Exploring the Influences of External Factors on the Veteran Disability Compensation Program 2021
Explores factors affecting the performance and scope of the veteran disability compensation program.
Publications on the Patient Protection and Affordable Care Act
2021
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Temporary Safety-Net Policies and Pandemic-Related Insurance Loss in New York State 2021
The coronavirus disease 2019 pandemic–related recession and resulting job loss raised significant concerns that the U.S. uninsured population could increase, perhaps by millions. However, worrisome predictions about coverage loss have not materialized. RAND researchers (1) assess the importance of temporary provisions in stabilizing health insurance enrollment despite heavy job loss and (2) run simulations using New York state as a case study.
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Changes in Pediatric Dental Coverage and Visits Following the Implementation of the Affordable Care Act 2021
Comparing pre- and post-ACA periods, private dental insurance increased by 4.6% (P=0.013) and annual dental visits were unchanged (2.7%, P=0.071) comparing children likely or unlikely to be affected by the ACA.
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Low Rates of Pediatric Dental Coverage for Families Purchasing Marketplace Insurance Plans 2021
Pediatric dental care is an essential health benefit that the Affordable Care Act requires most private health plans to cover. It is unknown how these different pediatric dental coverage offerings may affect uptake of coverage.
2020
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Consolidation by Any Other Name: The Emergence of Clinically Integrated Networks 2020
In this report, the authors offer an initial assessment of clinically integrated networks (CINs) based on interviews with health system executives, describe how health systems (large and small) are using CINs strategically to compete in crowded health care markets, and identify why CINs bear watching by the Federal Trade Commission and the larger health care community.
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Effects of a Public Option on Health Insurance Costs and Coverage 2020
This brief describes how a public option for health care—that is, a government-sponsored health insurance plan with publicly determined provider payment rates—would affect insurance costs and coverage.
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Public Options for Individual Health Insurance: Assessing the Effects of Four Public Option Alternatives 2020
There is growing interest in a "public option" for individual market insurance to improve affordability and enrollment. The authors consider four public option alternatives that vary based on the rates providers are paid, whether the option is implemented on or off Health Insurance Marketplaces, and whether premium tax credits are available to higher-income individuals.
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The Affordable Care Act, Breastfeeding, and Breast Pump Health Insurance Coverage 2020
Viewpoint on the Affordable Care Act, breastfeeding, and breast pump health insurance coverage.
2019
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Effects of Alternative Insurer Responses to Discontinued Federal Cost-Sharing Reduction Payments: Broad Loading as an Alternative to Silver Loading 2019
Although the federal government is no longer making cost-sharing reduction (CSR) payments to insurers, insurers are still required to provide CSR subsidies to qualifying enrollees. As a result, to fund CSRs, most states and insurers have adopted a practice known as silver loading, in which only the premiums of silver-tiered individual market plans are increased. In this report, the authors address the effects of disallowing this practice.
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Medicare for 50-to-64-Year-Olds: Assessing the Effects of Allowing Older Adults to Buy Into the Medicare Program 2019
In this report, the authors analyze how allowing adults ages 50 and older to buy into the Medicare program could affect health insurance coverage, individual market premiums, and federal health care spending. Their findings suggest that a Medicare buy-in could offer significantly more-affordable coverage to older adults while potentially leading to higher premiums for the pool of people remaining on the individual market.
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Options for Reinvesting Savings from Restored Federal Cost-Sharing Reduction Payments: Examining the Effects of Two Policy Alternatives on Spending and Enrollment in the Individual Health Insurance Market 2019
Earlier research established that the federal government would likely save money if federal cost-sharing-reduction (CSR) payments to insurers under the Affordable Care Act were restored, but total health insurance enrollment would decrease. The authors of this report analyze what would happen if federal lawmakers used the savings from restoring CSR payments to provide additional health insurance subsidies or to finance reinsurance.
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Specialty Care Access for Medicaid Enrollees in Expansion States 2019
In a survey of community health center medical directors in 9 Medicaid expansion states and DC, nearly 60% reported difficulty obtaining new specialist visits and multiple access barriers on behalf of their patients.
2018
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Early Impact of the Affordable Care Act Coverage Expansion on Safety-Net Hospital Inpatient Payer Mix and Market Shares 2018
Following Medicaid expansion, non safety-net hospitals experienced a greater percentage increase in Medicaid stays than did safety-net hospitals, which may reflect patient choice or a crowd-out of private insurance.
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The Effect of Eliminating the Individual Mandate Penalty and the Role of Behavioral Factors 2018
Under alternative assumptions about consumer responses, we find that enrollment falls by 2.8 million to 13 million people nationwide and premiums for bronze plans increase by 3 percent to 13 percent when the mandate penalty is removed.
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Effect of the Affordable Care Act on Breastfeeding Outcomes 2018
When new mothers have affordable access to lactation support services and breast pumps, they are more likely to breastfeed until their infants are ready to transition to solid foods.
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The Effects of Alternative Payment Models on Physician Practices: Follow-Up Study 2018
Physician practice engagement with alternative payment models (APMs) would be enhanced by simpler APMs, a slower pace of change, greater support for new capabilities and timely data, and reexamination of practice response to APMs with financial risk.
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Effects of Health Care Payment Models on Physician Practice in the United States: Follow-Up Study 2018
This report, sponsored by the American Medical Association (AMA), describes how alternative payment models (APMs) affect physicians, physicians' practices, and hospital systems in the United States. Payment models discussed include fee for service, capitation, episode-based and bundled, shared savings, pay for performance, retainer-based, and combined payment models such as medical homes and accountable care organizations.
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Expanding Enrollment Without the Individual Mandate: Options to Bring More People Into the Individual Market 2018
The options analyzed would increase individual market enrollment by 400,000 to 3.2 million in 2020. Net increases in total enrollment (300,000 to 2.4 million) are smaller because of offsetting decreases in employer-sponsored insurance.
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Extending Marketplace Tax Credits Would Make Coverage More Affordable for Middle-Income Adults 2018
Middle-income adults ages 50-64 would have more affordable coverage if the ACA's tax credits were extended to all income groups; this would improve the individual market risk pool because premiums for this group would exceed the cost of their care.
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Impacts of the Dependent Care Expansion on the Allocation of Mental Health Care 2018
The dependent care expansion increased use of mental health care among a patients with significant mental health needs without lowering quality of care or increasing racial or ethnic disparities in access.