The Patient Protection and Affordable Care Act—health care reform—fundamentally changed health insurance and access to health care. Our researchers are unpacking the landmark law, studying the challenges of implementation, and using our Health Insurance Policy Simulation Model to estimate how its proposals will affect children, seniors, and families, as well as doctors, small businesses, and the national debt.
The Urban Institute also studies cost, coverage, and reform options for Medicare and Medicaid and analyzes trends and underlying causes of changes in health insurance coverage, access to care, and Americans’ use of health care services. Read more.
This report is the first state-level projection of ACA coverage gains for racial/ethnic groups. Absent ACA coverage provisions, Latinos, blacks, and American Indian/Alaska Natives are overrepresented among the uninsured. With the ACA and current state Medicaid expansion decisions, uninsurance rates are projected to fall for each racial/ethnic group, narrowing coverage differences between whites and each minority group, except for blacks. If all states were to expand their Medicaid programs, we project that uninsurance rates would fall further for all racial/ethnic groups, with blacks experiencing a marked reduction. Effective outreach can further reduce uninsurance rates for all racial/ethnic groups
Starting in 2015, the ACA gives states the option to implement a Basic Health Program (BHP) that covers low-income residents through state-contracting plans outside the health insurance marketplace. Some view BHPs as an effective strategy for improving affordability of coverage and reducing churning between Medicaid and marketplace plans. This paper reviews BHP's federal legal requirements and funding mechanisms. It also analyzes key policy issues, including BHP's implications for state costs and marketplace viability.
Some states are considering adoption of the Basic Health Program (BHP) to make coverage more affordable to low income consumers. This paper provides detailed information about the characteristics of BHP-eligible residents in each state. It explains how policymakers can use that information to estimate average federal BHP payments per BHP-eligible resident, both overall and within various age and income bands. The paper also explains in detail how federal BHP payments are calculated.
Using the Health Reform Monitoring Survey and state-level interviews, this paper identifies effective strategies to educate uninsured consumers about available health coverage assistance and to help them enroll. Researchers describe promising state practices, such as Kentucky insurance brokers' targeting of firms that do not offer coverage, enrolling workers at those companies into Marketplace plans; 46 percent of America's subsidy-eligible uninsured work for similar employers that do not offer insurance. The report emphasizes the importance of continuing to fund hands-on application assistance.
This report examines three barriers experienced during the 2014 open enrollment period in Marketplaces: Medicaid backlogs, procedural challenges facing disadvantaged populations, and difficulty with plan selection. It also explains promising strategies states have used to overcome those barriers, including using Medicaid computer systems to make eligibility determinations for the Marketplace and simplifying consumer choices by standardizing plan designs within each metal tier. These and other practices suggest directions to pursue in improving Marketplace enrollment for 2015 and beyond.