Publications on the Patient Protection and Affordable Care Act

2017

• A Comprehensive Assessment of Four Options for Financing Health Care Delivery in Oregon 2017

  Chapin White, Christine Eibner, Jodi L. Liu, Carter C. Price, Nora Leibowitz, Gretchen Morley, Jeanene Smith, Tina Edlund, Jack Meyer

  This report compares the projected impacts and feasibility of four options for financing health care for Oregon residents. The Single Payer option and the Health Care Ingenuity Plan would achieve universal coverage, while the Public Option would add a state-sponsored plan to the Affordable Care Act Marketplace. Under the Status Quo option, Oregon would maintain its expansion of Medicaid and subsidies for nongroup coverage through the Marketplace.

• Did the Affordable Care Act's Dependent Coverage Expansion Affect Race/Ethnic Disparities in Health Insurance Coverage? 2017

  Joshua Breslau, Bing Han, Bradley D. Stein, Rachel M. Burns, Hao Yu

  While the ACA's Dependent Coverage Expansion has increased insurance coverage, it has also widened race/ethnic disparities because it benefits only those young adults whose parents have private coverage.

• Did the Dependent Coverage Expansion Increase Risky Substance Use Among Young Adults? 2017

  Joshua Breslau, Hao Yu, Bing Han, Rosalie Liccardo Pacula, Rachel M. Burns, Bradley D. Stein

  This analysis of the dependent coverage expansion under the ACA suggests that historical trends rather than the insurance expansion itself account for increases in substance use among people ages 19-25 since 2010.

• The Effect of Health Insurance Coverage Expansions on Auto Liability Claims and Costs 2017

  Srikanth Kadiyala, Paul Heaton

  Examines the effect of health insurance coverage expansions on auto liability claims and costs.

• The Effects of Iowa's Proposed Stopgap Measure on Health Insurance Costs and Coverage 2017

  Sarah A. Nowak, Preethi Rao, Jodi L. Liu, Christine Eibner

  This report uses RAND's COMPARE microsimulation model to estimate the effects of a 1332 waiver application from the state of Iowa. The waiver is designed to stabilize Iowa's Affordable Care Act individual market through a series of modifications. We estimate that the application would increase the federal deficit, but would decrease federal spending per enrollee on the ACA-compliant market.

• The Effects of the American Health Care Act on Health Insurance Coverage and Federal Spending in 2020 and 2026 2017

  Christine Eibner, Jodi L. Liu, Sarah A. Nowak

  The authors analyzed a version of the American Health Care Act (AHCA), a bill proposed in the U.S. House of Representatives on March 6, 2017. The bill would have repealed and replaced many provisions of the Affordable Care Act (ACA). The authors used RAND's COMPARE microsimulation model to assess how the AHCA would affect such outcomes as health insurance enrollment, consumer out-of-pocket costs, and the federal deficit relative to the ACA.

• Examining the Implementation of the Medicaid Primary Care Payment Increase 2017

  Justin W. Timbie, Christine Buttorff, Virginia Kotzias, Spencer R. Case, Ammarah Mahmud

  For the years 2013 and 2014, the Affordable Care Act authorized enhanced payments for qualifying providers of primary care services participating in the Medicaid program that would be funded entirely by federal dollars. RAND researchers conducted a nine-state independent case study into stakeholder experiences planning for, implementing, and evaluating the impact of the policy to inform the design of similar, future payment policies.

• Financing Health Care in Oregon: Four Policy Options 2017

  Chapin White, Christine Eibner, Jodi L. Liu, Carter C. Price, Nora Leibowitz, Gretchen Morley, Jeanene Smith, Tina Edlund, Jack Meyer

  This presentation describes four options for financing health care for residents of the state of Oregon and compares the projected impacts and feasibility of each option. The Single Payer option and the Health Care Ingenuity Plan would achieve universal coverage; the public option would add a state-sponsored plan to the Affordable Care Act (ACA) marketplace.

• How Might Veterans and the VA Health System Be Affected by Repeal of the Affordable Care Act? 2017

  Michael Dworsky, Carrie M. Farmer, Mimi Shen

  The American Health Care Act would increase uninsurance among veterans and demand for Department of Veterans Affairs care by a greater margin than simply returning to pre–Affordable Care Act levels of coverage.

• The Impact of Health Reform on Purchased Care Access: National Health Reform and Modernization of the Military Health System Study 2017

  Andrew W. Mulcahy, Italo A. Gutierrez, Tadeja Gracner, Teague Ruder, George E. Hart, Melony E. Sorbero

  The authors estimated how an influx of newly insured patients through the Affordable Care Act's coverage expansion may change the way that civilian providers choose to interact with the TRICARE program. The report culminates in lists and maps of counties where civilian physicians are most likely to face financial incentives to substitute newly insured patients for current TRICARE patients.

• Impact of the Affordable Care Act's Dependent Coverage Expansion on the Health Care and Health Status of Young Adults: What Do We Know So Far 2017

  Joshua Breslau, Bradley D. Stein, Bing Han, Shoshana R. Shelton, Hao Yu

  Under the ACA's dependent coverage expansion, there has been an increase in behavioral health treatment and a decrease in high out-of-pocket expenses and ER visits among young adults.

• Options to Expand Health Insurance Enrollment in the Individual Market 2017

  Christine Eibner, Jodi L. Liu

  Policymakers have many options to expand coverage in the individual market. We considered federal investments that would enhance, extend, or increase the tax credits available to enrollees, as well as reinsurance approaches that would lower premiums.

• Oregon's Options to Overhaul Health Care Financing: Health Care Reform 2.0? 2017

  Chapin White, Christine Eibner, Jodi L. Liu, Carter C. Price, Nora Leibowitz, Gretchen Morley, Jeanene Smith, Tina Edlund, Jack Meyer

  This analysis of three options to reform health care payment in Oregon (two state-based plans that would ensure coverage for all state residents and a state-sponsored plan offered in Oregon's nongroup market) found benefits and trade-offs for each.

• Patient Perceptions of Integrated Care and Their Relationship to Utilization of Emergency, Inpatient and Outpatient Services 2017

  Ashley-Kay Fryer, Mark W. Friedberg, Ryan W. Thompson, Sara J. Singer

  Patients who perceive their care to be integrated make less use of both emergency department and outpatient care.  

• Variation in Dermatologist Visits by Sociodemographic Characteristics 2017

  Andrew W. Mulcahy, Ateev Mehrotra, Karen E. Edison, Lori Uscher-Pines

  Medicaid enrollees are less likely than those with private insurance to see a dermatologist or receive care for a skin condition, suggesting that efforts need to be made to increase access to skin specialists.

• Veterans' Health Insurance Coverage Under the Affordable Care Act and Implications of Repeal for the Department of Veterans Affairs 2017

  Michael Dworsky, Carrie M. Farmer, Mimi Shen

  This report describes the Affordable Care Act's (ACA's) effects on nonelderly veterans' insurance coverage and demand for Department of Veterans Affairs (VA) health care and assesses the coverage and VA utilization changes that could result from repealing the ACA.

2016

• Assessing Policy Options for Subsidies to Improve the Affordable Care Act: One Approach Could Insure More People, Reduce Premiums, and Save $14 Billion per Year 2016

  Evan Saltzman, Christine Eibner, Alain C. Enthoven

  Of three alternatives examined for expanding health insurance and lowering premiums with no additional federal spending, extending the Affordable Care Act's subsidies to all consumers and placing a floor on subsidies had the greatest benefit.

• Assessing the Role of State and Local Public Health in Outreach and Enrollment for Expanded Coverage: A Case Study on Houston, Texas 2016

  Laura Runnels, Kate Heyer, Courtney Armstrong, Malcolm V. Williams, Laurie T. Martin

  Part of a series highlighting innovative models and best practices for leveraging local health departments' involvement in Patient Protection and Affordable Care Act outreach and enrollment, this brief reports on a case study on Houston, Texas, that captures nuanced differences in how health departments support these efforts, identifies facilitators and barriers to these approaches, and develop lessons learned from these activities.

• Assessing the Role of State and Local Public Health in Outreach and Enrollment for Expanded Coverage: A Case Study on Tacoma–Pierce County, Washington 2016

  Nazleen Bharmal, Malcolm V. Williams, Laurie T. Martin, Christian Lopez

  Part of a series on innovative models and best practices for leveraging local health departments' involvement in Patient Protection and Affordable Care Act outreach and enrollment, this report describes a case study on Tacoma--Pierce County, Washington, that captures nuanced differences in how health departments support these efforts, identifies facilitators and barriers to these approaches, and develop lessons learned from these activities.

• Assessing the Role of State and Local Public Health in Outreach and Enrollment for Expanded Coverage: A Case Study on Boston and Massachusetts 2016

  Kate Heyer, Nazleen Bharmal, Laurie T. Martin, Malcolm V. Williams, Courtney Armstrong

  Part of a series highlighting innovative models and best practices for leveraging local health departments' involvement in Patient Protection and Affordable Care Act outreach and enrollment, this report describes a case study on Boston and Massachusetts that captures nuanced differences in how health departments support these efforts, identifies facilitators and barriers to these approaches, and develop lessons learned from these activities.

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