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Georgia: Individual State Report - State-level Field Network Study of the Implementation of the Affordable Care Act

December 18, 2015

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.According to the report, much of the reduction in Georgia's uninsured population can be attributed to the extensive education and outreach efforts that were carried out by a variety of nonprofit and community-based organizations. Many media organizations also played a role through various public information activities and their extensive coverage of the eligibility requirements, the process for signing up for coverage through the federal health insurance marketplace, and opportunities for obtaining consumer assistance with the enrollment process.Unlike many other states that embraced a more positive response to health reform, Georgia's state government did not engage in any formal education, public information, or outreach activities to assist eligible low-income households in connecting to the most appropriate health insurance plan for their needs and circumstances through the marketplace. The report concludes that while notable gains were made in extending health care coverage to the uninsured during the first two enrollment periods, given the size of Georgia's "coverage gap," further reductions in the state's uninsured population will likely depend on state officials crafting an alternative to Medicaid expansion acceptable to the state's political leadership.

Ohio: Individual State Report - State Level Field Network Study of the Implementation of the Affordable Care Act

September 29, 2015

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.Over the past year, state agency leadership and some members of the legislature have taken an interest in exploring various healthcare reforms in Ohio that address rising healthcare costs and identifying ways to improve healthcare quality, efficiency, and improve overall health outcomes for Ohioans. For example, the legislature included language around healthcare price transparency in the most recent state budget and formed a study committee for the summer of 2015 with the purpose of examining healthcare efficiencies that lead to better health outcomes at a lower cost to Ohioans.

Minnesota: Individual State Report - State Level Field Network Study of the Implementation of the Affordable Care Act

August 3, 2015

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.By the end of the second enrollment period in 2015, MNsure (the insurance marketplace) reported that more than 300,000 individuals had enrolled in health insurance coverage through the marketplace since its launch. Eighty percent of this new coverage is due to growth in public program enrollment, with the remaining coverage due to QHP (qualified health plans) enrollment. Between September 30, 2013, and May 1, 2014, the number of uninsured Minnesotans fell by 180,500 -- a reduction of 40.6 percent. Minnesotans saved $30 million on their insurance premiums through tax credits in 2014.While the increase in health insurance coverage was driven particularly by an increase in the number of Minnesotans enrolled in public health insurance programs, enrollment in private health insurance plans has also increased. As MNsure moves forward, it is important to maintain a strong private QHP market, as those premiums significantly contribute to the marketplace's revenues.

Arkansas: Baseline Report - State-Level Field Network Study of the Implementation of the Affordable Care Act

May 29, 2015

A report, released by the Rockefeller Institute of Government and the Arkansas Center for Health Improvement (ACHI), reveals significant collaboration between Arkansas's public and private sectors to expand health care coverage through the Health Care Independence Program (commonly known as the "private option") and the federally facilitated marketplace partnership.The report is the most recent in a series of state and regional studies advanced by a national network examining the rollout of the Affordable Care Act (ACA). The national network, with 40 states and 74 researchers, is an effort of the Rockefeller Institute of Government at the State University of New York, the Washington-based Brookings Institution, and the Fels Institute of Government at the University of Pennsylvania.

New Hampshire: Baseline Report - State Level Field Network Study of the Implementation of the Affordable Care Act

January 21, 2015

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.New Hampshire's experience with implementing the ACA in 2013 and 2014 underscores the state's "wait and see" approach to health care reform. Since the passage of the ACA in March 2010, a wide range of national polls demonstrated that the public remains fundamentally split about the law and its effects; unlike other major health care reforms (e.g., the Medicare Modernization Act of 2003) the public has not warmed to the ACA over time. The stability of public attitudes towards the ACA is striking; despite month-to-month variations, surveys by the Kaiser Family Foundation, Gallup, and other major polling organizations reveal that public views of the ACA have changed little over the past four years. This ongoing partisan and policy divide is evident in the Granite State, as Republicans continue to oppose the ACA, while Democrats embrace reform -- on New Hampshire's terms.

Virginia: Baseline Report - State Level Field Network Study of the Implementation of the Affordable Care Act

January 6, 2015

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.By and large, Virginia opponents of the Affordable Care Act have been able to thwart full implementation at the state level. This can be seen in Virginia's decision to default to a federally facilitated marketplace and refusal to close the coverage gap. Having control of the executive branch and legislature until 2014 allowed lawmakers to minimize the impacts of the ACA, implementing only what was legally required of them and ignoring calls from advocates for low-income people who called for fuller implementation.There remains the possibility for significant changes, including the structure and functioning of the marketplace as well as closing the coverage gap that would alter the state and national policy landscape. There remains serious debate about if and how Virginia will close the coverage gap. If Virginia moved forward, nearly 400,000 Virginians could get access to quality, affordable health care. Moreover, some advocates have asserted that Virginia could be the linchpin in opening up the South to Medicaid expansion.

Pennsylvania: Base Line Report - State Level Field Network Study of the Implementation of the Affordable Care Act

January 5, 2015

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.Although the ACA will no doubt have real financial consequences for insurers, hospitals, and health care providers, at this early stage in implementation, it is difficult to calculate precise gains and losses. For example, the Hospital Association of Pennsylvania supported the ACA, believing, in part, that reform was necessary to reduce current levels of uncompensated care and to reduce reliance on emergency care for patients who put off treatment for as long as possible to avoid out-of-pocket costs. The association agreed to significant cuts in Medicare and Medicaid to support the bill's passage. However, because cost savings from universal coverage have not yet been realized, hospitals reported cutting staff in April 2014 to offset the loss of Medicaid and Medicare funding. Safety net hospitals, which are required to serve all populations, seem especially affected, as many of their patients who fall into the Medicaid coverage gap are still showing up in emergency rooms without insurance.

Kansas: Baseline Report - State Level Field Network Study of the Implementation of the Affordable Care Act

December 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.The Kansas report highlights the diverse approaches to implementation taken by elected officials including Insurance Commissioner Sandy Praeger, Governor Sam Brownback, and the Kansas Legislature. The political landscape changed this year when Commissioner Praeger decided not to seek re-election. Her replacement, Commissioner-Elect Ken Selzer, has expressed opposition to the ACA.

Michigan: Baseline Report - State Level Field Network Study of the Implementation of the Affordable Care Act

December 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.Michigan has taken a mixed approach to implementing the Patient Protection and Affordable Care Act (ACA). It very nearly became the first state led entirely by Republicans to create a health insurance exchange as part of the ACA. Instead, Michigan was one of the more than thirty states to default to a federally run exchange. The state decided to adopt the Medicaid expansion, but with a delayed start date of April 2014.

Connecticut: Baseline Report - State Level Field Network Study of the Implentation of the Affordable Care Act

October 15, 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.Connecticut demonstrates how well even a smaller state can do in implementing health insurance reform through its own exchange. Broad political and industry support for a state-based exchange has resulted in one of the very best functioning exchanges in the country. Difficult or potentially contentious issues that Connecticut may face in coming years include: 1) high health care costs and the diminished level of price competition among hospitals; 2) whether additional insurers will enter the exchange and whether the new nonprofit insurance co-op will remain financially viable; 3) whether the SHOP exchange will achieve critical mass; and 4) the appropriate level of consumer representation on the exchange board.

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

August 20, 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.There is clear alignment among most groups and institutions on the state's adoption and implementation of the ACA. Because of its all-payer rate system, competition between private plans and exchange plans is muted. Some conservative elements in the Democratic-heavy legislature oppose rate-setting and the state's generous Medicaid expansions as well as its affirmation of the ACA. But with strong Democratic majorities in both houses, together with Democrats in the governor's and lieutenant governor's offices and professionals with policy and political expertise, the state's progressive reformers are clear winners. The state's inclusive and generous eligibility decisions will afford coverage to a broad portion of the state's uninsured populations. Advocates for these groups also win. In the case of Maryland, the "stars were aligned" to formulate an aggressive and expansive approach to the law. Minority opposition simply could not mount effective challenges to these forces.

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

August 15, 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.Kentucky's health benefit exchange has thus far been among the nation's leaders in successful implementation, its sustainability will depend on political leadership, the ability of supporters to mount successful public relations and constituent campaigns, and ongoing fiscal support. All these elements will be hotly contested in the next year.