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Marketplace Policy and Strategy

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Webinar & Presentations

This recording features highlights from NASHP's 34th Annual Conference.

Commentary

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.

Commentary

This expert perspective summarizes the provisions of the No Surprises Act relating to air ambulances and notes particular implications for state regulators and marketplace officials.

Resource Page

This resource page compiles the latest Robert Wood Johnson funded research on the benefits of closing the Medicaid coverage gap.

Blog

This blog post examines how the American Rescue Plan Act affected the affordability, choice, and coverage stability of health plans on 12 different state-based marketplaces. 

Commentary

This commentary examines state action during the 2021 legislative session to address rising drug costs.

Commentary

This commentary explains how since March 2020, many states have rapidly leveraged federal and state flexibilities under the public health emergency to expand telehealth capabilities and reimbursement through both public and private payers.

Blog

This blog highlights how state-based Marketplaces are launching integrated and innovative outreach campaigns—including tapping into existing public health and COVID-19 vaccination efforts—to reach residents and alert them to the fact that the American Rescue Plan Act provides more people than ever before with access to financial help to pay for health insurance.

Commentary

This article highlights NASHP’s Center for State Rx Drug Pricing five years of state action to lower drug costs.

Commentary

This commentary reviews provisions of the U.S. Departments of Health & Humans Services and Treasure final 2022 Notice of Benefit & Payment Parameters of particular import to the state-based marketplaces and state insurance regulators.

Brief

This brief seeks to show the maximum potential impact of the American Rescue Plan Act's (ARPA) enhanced marketplace subsidies on health insurance coverage by modeling the new subsides as if they were permanent changes.

Brief

This toolkit outlines template language that state-based marketplaces can adapt and use in consumer-facing communications regarding new Internal Revenue Service (IRS) information about how consumers can receive relief from repayment of excess advance premium tax credits for 2020 under the American Rescue Plan Act.

Brief

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.

Webinar & Presentations

This webinar addresses key provisions of the American Rescue Plan package, the $1.9 trillion budget reconciliation package signed into law by President Biden on March 11.

Report

This report assesses awareness of and experiences with publicly subsidized coverage options among adults who were uninsured in September 2020.

Report

This report describes the methodology of the Health Insurance Policy Simulation model and presents the model’s 2020 current-law baseline, which reflects health care and coverage after 2020 Open Enrollment and before the COVID-19 pandemic.

Commentary

This commentary explores the high levels of profitability insurers have seen in 2020. 

Commentary

This commentary focuses on several provisions of the proposed 2022 “Notice of Benefit & Payment Parameters" that have implications for state oversight of insurance markets and the state-based marketplaces.  

Brief

This brief explores the shares of a typical nongroup insurance premium attributable to essential health benefits and estimates the financial implications should they be eliminated from the nongroup insurance benefit package.

Commentary

This commentary examines state-based health insurance marketplaces' efforts to actively connect consumers to health insurance coverage during the annual open enrollment period that launched Nov. 1. 

Brief

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.

Webinar & Presentations

This map current state activity related the Affordable Care Act’s Section 1332 waivers.

Commentary

This commentary considers ways states could potentially redirect insurers’ extra cash to benefit policyholders and the public.

Webinar & Presentations

This guide provides answers to frequently asked questions about selecting and using health insurance coverage and applying for financial help for 2021's open enrollment period.

Commentary

This commentary explores the importance of clearly communicating to consumers what health coverage options are available for the remainder of 2020 and heading into 2021. 

Brief

This brief reviews the evidence on how the Affordable Care Act has affected individual and family health care coverage, access, affordability, hospital finances and national health expenditures.

Brief

This brief considers how a Supreme Court ruling overturning the Affordable Care Act would affect average people and illustrative, hypothetical families in different circumstances.

Commentary

This commentary highlights several strategies states can pursue to help ensure a successful open enrollment period this year amid the COVID-19 pandemic.

Report

This report examines activity across six states that are exploring social insurance initiatives to help finance long-term services and supports.

Commentary

This commentary discusses how state Medicaid, children’s health insurance programs, and health insurance marketplaces prepare for an expected increase in demand due to COVID-19, an economic downturn and ensuing budget crises, and unpredictable federal relief efforts.

Webinar & Presentations

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.

Webinar & Presentations

This webinar highlighted how states should adapt their strategies during COVID-19 as they plan their open enrollment outreach and education campaigns, and how to ground these efforts in terms of audience targeting and messaging.

Commentary

This commentary considers five frequently heard worst-case scenarios related to the Affordable Care Act and provides research evidence that these fears did not come to pass.

Commentary

This commentary outlines how state legislative sessions took a hit this year from the novel coronavirus pandemic.

Report

This report provides the first nationally representative estimates of changes in coverage during the initial months of the recession induced by the COVID-19 pandemic.

Commentary

This commentary features insights from state health agencies and health insurance marketplaces that have actively identified opportunities to conduct outreach in communities disproportionately affected by COVID-19.

Report

Stakeholders in six states assess the impact of Medicaid insurers increasing dominance in the ACA marketplaces.

Commentary

This commentary compiles thoughts from navigators across five states using the federally-facilitated marketplace about how they are faring during the COVID-19 pandemic.

Commentary

This commentary outlines how continuity between Medicaid and the marketplace is more important than ever.

Commentary , Report

06.2020 / By The RAND Corporation

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.

Commentary

This commentary examines strategies that successfully drove enrollment in state-based marketplaces during the COVID-19 pandemic.

Commentary

This commentary provides an overview of strategies that states can consider to help address gaps in coverage to ensure as many people as possible get access to comprehensive care as the country continues to respond and recover from the COVID-19 health and economic crisis.

Commentary

This commentary discusses state employee health plans (SEHPs) and the rapid changes they are making to address the COVID-19 pandemic.

Report

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.

Commentary

This commentary discusses the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) and the potential eligibility challenges it creates for both individuals and states.

Report

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.

Commentary

This commentary discusses new federal and state laws that are making significant steps to eliminate consumer cost-sharing for coronavirus (COVID-19) testing, diagnosis, and prevention.

Commentary

This commentary includes a list of the unique special enrollment periods (SEPs) available in state-based marketplaces, including life-changing events, unexpected health plan changes, or enrollment in dental coverage.

Commentary

This commentary features recommended communication strategies and examples for how states can elevate coverage options and help ensure that more residents can access health insurance during these uncertain times.

Brief

This brief includes communication examples to help states answer questions on how health insurance covers COVID-related testing and treatment, encourage consumers to enroll in coverage, and engage with providers to keep them informed.

Commentary

This commentary examines state strategies to promote health insurance enrollment to protect consumers from potentially exorbitant medical bills during the COVID-19 pandemic.

Report

This report assesses the cost of Medicaid relative to private insurance in the health insurance landscape under the Affordable Care Act (ACA).

Brief

This brief is a compilation of state marketplace communications examples during the novel coronavirus outbreak.

Brief

This brief provides a template for states to inform residents of health insurance options during the COVID-19 pandemic.

Webinar & Presentations

In this webinar, experts explore the key health care provisions in the Families First Coronavirus Response Act and the implications for states.

Brief

This brief is a compilation of communication examples from state departments and agencies during the COVID-19 pandemic.

Report

This Special Enrollment Period (SEP) Reference Chart is a tool for those who are helping people enroll in health coverage through a special enrollment period.

Brief

This brief provides some answers about who is eligible to enroll in coverage as many seek new health coverage, or help paying for coverage, during the novel coronavirus outbreak.

Commentary

This blog posts pulls together frequently asked questions about the novel coronavirus to help guide Navigators, brokers, assisters, and consumers through this complex and trying time.

Report

01.2020 / By Urban Institute

This report shows the changes in average lowest silver premiums from 2017 to 2020 by state and in the lowest silver premiums offered by each insurer in selected markets.

Dataset

This resource identifies areas where states are doing well and areas where they can improve on healthcare affordability.

Report

This report identifies the states and people who would face the largest coverage losses if the Affordable Care Act were repealed, including estimates by city.

Report

12.2019 / By Urban Institute

This report examines preferences between a public option for health insurance and Medicare for All among nonelderly adults.

Commentary

This perspective outlines benefits and risks of health plan standardization, raises critical questions that states will need to consider, and offers a decision roadmap for states implementing a standardized benefit design requirement.

Commentary

This piece investigates each of the non-ACA-compliant plan types and provides a brief description along with current estimates of enrollment or projected enrollment.

Report

This guide is a practical, hands-on resource to help assisters and consumers navigate this enrollment season.

Report

10.2019 / By Urban Institute

This report analyzes commercial insurers’ experiences competing in marketplaces with managed care organizations, which only offered coverage within public programs prior to ACA implementation.

Report

This report investigates what is motivating states to transition to full state-based marketplace status, assesses the benefits and risks of such a switch, and identifies considerations for other states considering a similar move.

Report

09.2019 / By Urban Institute

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. 

Report

09.2019 / By Urban Institute

This brief describes interviews with 10 Medicare Advantage plans, Medicare Advantage experts, and social service providers to discuss new benefits added under the Centers for Medicare & Medicaid Services' increased flexibility in plan year 2019.

Report

09.2019 / By Urban Institute

This report updates previous analysis of the coverage and health spending implications of Healthy America and analyzes two additional options: one without an individual requirement and one that would lead to universal coverage for all legal residents of the US.

Report

08.2019 / By Urban Institute

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.

Brief

06.2019 / By Urban Institute

This analysis examines how people with different characteristics would be affected if the Texas v. United States decision invalidates the Affordable Care Act.

Report

This report examines ACA marketplace participation by insurers that participated in Medicaid but not in private insurance markets prior to the ACA.

Report

04.2019 / By Urban Institute

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.

Brief

04.2019 / By Urban Institute

This brief found that ACA markets have become more competitive between 2018 and 2019, but have not regained the level of competition they had in 2017.

Journal Article

This article estimates the costs of implementing state-based reinsurance programs in four large states whose size provides a useful cost-projection base for other state policymakers considering reinsurance programs.

Report

This analysis examines the use of 1332 State Innovations Waivers to stabilize individual health insurance markets, comparing the use of this strategy in three states; assessing how they navigated the process; identifying lessons learned; and discussing future concerns.

Report

The brief provides a roadmap of policy, program design, and financing considerations for states that are contemplating development of a state-based reinsurance program under 1332 waiver authority.

Webinar & Presentations

This webinar walked through key components of the proposed annual Notice of Benefit and Payment Parameters for 2020, and discussed potential state considerations for states.

Report

02.2019 / By Urban Institute

This study assesses short-term plan insurers’ marketing tactics in the wake of new federal rules and how regulators have prepared for this new market.

Report

01.2019 / By Urban Insitute

The Urban Institute conducted interviews with marketplace administrators and insurers selling marketplace coverage in ten states. They analyze marketplace insurer participation and pricing decisions, as well as several related topics.

Report

12.2018 / By Urban Institute

This analysis examine four policy scenarios meant to improve the ACA, which, taken together, could reduce the number of uninsured by 12.2 million people and to 7.3 percent uninsured.

Webinar & Presentations

This webinar discusses the implications of the proposed regulations easing the rules governing health reimbursement arrangements (HRA) and other account-based, tax-preferred health care benefits; and possible state responses.

Report

Alaska, Minnesota and Oregon were the first to gain approval and federal funding to implement their own reinsurance programs under a 1332 waiver. This issue brief assesses their progress and lessons learned to date.

Brief

11.2018 / By Urban Institute

This monitoring and tracking project will document changes to the implementation of national health reform to help states, researchers and policymakers learn from the process as it unfolds.

Report

11.2018 / By Urban Institute

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.

Report

The brief provides a roadmap of policy, program design, and financing considerations for states that are contemplating development of a state-based reinsurance program under 1332 waiver authority.

Report

08.2018 / By Urban Institute

The Trump administration finalized regulations for short-term limited duration policies in early August 2018, which increase the maximum length of short-term, limited-duration insurance policies to just less than one year. This report provides updated tables taking these state legislative changes into account.

Report

08.2018 / By Urban Institute

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.

Report

This report explores options for states as they consider oversight of risk-bearing organizations (RBOs), with a focus on states that have elected to act to protect against provider insolvency. The State Health Policy Highlight reviews specific state considerations when overseeing RBOs; case studies examine approaches in California, Massachusetts, New York and Texas.

Report

06.2018 / By Urban Institute

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.

Webinar & Presentations

The Trump Administration is expanding the availability of alternatives to Affordable Care Act-compliant health insurance. Rules to expand association health plans and short-term limited duration health plans are imminent. This webinar explores what options states have to respond to these developments, featuring experts from Georgetown University’s Center for Health Insurance Reform.

Graphic

A state-by-state map of delivery system and payment reform.

Webinar & Presentations

This webinar untangles HHS's annual Notice of Benefit and Payment Parameters and its many implications for states. The rule is a collection of policies governing the ACA’s marketplaces, insurance reforms, and premium stabilization programs. Speakers include Sabrina Corlette and Justin Giovannelli from Georgetown’s Center on Health Insurance Reforms, Joel Ario from Manatt Health, and Jason Levitis.

Journal Article

04.2018 / By Urban Institute

The Affordable Care Act (ACA) made private nongroup health insurance more accessible to nonelderly adults with chronic conditions through the federal and state-based Marketplaces. As repeal of the ACA individual mandate takes effect in 2019, protecting coverage gains while stabilizing nongroup premiums may depend on state-level efforts to spread the risk of enrollees’ health care costs across a balanced insurance pool.

Journal Article

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.

Report

03.2018 / By Urban Institute

Although congressional efforts to repeal and replace the Affordable Care Act (ACA) did not succeed in 2017, the law continues to face an uncertain future. This brief examines insurers’ participation and pricing decisions for the 2018 and 2019 plan years through structured interviews with 10 insurance companies participating in the individual market in 28 states and the District of Columbia.

Brief

Many states continue to encounter challenges in stabilizing their individual health insurance markets, including large premium increases and declining insurer participation. One solution is a state-based reinsurance program similar to the federal program that reduced premiums by more than 10 percent per year from 2014 to 2016. The brief provides a roadmap of policy, program design, and financing considerations for states that are contemplating development of a state-based reinsurance program under 1332 waiver authority.

Webinar & Presentations

With effective repeal of the federal individual insurance mandate scheduled for 2019, many state policymakers are exploring ways to stabilize their insurance markets, including creating a state-based mandate similar to one in Massachusetts. This webinar includes a deep dive into Massachusetts’ mandate, and features a Maryland proposal to create an auto-enrollment process for individuals through its marketplace.

Commentary

In response to President Trump’s October 12 executive order, the U.S. Departments of Health and Human Services, Labor and Treasury have published proposed rules to expand the availability of health coverage sold through short-term, limited duration insurance (STLDI).

Report

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.

Brief

01.2018 / By Urban Institute

This brief provides an analysis of legislation recently introduced in the U.S. Senate that would create a mechanism for states to offer their residents the opportunity to buy a Medicaid-based public insurance option.

Report

This report examines the issue that with no individual mandate and expanded non-comprehensive coverage, the divisions between states will deepen, and market conditions will deteriorate for unsubsidized farmers and others seeking coverage in states that don’t protect their risk pool.

Report

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.

Webinar & Presentations

RWJF’s SHVS together with experts from Manatt Health, host this webinar that highlights and defines potential policy options, including the “Medicaid Buy-in,” that states may consider to leverage Medicaid to achieve their goals with respect to coverage availability and affordability. Conditions that make each option more or less favorable for a state, and implementation issues or other considerations in play for states are discussed.

Brief

Uncertainty about the future of health insurance options and concern about the ability of Affordable Care Act (ACA) marketplaces to offer adequate competition and choice have spurred states to look for new coverage approaches. Innovative strategies states are proposing include allowing consumers to buy into state Medicaid programs and developing state-specific coverage options within the ACA’s framework.

Brief

As Congress barrels toward the end of the year, several bills are in play that will have major and almost immediate ramifications for health insurance markets. They include: Tax Cuts and Jobs Act (H.R. 1); The Alexander-Murray insurance market stabilization bill; The Nelson-Collins reinsurance program bill; and the temporary elimination of the health insurance tax (H.R. 4620).

Brief

CMS released two informational bulletins detailing a new, streamlined approach for the review and management of Section 1115 demonstrations and state plan amendments and 1915 waivers. The streamlined approach may enhance states' ability to design innovative health care delivery initiatives in their Medicaid programs. These changes come at a critical time as states develop new approaches to reduce health care costs and stem the opioid epidemic.

Brief

HHS released proposed changes in its annual notice that governs standards for issuers and the health insurance marketplaces. The annual notice is one of the most significant tools the Administration wields in shaping the health insurance markets and this proposed notice carries significant implications for markets and states.

Brief

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.

Brief

With three states using Section 1332 waivers to help fund reinsurance programs for the 2018 plan year, many more state officials are considering the model for their state in future years. Having worked directly with the 2018 reinsurance states, State Health and Value Strategies presents a to-do list for states as they consider reinsurance for 2019.

Report

11.2017 / By Urban Institute

This report examines six states that faced the prospect of bare counties for 2018: Iowa, Nevada, Ohio, Oklahoma, Tennessee, and Washington.

Webinar & Presentations

The research included in this panel illustrates both the intended and unintended consequences of state policy decisions on a range of health systems outcomes and highlights the necessity of access to different types of federal surveys for the purposes of health policy evaluation. Federal survey data is especially critical when analyzing variation between states, as when comparing outcomes by Medicaid expansion status. As policy flexibility for states continues to grow, this ability to compare states to one another will continue to be essential.

Brief

This brief puts a state lens on emerging proposals in the ACA repeal and replace debate. Over the last decade, 21 states introduced legislation to sell across state lines, only five states enacted such laws, but no insurer has yet to offer.

Brief

Sens. Lamar Alexander (TN) and Patty Murray (WA) released a bipartisan bill designed to bring short-term stability to the health insurance market. While there are indications that Alexander and Murray secured the 60 votes needed for passage in the Senate, it faces an uncertain fate in the House and with the President. 

Brief

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.

Brief

While there are risks to the stability of their markets that states cannot well control, one important route to adverse market outcomes may be state policy decisions. There are frequent calls for more state flexibility, but these data suggest that the exercise of existing state flexibility is one way that states have visited a considerable amount of trouble upon their markets. Yet there is a hopeful note here as well, since this suggests that there are steps that states can take to improve their situation.

Report

This report discusses the scope of state authority and tools available to ensure that consumers living within their borders benefit from the insurance protections promised under federal law. It also discusses specific statutory and administrative options for states in the event of selected possible federal administrative actions, including a: Rollback of the essential health benefits; relaxation of marketplace health plan oversight; re-definition of what constitutes minimum essential coverage; loosening of medical loss ratio standards; and an expansion of off-marketplace enrollment opportunities.

Brief

This blog reviews cost-sharing reduction (CSR) programs designed to reduce the cost of insurance for consumers purchasing policies on individual markets.

Graphic

This chart summarizes major provisions included in the 2010 Affordable Care Act, provisions included in the American Health Care Act passed by the House on May 4, 2017, as well as preliminary analysis of the Senate Better Care Reconciliation Act (BCRA) discussion draft as amended on June 26, 2017, and then revised on July 13, 2017 and July 20, 2017.

Brief

The Senate released two bills as part of its efforts to repeal the Affordable Care Act (ACA): A revision to the Better Care Reconciliation Act (BCRA) eliminating the “Ted Cruz Amendment,” which provided funding to create coverage alternatives for high-risk individuals, and the Obamacare Repeal Reconciliation Act (ORRA), which would repeal many of the major provisions of the ACA within a two-year period, but does not offer plans to replace those provisions.

Brief

The data thus far suggest that most counties will have at least two insurers offering plans on the exchange, and most people will be able to choose from at least three.

Brief

06.2017 / By Urban Institute

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.

Webinar & Presentations

Watch: Webinar discussing the impact of ACA implementation in Kentucky.

Brief

The AHCA, which proposes to repeal and replace the ACA, would dismantle the Prevention and Public Health Fund (PPHF). States received over $625 million from the PPHF in fiscal year 2016, and stand to lose more than $3 billion over five years if it is repealed. The bill would repeal all new appropriations for the PPHF starting in fiscal year 2019, and rescind any funds left over at the end of 2018.

Brief

HHS Secretary Tom Price issued a letter to governors encouraging them to take advantage of Sec. 1332 State Innovation Waivers under the Affordable Care Act and cited Alaska‘s request as an example. Alaska’s waiver seeks federal funds to support a reinsurance plan to stabilize its individual insurance market.

Graphic

This chart summarizes how the American Health Care Act, passed out of House committees the day before, differed from the Affordable Care Act. State leaders, representing the diversity of states and breadth of state health policy agencies and officials, met at a summit to discuss those changes and how they might affect states.

Brief

Congressional action to repeal and replace the ACA is on the fast track. The administration and GOP leaders have outlined a three-pronged effort to reform healthcare beginning with passage of the American Health Care Act (AHCA). Congress released Manager’s Amendments to the AHCA, inclusive of a series of policy and technical changes to the bill. Here is a full statutory text of policy and technical amendments.

Brief

While the focus of debate regarding repeal of the Affordable Care Act (ACA) has been on Marketplaces and the Medicaid expansion, myriad other provisions of the ACA are at risk of repeal—including those that streamline Medicaid eligibility and enrollment systems and implement a national, simplified standard for income eligibility. As of January 2016, 37 states are able to complete an eligibility determination in real time, defined as less than 24 hours, and among these, 11 states report that at least half of their applicants receive an eligibility determination in real time. The future of the ACA’s streamlined eligibility and enrollment-related provisions and the system improvements states have invested in to implement them are the subject of this issue brief.

Brief

Recent state waivers can inform the question of whether and how low-income individuals could benefit from health savings accounts (HSAs) with high-deductible health plans. State experiences incorporating health savings accounts into Medicaid can be instructive, as policymakers consider the role of HSAs in proposed health care reforms. This brief looks at health savings and similar accounts in Michigan and Indiana.

Brief

Congress began its ACA repeal effort and evolving replacement options are receiving considerable attention. NASHP is tracking issues that appear in multiple proposals and will provide state perspectives, including: How might they impact states? What might they cost? Have they been tried before in states and what did we learn from past initiatives?

Graphic

This chart provides an overview of ACA provisions and snapshot of the implications for states if the ACA is repealed. States are the primary regulator of insurance and as such had laws in place prior to the enactment of ACA. Some states repealed those laws and replaced them with ACA provisions, while other states revised their laws but left other old, preempted laws on the books. 

Report

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.

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