Publications on the Patient Protection and Affordable Care Act

2016

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

  Julia Joh Elligers, 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 West Virginia 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.

• Child Poverty in the United States Today: Introduction and Executive Summary 2016

  Benard Dreyer, Paul J. Chung, Peter G. Szilagyi, Shale Wong

  This executive summary summarizes what is known about the scope of childhood poverty in the United States today, as well as its effects on health and well-being for U.S children.

• Consumer Decisionmaking in the Health Care Marketplace 2016

  Erin Audrey Taylor, Katherine Grace Carman, Andrea Lopez, Ashley N. Muchow, Parisa Roshan, Christine Eibner

  To understand how consumers make decisions and the extent to which various factors can hinder decisionmaking, RAND researchers reviewed the literature on health insurance choice and on designing websites to support consumers' choices and, where possible, gleaned best practices from the literature. To understand the approaches health insurance websites have taken to convey information to consumers, they then reviewed 20 websites.

• Demographic, Insurance, and Health Characteristics of Newly Enrolled HIV-positive Patients After Implementation of the Affordable Care Act in California 2016

  Derek D. Satre, Sujaya Parthasarathy, Andrea Altschuler, Michael Silverberg, Erik D. Storholm, Cynthia I. Campbell

  After key ACA provisions went into effect in 2014, enrollment of HIV-positive patients increased. Those newly enrolled in a large California health plan were more likely to be male, in a high-deductible plan, and to have better viral control.

• Donald Trump's Health Care Reform Proposals: Anticipated Effects on Insurance Coverage, Out-of-Pocket Costs, and the Federal Deficit 2016

  Evan Saltzman, Christine Eibner

  The Trump health care proposal would decrease the number of insured and increase consumer health spending among those with marketplace insurance relative to current law. The policies would also increase the federal deficit by varying amounts.

• The Effect of the 2014 Medicaid Expansion on Insurance Coverage for Newly Eligible Childless Adults 2016

  Michael Dworsky, Christine Eibner

  The authors used the National Health Interview Survey (NHIS) to estimate how the Affordable Care Act Medicaid expansion affected health insurance enrollment, by source of coverage, among childless adults who became newly eligible for Medicaid in 2014. The NHIS data allowed the authors to report changes in enrollment by source of coverage and to conduct subgroup analyses of Medicaid take-up by gender, age, and other characteristics.

• Evaluating the CARE Act: Implications of a Proposal to Repeal and Replace the Affordable Care Act 2018

  Christine Eibner, Sarah A. Nowak

  Policymakers seeking to adopt the CARE Act, or to pursue a similar repeal-and-replace policy, may need to maintain some of the ACA's revenue-generating provisions, adopt alternative revenue-generating provisions, or reduce the generosity of tax credits to achieve budget neutrality.

• Financial Loss for Inpatient Care of Medicaid-insured Children 2016

  Jeffrey D. Colvin, Matt Hall, Jay G Berry, Laura M. Gottlieb, Jessica L. Bettenhausen, Samir S. Shah, Evan S. Fieldston, Patrick H. Conway, Paul J. Chung

  Medicaid financial losses at children's hospitals greatly exceed losses at other types of hospitals.

• Gaining Coverage Through Medicaid or Private Insurance Increased Prescription Use and Lowered Out-of-Pocket Spending 2016

  Andrew W. Mulcahy, Christine Eibner, Kenneth Finegold

  A growing body of literature describes how the Affordable Care Act (ACA) has expanded health insurance coverage. What is less well known is how these coverage gains have affected populations that are at risk for high health spending.

• Health Insurance and Workers' Compensation Claiming: Evidence from the Affordable Care Act 2016

  Philip Armour, Prodyumna Goutam, Paul Heaton

  Exploits the Affordable Care Act young adult dependent coverage expansion to measure the effect of health coverage expansions on workers' compensation claim frequency and severity.

• Hillary Clinton's Health Care Reform Proposals: Anticipated Effects on Insurance Coverage, Out-of-Pocket Costs, and the Federal Deficit 2016

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

  The Clinton health care proposal would increase the number of insured individuals and decrease consumers' health spending relative to current law. However, the policies with the largest coverage gains also increase the federal deficit the most.

• How Does Expanding Health Insurance Coverage Affect Workers' Compensation Costs? 2016

  Philip Armour, Prodyumna Goutam, Paul Heaton

  The Affordable Care Act's expansion of coverage for people under age 26 led to a 1-percent reduction in uninsurance, equating to a 0.8-percent decrease in workers' compensation claim frequency, and a roughly 1-percent decrease in overall claim costs.

• Knowledge as a Predictor of Insurance Coverage Under the Affordable Care Act 2016

  Maximiliane Hoerl, Amelie Wuppermann, Silvia Helena Barcellos, Sebastian Bauhoff, Joachim K. Winter, Katherine Grace Carman

  People who do not understand health insurance concepts, or the financial concepts associated with health insurance, are more likely to remain uninsured.

• Lactation Support Services and Breastfeeding Initiation: Evidence from the Affordable Care Act 2016

  Kandice A. Kapinos, Lindsey Bullinger, Tami Gurley-Calvez

  The likelihood that mothers with private health insurance would start breastfeeding increased by 2.5 percentage points after the Affordable Care Act mandated the coverage of lactation support services.

• Medical Device Innovation in the Era of the Affordable Care Act: The End of Sexy 2016

  Soeren Mattke, Harry H. Liu, Patrick Orr

  In this Perspective, the authors explore why medical device innovation has traditionally focused on improving performance, with little regard to cost. They argue that new incentives in the health care sector, accelerated by the Affordable Care Act, will force device manufacturers to embrace "the end of sexy" and redirect investments from the spectacular toward the prudent. They explore consequences for manufacturers, investors, and policymakers.

• The National Adult Immunization Plan: Strengthening Adult Immunization Through Coordinated Action 2017

  Bruce G. Gellin, Angela K. Shen, Rebecca Fish, Maggie A. Zettle, Lori Uscher-Pines, Jeanne S. Ringel

  Addressing persistent structural and policy barriers to adult immunization will benefit all Americans.

• Private Health Insurance Exchanges: Early Evidence and Implications for the Future 2016

  Christine Buttorff, Sarah A. Nowak, James Syme, Christine Eibner

  Private exchanges offer employer health insurance, combining online shopping, increased plan choice, benefit administration, and cost-containment strategies. This report examines how private exchanges function, how they may affect employers and employees, and the possible implications for the Affordable Care Act's Small Business Health Options Program Marketplaces.

2015

• The Affordable Care Act: An Opportunity for Improving Care for Substance Use Disorders? 2014

  Katherine E. Watkins, Carrie M. Farmer, David De Vries, Kimberly A. Hepner

  The ACA expands coverage for substance use treatment, but provides no measures for assessing its quality.

• Affordable Care Act Provision Lowered Out-of-Pocket Cost and Increased Colonoscopy Rates Among Men in Medicare 2015

  Mary K. Hamman, Kandice A. Kapinos

  Colorectal cancer screening is one of the few cancer screenings with an A rating from the US Preventive Services Task Force, meaning that the procedure confers a substantial health benefit.

• Alternatives to the ACA's Affordability Firewall 2015

  Sarah A. Nowak, Evan Saltzman, Amado Cordova

  The Affordable Care Act implements the employer mandate, which requires firms with more than 50 employees to offer health insurance or face penalties, and the individual "affordability firewall," which limits subsidies to individuals lacking access to alternative sources of coverage that are "affordable." This report examines the policy impacts of the affordability firewall and investigates two potential modifications.

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