A project of the George Washington University's Hirsh Health Law and Policy Program and the Robert Wood Johnson Foundation

Third Party Resources

Georgetown releases report on post-ACA network design

Posted on September 23, 2014

Researchers at Georgetown University’s Center on Health Insurance Reforms (CHIR) conducted a six-state case study to assess changes in the network design of plans offered through the health insurance marketplaces, as well as the response of state officials in the face of consumer and provider concerns. The report finds that insurers have narrowed their networks, relative to what they offered in the past, however states and insurers reported few consumer complaints about the ability to obtain medically necessary care in-network. Most of the study states are unlikely to take action to change their standards for network adequacy, however, half of the states studied will require insurers to provide better, up-to-date provider directories, so that consumers can better understand which providers are in which plan networks before they buy.

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10.3 million adults estimated to have gained coverage under the ACA

Posted on July 24, 2014

A new study published in the New England Journal of Medicine found that an estimated 10.3 million adults gained insurance coverage under the Affordable Care Act (ACA).  The study, performed by Harvard researchers, reported a 5.2% decline in the uninsured rate during the first open enrollment period.  Data analyzed for this project included Gallup polls and ACA enrollment statistics from the US Department of Health and Human Services (HHS).

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Two new ACA studies released

Posted on June 26, 2014

A new study published in Health Affairs found that open enrollment for the Affordable Care Act (ACA) should coincide with the tax filing season. The researchers argued that consumers are more likely to make better decisions with their health coverage when taxes are on their minds, not the stresses associated with holiday spending. Currently, ACA open enrollment for 2015 is scheduled for November 15, 2014 to February 15, 2015.

Another study from the Urban Institute indicates that Medicaid expansion was associated with a reduction in the number of uninsured individuals as of March 2014. The study, which relied upon data from Urban’s Health Reform Monitoring Survey, found that states expanding Medicaid saw a drop in the uninsurance rate by 4%, whereas states that did not expand Medicaid saw a 1.4% reduction. Unlike the ACA open enrollment period, individuals eligible for Medicaid can enroll in the program at any point in a year.

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New brief discusses premium rate review

Posted on June 20, 2014

The Robert Wood Johnson Foundation and the Leonard Davis Institute of Health Economics at Penn released a brief on premium proposals and rate review under the Affordable Care Act (ACA). The brief, Deciphering the Data: Health Insurance Rates and Rate Review, discusses the economic, political, and regulatory factors that contribute to rate determinations. Additionaly, the brief discusses how states with prior approval for rate review authority increased their capacity and scope to coincide with requirements under the ACA.

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KFF survey discusses ACA “plan switchers”

Posted on June 19, 2014

A new survey conducted by the Kaiser Family Foundation (KFF) discusses the experience of individuals that were enrolled in the individual health insurance market prior to the Affordable Care Act (ACA), and then switched into the ACA health insurance Marketplace. The survey found that 46% of these individuals have lower premiums after switching to the ACA Marketplace, while 39% have higher premiums. Additionally, about 50% of these “plan switchers” received cancellation notices from their insurance issuers because their plans were deemed non-compliant with the ACA prior to the issuance of the transitional policy.

The survey also indicated that affordability is still an issue for individuals enrolled in ACA plans, as 6 in 10 of those surveyed fear their plans may become unaffordable in the future.

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Article discusses likelihood of funding gaps for safety-net hospitals

Posted on June 2, 2014

A new article published in Health Affairs finds that some safety-net hospitals will still face funding issues, even after implementation of the Affordable Care Act (ACA). The article cites rising healthcare costs, the number of Americans still without insurance, and the disproportionate share hospital payment reductions within the ACA as reasons contributing to the continuation of funding gaps for many safety-net hospitals. States that did not expand Medicaid may be particularly impacted by these funding gaps, as they will not be receiving federal expansion money to offset the cuts in the safety-net funds.

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Report discusses use of narrow networks

Posted on May 30, 2014

Under the Affordable Care Act (ACA), many insurers have been creating plans with narrower provider networks. A new report discusses how to use narrow networks as a means to contain costs, but not compromise patient access to care. The report, published by the Urban Institute and The Center on Health Insurance Reforms at Georgetown University, suggests that the appropriate balance between consumer choice and containing costs can be achieved through regulations, transparency, and oversight.

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Exemptions and Special Enrollment Periods under the ACA

Posted on May 14, 2014

Below are three tables that describe the exemptions and SEPs in the ACA. The first table enumerates the exemptions and the method by which an individual may claim them. The second table focuses specifically on one type of exemption pathway- hardships. This table lists several specific events that will qualify as a hardship exemption and how to claim them. The third table describes the SEPs, including the rationale behind them and who is affected.

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RWJF and Urban report discusses repealing employer mandate

Posted on May 12, 2014

A new report released by the Urban Institute and the Robert Wood Johnson Foundation stated that aside from costs, there would be a minimal impact if the administration removed the Affordable Care Act’s (ACA) employer mandate. The report, Why Not Just Eliminate the Employer Mandate?, stated that repealing the provision would result in 200,000 fewer individuals being covered in 2016, 500,000 fewer receiving employer-sponsored coverage, and 300,000 more qualifying for Medicaid or health insurance subsidies. Repealing the employer mandate, which the report states is not pivotal in expanding coverage under the ACA, would remove the business industry’s main issue with the ACA. The biggest challenge with removing the employer mandate would be finding a pay-for to account for the $130 billion the provision was anticipated to generate in fines and the costs of providing more subsidies.

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Study finds large employers could save money under ACA by dropping benefits

Posted on May 1, 2014

A report issued by S&P Capital IQ found that if publicly traded companies drop employer-sponsored insurance (ESI) benefits by 2020, they could save more than $700 billion by 2025. The report, released earlier today, said that these companies would save substantially by paying the Affordable Care Act’s (ACA’s) penalty rather than paying premium contributions and other costs associated with offering ESI. The authors postulate that once several notable companies elect to no longer offer ESI, many others will follow suit, leading to potentially 90% of major corporation employees receiving ACA Marketplace coverage by 2020.

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