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Implications of the ACA Medicaid Expansion: A Look at the Data and Evidence

May 31, 2018

More than four years after the implementation of the Medicaid expansion included in the Affordable Care Act, debate and controversy around the implications of the expansion continue. Despite a large body of research that shows that the Medicaid expansion results in gains in coverage, improvements in access and financial security, and economic benefits for states and providers, some argue that the Medicaid expansion has broadened the program beyond its original intent diverting spending from the "truly needy", offers poor quality and limited access to providers, and has increased state costs. New proposals allow states to implement policies never approved before including conditioning Medicaid eligibility on work or community engagement. New complex requirements run counter to the post-ACA movement of Medicaid integration with other health programs and streamlined enrollment processes. This brief examines evidence of the effects of the Medicaid expansion and some changes being implemented through waivers. Many of the findings on the effects of expansion cited in this brief are drawn from the 202 studies included in our comprehensive literature review that includes additional citations on coverage, access, and economic effects of the Medicaid expansion.

The Effects of Medicaid Expansion under the ACA: Updated Findings from a Literature Review

March 28, 2018

A substantial body of research has investigated effects of the Medicaid expansion under the Affordable Care Act (ACA) on coverage; access to care, utilization, affordability, and health outcomes; and various economic measures. This issue brief summarizes findings from 202 studies of the impact of state Medicaid expansions under the ACA published beginning in January 2014 (when the coverage provisions of the ACA went into effect) and updates earlier versions of this brief with studies through February 2018.1 More recent studies continue to support earlier findings but provide additional findings in key areas, including expansion's effects on health outcomes, access to services and medications for behavioral health and other needs, and providers' financial stability.

Abortion Coverage in the Bipartisan Health Care Stabilization Act of 2018 ( S.1771 )

March 22, 2018

The role of government in regulating abortion coverage began to be debated shortly after the landmark Supreme Court ruling in Roe v Wade. Since 1976, the Hyde Amendment has blocked federal funds under Medicaid and other federal programs from being used to pay for abortion, allowing exceptions only for pregnancies that endanger a woman's life, or that result from rape or incest. The Affordable Care Act (ACA) interpreted the federal abortion-funding ban to include the federal tax credits that functioned as premium subsidies to help individuals afford Marketplace plans. This issue brief reviews current federal and state policies on private insurance coverage of abortion services, and how the Bipartisan Health Care Stabilization Act of 2018 would affect abortion coverage for women enrolled in the individual market.

Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost Sharing Policies as of January 2018: Findings from a 50-State Survey

March 20, 2018

This 16th annual 50-state survey provides data on Medicaid and the Children's Health Insurance Program (CHIP) eligibility, enrollment, renewal and cost sharing policies as of January 2018. It takes stock of how the programs have evolved as the fifth year of implementation of the Affordable Care Act (ACA) begins, discusses policy changes made during 2017, and looks ahead to issues that may affect state policies moving forward. It is based on a survey of state Medicaid and CHIP officials conducted by the Kaiser Family Foundation and the Georgetown University Center for Children and Families.Key FindingsMedicaid and CHIP provide a robust base of coverage for low-income children. All but two states cover children with incomes up to at least 200% of the federal poverty level (FPL, $41,560 per year for a family of three in 2018), including 19 states that cover children with incomes at or above 300% FPL. The ten-year extension of federal funding for CHIP approved by Congress provides states stable funding to maintain children's coverage and continues protections for children's coverage moving forward.There have been major gains in Medicaid eligibility for parents and other adults under the Affordable Care Act (ACA) Medicaid expansion, but eligibility remains limited in the 19 states that have not implemented the expansion. Among non-expansion states, the median eligibility level for parents is 43% FPL ($8,935 for a family of three in 2018) and other adults generally are ineligible. Alabama and Texas have the lowest parent eligibility limits at 18% FPL or $3,740 per year for a family of three. Additional states may expand Medicaid for adults in the coming year, which would reduce the number of poor uninsured adults who fall into the coverage gap. States moving forward with expansion may seek waivers to add requirements or restrictions for adults as a condition of expanding.Through significant investments of time and resources, most states have transformed their Medicaid and CHIP enrollment and renewal processes to provide a modernized, streamlined experience as outlined in the ACA. With these processes, a growing number of states are processing real-time eligibility determinations and automated renewals through electronic data matches with trusted data sources. Looking ahead, waivers and other proposed changes for adults, including premiums and cost sharing, work requirements, and lockout periods, require complex documentation and costly administrative processes that run counter to the simplified enrollment and renewal processes states have implemented under the ACA.

Women’s Connections to the Healthcare Delivery System: Key Findings from the 2017 Kaiser Women’s Health Survey

March 13, 2018

Women's ability to access the care they need depends greatly on the availability of high quality providers in their communities as well as their own knowledge about maintaining their health through routine checkups, screenings, and provider counseling. This brief presents findings from the 2017 Kaiser Women's Health Survey, a nationally representative survey of women ages 18 to 64 on their health status, relationships to regular providers and sites of care, and the frequency at which they receive routine preventive care. The Kaiser Family Foundation has conducted surveys on women's health care in 2001, 2004, 2008, and 2013. This brief focuses on findings from the newest 2017 survey and presents some findings compared to earlier years.

Kaiser Health  Tracking Poll – February 2018 : Health Care  and the 2018 Midterms, Attitudes Towards Proposed  Changes to Medicaid

February 27, 2018

With still a few months until the midterm elections are in full swing, the latest Kaiser Health Tracking Poll finds health care costs as the top health care issue mentioned by voters when asked what they want to hear 2018 candidates discuss. When asked to say in their own words what health care issue they most want to hear the candidates talk about during their upcoming campaigns, one-fifth (22 percent) of registered voters mention health care costs. This is followed by a series of other health care issues, such as Medicare/senior concerns (8 percent), repealing or opposition to the Affordable Care Act (7 percent), improve how health care is delivered (7 percent), increasing access/decreasing the number of uninsured (6 percent), or a single-payer system (5 percent). Health care costs is the top issue mentioned by Democratic voters (16 percent) and independent voters (25 percent), as well as one of the top issues mentioned by Republican voters (22 percent), followed by repealing or opposing the ACA (17 percent).

Key Healthcare Proposals in Governors’ Proposed Budgets for SFY 2019 from a Preliminary Look at 32 States

February 15, 2018

Key Healthcare Proposals in Governors' Proposed Budgets for SFY 2019 from a Preliminary Look at 32 States.

Living in an Immigrant Family in America: How Fear and Toxic Stress are Affecting Daily Life, Well-Being, & Health

December 13, 2017

Immigration policy has been and continues to be a controversial topic in the U.S. Over the course of the election and since taking office, President Trump has intensified national debate about immigration as he has implemented policies to enhance immigration enforcement and restrict the entry of immigrants from selected countries the Administration believes may pose a threat to the country. The climate surrounding these policies and this debate potentially affect 23 million noncitizens in the U.S., including both lawfully present and undocumented immigrants, many of whom came to the U.S. seeking safety and improved opportunities for their families.They also have implications for the over 12 million children who live with a noncitizen parent who are predominantly U.S-born citizen children. We conducted focus groups with 100 parents from 15 countries and 13 interviews with pediatricians to gain insight into how the current environment is affecting the daily lives, well-being, and health of immigrant families, including their children.

Tracking Section 1332 State Innovation Waivers

December 12, 2017

Through Section 1332 of the Affordable Care Act (ACA), states may apply for innovation waivers to alter key ACA requirements in the individual and small group insurance markets. States can use the flexibility granted by 1332 waiver authority to shore up fragile insurance markets, address unique state insurance market issues, or experiment with alternative models of providing coverage to state residents. With Congressional efforts to repeal and replace the ACA on hold, attention will likely turn to 1332 waivers as states explore ways to address access and affordability issues in their individual and small group markets.While the ACA provides states with some flexibility to alter certain provisions using 1332 waiver authority, it establishes guardrails that limit the extent of the changes states may make. The current statutory language requires that state waiver applications must demonstrate that the innovation plan will provide coverage that is at least as comprehensive in covered benefits; at least as affordable (taking into account premiums and excessive cost sharing); cover at least a comparable number of state residents; and not increase the federal deficit. The ACA requirements states may seek to waive using Section 1332 authority include:Individual and employer mandates;Essential health benefits (EHBs);Limits on cost sharing for covered benefits;Metal tiers of coverage;Standards for health insurance marketplaces, including requirements to establish a website, a call center, and a navigator program; andPremium tax credits and cost-sharing reductions.Additionally, states may request an aggregate payment of what residents would otherwise have received in premium tax credits and cost-sharing reductions, referred to as subsidy pass-through funding. States may not waive certain provisions through section 1332, including guaranteed issue, age rating, and prohibitions on health status and gender rating. While states can submit ACA innovation waivers in conjunction with Medicaid waivers (under Sec. 1115 of the Social Security Act), innovation waivers cannot be used to change Medicaid program requirements.

How Many of the Uninsured Can Purchase a Marketplace Plan for Less than Their Shared Responsibility Penalty?

November 9, 2017

The Affordable Care Act (ACA) has expanded health insurance coverage by offering both penalties and incentives. The ACA expanded eligibility for Medicaid, and low and middle-income households who earn too much to qualify can purchase subsidized coverage on the health insurance marketplaces using premium assistance tax credits. Individuals, who do not obtain coverage, are subject to a tax penalty under the law's individual mandate unless they meet certain exemptions. While the percent of the population without health coverage has decreased substantially since the major coverage expansion in the ACA, about 10% of the population is still uninsured. Some of those who remain uninsured are eligible for premium subsidies large enough to cover the entire cost of a bronze plan, which is the minimum level of coverage people can buy to satisfy the individual mandate. Others could obtain coverage, after taking into account premium subsidies, for less than the penalty they would have to pay under the individual mandate. This analysis looks at the non-elderly uninsured eligible to enroll in a marketplace plan to determine how many of them would be financially better off enrolling in coverage than paying the penalty.

Key Global Health Positions and Officials in the U.S. Government

June 1, 2017

This fact sheet identifies key U.S. government global health positions and officials.

Key Issues in Children's Health Coverage

February 15, 2017

This brief reviews children's coverage today and examines what is at stake for children's coverage in upcoming debates around funding for the Children's Health Insurance Program (CHIP), repeal and replacement of the Affordable Care Act (ACA), and restructuring of Medicaid financing to a block grant or per capita cap. Following decades of steady progress, largely driven by expansions in Medicaid and CHIP, the children's uninsured rate has reached an all-time low of 5%. Medicaid and CHIP are key sources of coverage for our nation's children, covering nearly four in ten (39%) children overall and over four in ten (44%) children with special health care needs. Medicaid serves as the base of coverage for the nation's low-income children and covered 36.8 million children in fiscal year 2015. CHIP, which had 8.4 million children enrolled in fiscal year 2015, complements Medicaid by covering uninsured children above Medicaid eligibility limits.There is much at stake for children's coverage in upcoming debates. New legislative authority is needed to continue CHIP funding beyond September 30, 2017. In addition, the Administration and Republican leaders in Congress have called for repeal and replacement of the ACA and restructuring of Medicaid financing to a block grant or per capita cap. Loss of CHIP funding, repeal of the ACA, and capping Medicaid financing all have the potential to reverse the coverage gains achieved to date and increase the number of uninsured children. In addition, rollbacks in coverage for parents could contribute to coverage losses among children and increased financial instability among families.Reductions in children's coverage would lead to reduced access to care and other long-term effects for children and increase financial pressure on states and providers. Reductions in children's coverage would result in fewer children accessing neededcare, including preventive services such as well child visits and immunizations. Research also suggests that reductions in children's coverage could have broader long-term negative effects on their health, education, and financial success as adults. In addition, loss of CHIP funding and reductions in federal Medicaid financing would create funding gaps that would increase financial pressure on states and providers.