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Affordable Care Act

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Through a number of provisions — such as individual and employer mandates, health insurance exchanges, and the expansion of Medicaid — the Patient Protection and Affordable Care Act (ACA) aims to expand access to health care for uninsured Americans. RAND has examined implementation challenges, cost and coverage implications, Medicaid expansion, state health insurance exchanges, and reforms to both care delivery and payment.

Journal Article

The Effect of Eliminating the ACA's Individual Mandate

Jul 12, 2018

Removing the financial penalties associated with the Affordable Care Act's individual mandate may cause enrollment to fall by 2.8 million to 13 million people. It could also result in a 3 to 13 percent increase in bronze plan premiums.
Report

Effects of the ACA's Medicaid Expansion on Health Insurance Enrollment

Dec 29, 2016

Increases in insurance coverage were larger in states that expanded Medicaid, but take-up was lower among men, Hispanics, and adults under 36.

Explore Affordable Care Act

Report

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

In this report, the authors assess the effects of disallowing the current practice of increasing only the premiums of silver-tiered individual market plans in response to discontinued federal payments of cost-sharing reductions (silver loading).

Jun 3, 2019
Journal Article

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

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.

Dec 27, 2018
Commentary

All Health Policy Is Local: The Case of the Individual Mandate Penalty in New York

As with many Affordable Care Act policies, how New York is dealing with the absence of the individual mandate penalty is a potent reminder that all health policy is local.

Oct 30, 2018
News Release

News Release

Complex and Rapidly Changing Payment Models Challenge Physician Practices

Physician payment models are becoming more complex and the pace of change is increasing, creating challenges for physician practices that might hamper their ability to improve the quality and efficiency of care despite their willingness to change.

Oct 24, 2018
Research Brief

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

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.

Oct 24, 2018
Report

Physicians Struggle to Keep Up with Changing Payment Models

Alternative payment models cause administrative burdens that take doctors away from patient care. Slowing the rate of change and simplifying payment models could help them focus on patients. And getting physicians' input on the design of new payment methods might improve their engagement.

Oct 24, 2018
Journal Article

Keeping Young Adults Insured Means More Mental Health Care

Lack of insurance has been a barrier to mental health treatment for young adults. The ACA's Dependent Care Expansion, which allows them to stay on their parents' policies until age 26, has increased use of mental health care among this high need group—without affecting quality of care or disparities in access.

Sep 21, 2018
Report

Impacts of Eliminating the Individual Mandate Penalty in New York

In 2019, the ACA's individual mandate penalty will be eliminated. How will this affect New York's nongroup insurance market? It could result in an estimated 23 to 25 percent increase in premiums and a 37 percent reduction in enrollment.

Sep 20, 2018
Journal Article

Journal Article

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

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.

Aug 24, 2018
Journal Article

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

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.

Aug 22, 2018
Commentary

Understanding the Impact of the Elimination of the Individual Mandate Penalty

Starting in 2019, the Affordable Care Act's individual mandate penalty will be eliminated, effectively ending the law's requirement that most people have health insurance. While declines in coverage and increases in premiums are likely, the magnitudes of these effects are highly uncertain.

Aug 10, 2018
Journal Article

Journal Article

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

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

Jun 14, 2018
Journal Article

Journal Article

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

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.

Apr 12, 2018
Journal Article

Journal Article

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

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.

Feb 14, 2018
Journal Article

Effect of the Affordable Care Act on Breastfeeding Outcomes

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.

Feb 9, 2018
Commentary

Tax Reform Could Raise Car Insurance Rates

The new tax law eliminates the individual mandate. When this repeal takes effect in 2019, millions more Americans are expected to go without health insurance. Auto insurers will likely pick up the tab for some of that population's medical care. That could raise car insurance premiums.

Feb 4, 2018
Journal Article

Options to Expand Health Insurance Enrollment in the Individual Market

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.

Oct 31, 2017
Blog

Beyond the Headlines: RAND's Christine Eibner Discusses Health Care Reform

The issue of how to improve health care in the United States is complicated. At a RAND event, senior economist and Paul O'Neill Alcoa Chair in Policy Analysis Christine Eibner discussed modifications to the Affordable Care Act and the long-term outlook for health care reform.

Oct 27, 2017
Report

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

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.

Oct 17, 2017

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RAND Topic:
Affordable Care Act

Topic Synonyms:
ACA;
Health Care Bill;
Health Care Reform Bill;
Healthcare Bill;
Healthcare Reform Bill;
HR 3200;
Patient Protection and Affordable Care Act

Research conducted by

RAND Health Care