Publications on the Patient Protection and Affordable Care Act

2019

• Effects of Alternative Insurer Responses to Discontinued Federal Cost-Sharing Reduction Payments: Broad Loading as an Alternative to Silver Loading 2019

  Preethi Rao, Sarah A. Nowak

  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.

2018

• Early Impact of the Affordable Care Act Coverage Expansion on Safety-Net Hospital Inpatient Payer Mix and Market Shares 2018

  Vivian Y. Wu, Kathryn R. Fingar, H. Joanna Jiang, Raynard Washington, Andrew W. Mulcahy, Eli Cutler, Gary Pickens

  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.

• The Effect of Eliminating the Individual Mandate Penalty and the Role of Behavioral Factors 2018

  Christine Eibner, Sarah A. Nowak

  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.

• Effect of the Affordable Care Act on Breastfeeding Outcomes 2018

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

  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.

• The Effects of Alternative Payment Models on Physician Practices: Follow-Up Study 2018

  Mark W. Friedberg, Peggy G. Chen, Molly Simmons, Tisamarie Sherry, Peter Mendel, Laura Raaen, Jamie Ryan, Patrick Orr, Carol Vargo, Lindsey Carlasare, et al.

  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.

• Effects of Health Care Payment Models on Physician Practice in the United States: Follow-Up Study 2018

  Mark W. Friedberg, Peggy G. Chen, Molly Simmons, Tisamarie Sherry, Peter Mendel, Laura Raaen, Jamie Ryan, Patrick Orr, Carol Vargo, Lindsey Carlasare, et al.

  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.

• Expanding Enrollment Without the Individual Mandate: Options to Bring More People Into the Individual Market 2018

  Jodi L. Liu, Christine Eibner

  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.

• Extending Marketplace Tax Credits Would Make Coverage More Affordable for Middle-Income Adults 2018

  Jodi L. Liu, Christine Eibner

  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.

• Impacts of the Dependent Care Expansion on the Allocation of Mental Health Care 2018

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

  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.

• Impacts of the Elimination of the ACA's Individual Health Insurance Mandate Penalty on the Nongroup Market in New York State 2018

  Preethi Rao, Christine Eibner, Sarah A. Nowak

  How will elimination of the Affordable Care Act's individual mandate penalty affect the nongroup insurance market in the state of New York? Researchers used RAND's COMPARE microsimulation model to estimate the effects, taking into account New York's unique health care landscape.

• Medicare Advantage Penetration and Hospital Costs Before and After the Affordable Care Act 2018

  Rachel M Henke, Zeynal Karaca, Teresa B. Gibson, Eli Cutler, Chapin White, Herbert S. Wong

  Prior to the ACA, Medicare Advantage (MA) enrollment growth led to small reductions in inpatient for the entire population over age 65.  After the ACA, this impact diminished, contrary to the hypothesis that the MA ACA payment would amplify this effect.

• What Is the Impact on Enrollment and Premiums If the Duration of Short-Term Health Insurance Plans Is Increased? 2018

  Preethi Rao, Sarah A. Nowak, Christine Eibner

  Extending the duration of short-term individual health plans will have little effect on premiums or enrollment in the individual market.

2017

• The Benefits and Drawbacks of Alternative Tax Subsidization Approaches for Health Insurance 2017

  Christine Buttorff, Katherine Grace Carman, Christine Eibner

  This report reviews the features of tax-based approaches to subsidizing health insurance, including tax credits and tax deductions, and summarizes their associated benefits and drawbacks. Different approaches could affect consumer premium payments, health insurance enrollment, federal costs, total health spending, and work incentives.

• The Clinical Pharmacy Specialist: Part of the Solution 2017

  Adam J. Rose, Megan B. McCullough, Barry L. Carter, Robert S. Rudin

  Efforts to create high-functioning primary care teams should take advantage of the knowledge and skills of clinical pharmacy specialists

• 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.

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