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Improving Individual Health Insurance Markets

October 12, 2017

In the U.S. health care system, the individual healthcare insurance marketplace has always been something of an afterthought. Most Americans of working age receive coverage through their employer. Older Americans and those with disabilities typically get benefits from Medicare. Fewer than one in ten Americans purchase coverage directly from statewide individual marketplaces, established through the Affordable Care Act, or purchase unsubsidized plans outside these markets. Nevertheless, this represents tens of millions of individuals who depend on the quality and choice of the products in the individual market.

International Healthcare Systems and the US Health Reform Debate

August 17, 2017

The ongoing challenges within the US healthcare system include its high costs, uneven access, and tremendous complexity. These deficits regularly generate calls for full-scale health reform from both sides of the political aisle. Republicans in Washington DC have consistently proposed to repeal the Affordable Care Act (ACA) and replace it with a less regulated system; most progressives in California would like to do away with the ACA in favor of "single-payer" healthcare modeled on the Canadian system. When considering the desirability of reforms, whether they come from the right or the left, it makes sense to look at how other developed countries are tackling their own healthcare challenges.

A Pragmatic Approach to Medicaid Reform: Increasing Sustainability, Flexibility, and Value for Medical Spending

April 16, 2017

A series of proposals at the federal level have focused on Medicaid, the healthcare coverage program for low-income people that goes by the name "Medi-Cal" in California. There has been an intense focus, in particular, on the budgetary cost of coverage through this program. Therefore, whether one believes enrollment in the program needs to be expanded or curtailed, it is essential to increase the affordability of the care that the program finances. This brief lays out some key statistics and considerations—particularly related to the impact of Medi-Cal on the state economy—that policymakers should take into account. It also advances a series of policy recommendations aimed at increasing both the quality of the care Medicaid finances, as well as the fiscal sustainability of the program.

California: Round 1 - State-Level Field Network Study of the Implementation of the Affordable Care Act

March 1, 2014

This report is part of a series of 21 state and regional studies examining the rollout of the ACA. The national network -- with 36 states and 61 researchers -- is led by the Rockefeller Institute of Government, the public policy research arm of the State University of New York, the Brookings Institution, and the Fels Institute of Government at the University of Pennsylvania.In September 2010, six months after the passage of the Affordable Care Act, California became the first state in the nation to create its own insurance exchange, eventually named Covered California. This accelerated timeline was consistent with California's desire to be, in the words of the state's Health and Human Services Secretary and Exchange Board Chair Diana Dooley, the "lead car" in implementation of federal health care reform. Because of the speed with which it approached this task, as well as the sheer size of its coverage expansion, the decisions California has made have been influential both regionally and nationally. What has transpired in the state has had implications for other states as they addressed difficult issues, including minimizing adverse selection, promoting cost-conscious consumer choice, and seamlessly coordinating with public programs.

Overdraft America: Confusion and Concerns About Bank Practices

May 3, 2012

Based on a survey, examines the prevalence of overdraft penalty and transfer fees by age and income, as well as consumer satisfaction with overdraft fee options. Makes policy recommendations.

State-Based Coverage Solutions: The California Health Benefit Exchange

May 26, 2011

Examines California's choices in designing an exchange to allow it to function as an active purchaser, mitigate adverse selection against and within the exchange, and not preclude community-based health plans from developing commercial offerings.