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.
The Affordable Care Act's "Cadillac tax" consists of a 40-percent excise tax on premiums for employer-sponsored health plans in excess of a dollar limit. This report uses RAND's COMPARE microsimulation model to compare the effects of the Cadillac tax versus an alternative tax, based on an exclusion gap, on families in different income ranges.
Our primary objective was to examine the variability in drug coverage in the exchanges across plan types (health maintenance organization or preferred provider organization) and metal tiers (bronze, silver, gold, and platinum).
The Affordable Care Act has reduced the number of uninsured; an emerging challenge is to help the newly insured choose coverage wisely and use it to access primary care and preventive services.
Little is known about the health status of the 7.3 million Americans who enrolled in insurance plans through the Marketplaces established by the Affordable Care Act in 2014.
This report describes who ultimately pays for health care in Vermont by tracing spending back to the original funding source. The authors estimate the economic incidence of health spending in Vermont for 2012 and as projected for 2017.
In this research report, RAND Corporation researchers assess the expected change in enrollment and premiums in the Patient Protection and Affordable Care Act–compliant individual market in federally facilitated marketplace (FFM) states if the U.S. Supreme Court decides to eliminate subsidies in FFM states.
The project reported here aimed to describe the effects that alternative health care payment models have on physicians and physician practices in the United States. Project findings should help guide efforts to improve current and future alternative payment programs and help physician practices succeed in these new payment models. The report provides both findings and recommendations.
On behalf of the Patient-Centered Outcomes Research Institute (PCORI), RAND conducted a series of focus groups to explore the views of payers, purchasers, and industry stakeholders on comparative effectiveness research (CER). This report describes stakeholders' health-related decisions, information needs, and views on being involved in CER. Key themes emerging from the discussions are presented, along with implications for PCORI's future work.
To date, most Affordable Care Act implementation efforts have focused on getting individuals enrolled in health insurance coverage. Confirming that the newly insured access and remain engaged with appropriate health care has received less attention. This perspective describes lessons learned from conversations with a variety of health care industry stakeholders and calls for more-holistic thinking on ways to support consumers beyond enrollment.
Growth in federal, state, and private funding is fueling the initiation of home visiting programs around the country.
Describes the extent to which eliminating the subsidies offered by the Affordable Care Act would disrupt the U.S. individual health insurance market.
Describes the extent to which reduced enrollment of 18-to-34-year-olds in the U.S individual health insurance market would lead to increased premiums.
Describes how removing the Affordable Care Act's individual mandate would affect health insurance premiums and the overall numbered of insured.
Describes the extent to which changing the subsidy structure of the Affordable Care Act would make the individual health insurance market more sensitive to the rate of young adult enrollment.
Mandated uniform out-of-pocket caps for those with group insurance will benefit very few individuals, and will not result in substantial reductions in financial burden.
To evaluate the potential for a patient-centered medical home initiative to reduce utilization and cost while improving quality, we examined a natural experiment involving 11 primary care practices in Cincinnati, Ohio.
A key challenge of health reform efforts is to make health insurance affordable for individuals and families who lack coverage without harming those with coverage or increasing federal spending.
While most of the Affordable Care Act's coverage-related provisions took effect in January 2014, there is limited information on insurance transitions that occurred in the period before and after these changes became operational. This report examines insurance transitions between September 2013 and November 2014 using longitudinal data from the RAND Health Reform Opinion Study.
This article describes the current status of home-based medical care in the United States and offers a brief narrative of a fictional homebound patient and the health events and fragmented care she faces.
