs of rising health care spending and uninsurance in the year prior to the COVID-19 pandemic and examines trends as well as comparisons across race/ethnicity and educational attainment.
This brief explores the ways in which public and private health insurance coverage options bolstered by the Affordable Care Act are mitigating the impact of employer-sponsored insurance losses during the COVID-19 pandemic.
Two webinars on open enrollment period 2021 explore COVID-19 implications and effective strategies to consider as states design their outreach and education campaigns in a shifting health care environment.
This report uses a microsimulation model to incorporates data on employment losses by industry, state, and demographic characteristics, allowing researchers to simulate employment losses and associated health insurance coverage.
This commentary gauges the potential effects on coverage and cost if public options become available in the country's health insurance exchanges, based on observations from a RAND COMPARE microsimulation model.
This report estimates how health insurance coverage could change as millions of workers lose their jobs because of the slowdown in economic activity resulting from public health efforts to reduce the spread of the coronavirus.
This report estimates the extent to which workers in industries most vulnerable to pandemic-related unemployment and their family members would be eligible for Medicaid, the Children’s Health Insurance Program, or marketplace subsidies if workers lose their jobs.
This commentary discusses the huge rise in the number of people without health insurance in the wake of mass layoffs resulting from the COVID-19 pandemic and are seeking strategies to protect them from high prescription drug prices.
This report assesses market trends in seven states—Colorado, Georgia, Iowa, Mississippi, New Hampshire, Texas, and Utah—through a review of insurer participation, premiums, and enrollment data and through structured interviews with health insurance brokers.
This brief estimates that in the four weeks leading up to April 11, 2020, as many as 18.4 million individuals in the United States may be at risk of losing their employer-sponsored health insurance (ESI) coverage, including policyholders and their dependents.
In this report, researchers reviewed laws and interviewed state officials and insurers in six states—California, Georgia, Massachusetts, North Carolina, Pennsylvania, and Texas—to determine current policies and best practices to protect patients from disruptions in services and financial burdens as a result of disputes between providers and payers.
This brief explores state variation in health insurance coverage changes during implementation of the primary health insurance coverage reforms of the Affordable Care Act (ACA) using data from the 2013 and 2017 American Community Survey.
This report assesses public support for Medicare for All proposals, as well as some incremental reforms for expanding health insurance coverage, using data from the March 2019 round of the Health Reform Monitoring Survey.
This analysis examines some of the consequences should a case pending before the U.S. Court of Appeals for the Fifth Circuit be decided in favor of the plaintiffs, who argue that the entire Affordable Care Act (ACA) be eliminated.
Data from the 2017 American Community Survey (ACS) show that many of the remaining uninsured are clustered in metropolitan areas; this map illustrates those geographic concentrations of the uninsured.
Using data from the American Community Survey and the Current Population Survey, this report assesses whether coverage gains from 2010 to 2016 were associated with changes in labor market outcomes across occupations.
This resource highlights articles published since January 2018 that report on the impact of Medicaid expansion in 33 states and DC, organized by health access and outcomes, economic impacts, and coverage impacts.
This report explores changes in coverage type between 2013 and 2016 overall and for key demographic and income subgroups. Between 2013 and 2016, the share of Americans ages 64 and younger without health insurance fell from 17 percent to 10 percent.
This brief examines changes in health insurance coverage and health care access and affordability for parents and their children between 2013 and 2018 using data from the Health Reform Monitoring Survey.
New health insurance coverage estimates from the American Community Survey show that there was a statistically significant 0.2 percentage point increase in the national uninsured rate between 2016 and 2017, for the first year since 2010. This graphic analyzes the data.
This report provides detailed estimates of changes in health insurance coverage types between 2013 and 2016 by demographic, socioeconomic, and geographic characteristics. In addition, state fact sheets detail coverage changes by income group in all 50 states and DC.
This report examines brokers’ evolving role in the individual market, consumer purchasing decisions, and brokers’ observations about how the market and consumers are responding to recent federal policy adjustments to the ACA.
The ACA has made considerable gains in health insurance coverage, but many remain uninsured. This is an update to a 2015 analysis of the characteristics of the remaining uninsured, focusing on people uninsured in 2017 as well as how the characteristics of this population have changed.
To understand the marketplace enrollment gains and losses observed in 2018 relative to 2017, the Urban Institute interviewed key stakeholders in Rhode Island, Washington, and New York, which saw marketplace enrollment increases, and in West Virginia and Louisiana, which saw enrollment drops. This report explains the different features of the five states, presents cross-state findings, and discusses important factors in next year’s open enrollment period.
This article uses data from the American Community Survey to examine changes in uninsurance and uninsurance disparities by race/ethnicity in Kentucky since the state’s implementation of the Affordable Care Act. It was published in the American Journal of Public Health.
We assessed rates of employer health insurance offer, take-up, and coverage in June 2013 and March 2017 among workers. Overall, offer rates remained stable, and take-up and coverage rates increased. In Medicaid expansion states, the share of workers with family incomes at or below 138 percent of the federal poverty level who had employer-based coverage held steady, while uninsurance rates declined.
The six household surveys documented in this article cover a broad array of health topics, including health insurance coverage (American Community Survey, Current Population Survey), health conditions and behaviors (National Health Interview Survey, Behavioral Risk Factor Surveillance System), health care utilization and spending (Medical Expenditure Panel Survey), and longitudinal data on public program participation (SIPP).
The Profile of Virginia’s Uninsured provides a detailed picture of the Commonwealth’s uninsured using the 2016 American Community Survey. In 2016, 10.3 percent of Virginians under age 65 were uninsured. Most of these uninsured nonelderly Virginians had family incomes at or below 200 percent of the Federal Poverty Level (FPL), and more than three-quarters were part of working families.
This article analyzes the impact of the Affordable Care Act on health insurance coverage for verterans in states that chose to expand Medicaid and in non-expansion states using data from the 2013 and 2014 American Community Survey. The analysis found a substantial 24 percent relative decline in the rate of uninsurance for U.S. veterans between 2013 and 2014. Coverage gains in rural areas were due to gains in Medicaid and individual market coverage. The increase in the insured rate was three times larger in Medicaid expansion states versus non-expansion states.
On February 20, 2018, the Departments of Treasury, Labor, and Health and Human Services released a proposed regulation that would increase the maximum length of short-term, limited-duration insurance policies to one year. The brief analyzes the national and state-specific effects of ending the individual mandate and loosening limits on short-term, limited-duration policies.
This report summarizes findings from the 2017 Minnesota Health Access Survey, focusing on trends in how Minnesotans obtained health insurance coverage, and provides an understanding of how the 2017 climate may have contributed to a contraction of coverage.
Prior to the passage of the Affordable Care Act in 2010, Minnesota's health insurance market was relatively high-functioning across indicators of health insurance access and quality of care, although the state faced common challenges in the area of health care costs. This report considers Minnesota's health insurance market before and after the passage of the ACA and the outlook for the state's market given the current policy environment.
Understanding premium increases for individual market plans is more complicated this year. In many states, carriers attempted to recapture that lost revenue by increasing the premium of the silver plan relative to other metals. ‘Silver-loading’ gives subsidized non-cost-sharing reduction (CSR) consumers the opportunity to purchase a relatively more affordable bronze or gold plan.
The prospects for these new players reflect tensions for the market as a whole. Clearly the massive number of net exits signals a retrenchment by many market participants in 2018, resulting in shrinking of territorial footprints and outright withdrawal by large parts of the industry. For a variety of reasons, including attempts to repeal the ACA, the potential of the individual market has not yet been fully realized. Yet, it still remains the source of coverage for millions of people.
This report provides an annual update to comparisons of uninsurance estimates from four federal surveys:
-The American Community Survey (ACS)
-The Current Population Survey (CPS)
-The Medical Expenditure Panel Survey - Household Component (MEPS-HC)
-The National Health Interview Survey (NHIS)
This SHADAC chartbook uses data from the Medical Expenditure Panel Survey-Insurance Component (MEPS-IC) to highlight the experiences of private-sector workers with employer-sponsored insurance (ESI) from 2012 through 2016 at the national level and in the states. The ESI chartbook is accompanied by state-level fact sheets summarizing key ESI characteristics from 2012 to 2016.
Mental health and substance use coverage could roll back to pre-Affordable Care Act (ACA) levels if the American Health Care Act (AHCA) becomes law. Analysis finds the AHCA could limit access to mental health treatment.
Before the ACA’s implementation, nearly one million veterans—almost one in 10—were uninsured. By 2015, the number of uninsured veterans fell to 552,000. Veterans uninsurance reduced by nearly 40 percent between 2013 and 2015 under the Affordable Care Act.
Health coverage transitions—sometimes referred to as churn—have always existed to some degree, but with the Affordable Care Act there are additional possibilities for churning to occur across multiple coverage sources. This report examines current efforts in some states to measure these coverage transitions and provides broader context on the issue of churn.
This article examines changes to health insurance coverage and access to health care among children, adolescents, and young adults since the implementation of the Affordable Care Act using data from the National Health Interview Survey. The authors found significant improvements in coverage among children, adolescents, and young adults since 2010, along with some gains in access.