Affordable Care Act

State-Based Marketplaces 2.0 – Part 1: The Coming Expansion in Access, Affordability, and Value

By ROSEMARIE DAY and DAVID W. JOHNSON, The Affordable Care Act (ACA) survived its third challenge at the Supreme Court on June 18, 2021, by a 7-2 vote, signaling that Obamacare is here to stay. With a divided Congress and a Biden administration challenged by multiple urgencies, there is little hope for national legislation to …

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How Marketplace Costs and Premiums Will Change if American Rescue Plan Subsidies Expire

In a new Policy Watch, KFF analysts explore the potential impact of the expiration of the American Rescue Plan Act’s enhanced financial help and new eligibility for the Affordable Care Act’s health insurance Marketplace federal subsidies. While the COVID-19 relief legislation passed earlier this year provides greater subsidy assistance through 2022, Democrats in Congress are…More

How Marketplace Costs and Premiums will Change if Rescue Plan Subsidies Expire

In this Policy Watch we explore the potential impact of the expiration of the American Rescue Plan Act’s enhanced financial help and new eligibility for the Affordable Care Act’s health insurance Marketplace federal subsidies. While the COVID-19 relief legislation passed earlier this year provides greater subsidy assistance through 2022, Democrats in Congress are currently considering …

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Recent and Anticipated Actions to Reverse Trump Administration Section 1557 Non-Discrimination Rules

The Biden Administration has started taking steps to reverse Trump Administration policy and regulations that significantly narrowed the implementation and administrative enforcement of Section 1557, the Affordable Care Act’s nondiscrimination provision, particularly as the regulations apply to gender identity and sexual orientation. In addition, several lawsuits challenging the regulations, which were initially issued by the…More

Supplemental Security Income for People with Disabilities: Implications for Medicaid

This issue brief describes key characteristics of SSI enrollees, explains the SSI eligibility criteria and eligibility determination process, and considers the implications of changes in the SSI program for Medicaid, including the effects of the COVID-19 pandemic and resulting economic downturn as well as proposals supported by President Biden that Congress might consider.

KFF Health Tracking Poll – May 2021: Prescription Drug Prices Top Public’s Health Care Priorities

The latest KFF Health Tracking Poll explores the public’s views on the U.S. role in distributing COVID vaccines to other countries, health care priorities for Congress, prescription drug regulations and price negotiations, and affordability changes in the COVID-19 relief bill.

New Analysis Summarizes Recent Research on the Effects of ACA Medicaid Expansion, Providing Context for Renewed Expansion Debates in States

New federal financial incentives for Medicaid expansion and the increased reliance on Medicaid as a coverage safety net during the pandemic have renewed debate in the 12 states that have not adopted the Medicaid expansion under the Affordable Care Act. A new KFF literature review provides context for these expansion debates by summarizing evidence from…More

Health Insurer Financial Performance in 2020

This analysis examines insurers’ financial data across markets through the end of 2020. It finds that average margins remained relatively high compared to recent years, suggesting many insurers remained profitable even as health spending rebounded and COVID-19 cases surged in the fall and winter.

What Are Some Policy Options for Reaching the 2.2 Million Uninsured People in the ACA’s “Coverage Gap”?

A new KFF issue brief explores several potential policy options that would help close the Affordable Care Act’s “coverage gap,” including providing further new incentives for states to expand Medicaid, creating a new “public option” or extending ACA Marketplace premium subsidies to low-income people who don’t currently qualify for federal help. At stake is affordable…More

Q1 2021 Health IT/Digital Health PC/VE, M&A, IPOs/ SPACs Activity

The first quarter of 2021 has been one of investor optimism as the vaccine rollout continues ahead of expectations and economic activity begins to accelerate in response.  Within the Health IT industry, the already strong investment and M&A trends seen in 2020 have only accelerated.  Over the course of the quarter, we observed $7 billion in private …

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Analysis Estimates 5.1 Million People Fall into the Affordable Care Act’s “Family Glitch”

A new KFF analysis estimates 5.1 million people nationally fall into the Affordable Care Act’s “family glitch” that occurs when a worker receives an offer of affordable employer coverage for themselves but not for their dependents, making them ineligible for financial assistance for marketplace coverage. The so-called glitch occurs because the ACA prohibits people with…More

The ACA Family Glitch and Affordability of Employer Coverage

This analysis estimates that 5.1 million people fall into the Affordable Care Act’s “family glitch,” which occurs when a worker receives an offer of affordable employer coverage for themselves but not for their dependents, making them ineligible for financial assistance for marketplace coverage. It explores the demographic characteristics of this group, including state-level estimates.

Declines in Uncompensated Care Costs for The Uninsured under the ACA and Implications of Recent Growth in the Uninsured Rate

The increase in the uninsured rate in recent years, as well as loss of coverage during the pandemic, has led to attention on the consequences of being uninsured. The need for medical care to test, treat, or prevent COVID-19 has also highlighted the potential consequences of uncompensated care for uninsured people. Uncompensated care costs occur …

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Sources of Payment for Uncompensated Care for the Uninsured

This brief estimates the level of public funding that was paid to help offset providers’ uncompensated care costs for the uninsured in 2017. To conduct the analysis, we rely on several secondary data sources including government budget appropriations and expenditure data for major public programs that provided funds to cover the cost of care for …

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Web Briefing: Understanding the Health Coverage and Affordability Provisions in the American Rescue Plan Act

The American Rescue Plan (ARP) Act signed into law earlier this month includes a number of provisions aimed at making health coverage more accessible and affordable amid the public health and economic crises created by the COVID-19 pandemic. Join KFF at a web briefing to explain these changes and their expected impact on consumers, insurance …

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How the American Rescue Plan Act Affects Subsidies for Marketplace Shoppers and People Who Are Uninsured

This brief use data from the American Community Survey (ACS) to provide estimates of eligibility for and the amount of financial assistance to purchase Marketplace coverage under the ARPA among both current individual market purchasers, as well as Marketplace-eligible uninsured people.

Impact of Key Provisions of the American Rescue Plan Act of 2021 COVID-19 Relief on Marketplace Premiums

This data note estimates how tax credits premiums will change for people at various ages and incomes under the temporary boost in subsidies included in the American Rescue Plan Act of 2021, the COVID-19 relief plan signed into law in March 2021.

Updated KFF Calculator Estimates Marketplace Premiums to Reflect Expanded Tax Credits in COVID-19 Relief Legislation

KFF has updated its 2021 Health Insurance Marketplace Calculator to reflect the expanded premium tax credits available to people who purchase their own coverage through their state’s health insurance exchange as passed by Congress in the American Rescue Plan Act and expected to be signed into law soon. The calculator allows users to enter their…More

Payers Struggle with Provider Data Management Too

Eric Demers, CEO of Madaket Health Provider data management is usually discussed from the provider perspective: the busy staff, the needless paperwork amid a pandemic, the faxing, emailing and uploading of data. In these scenarios, the health plans are often painted as the villains for their bureaucratic processes and unique requirements. But the reality is …

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KFF Tracking Poll: More Than a Third of Americans Say They’ve Struggled to Pay Living Expenses Since December; 6 in 10 Families Hit by COVID Have Lost A Job or Income

Majorities Favor Provisions to Expand Marketplace Tax Credits and Encourage States to Expand Medicaid As Congress considers an additional $1.9 trillion COVID-19 relief plan, more than a third (37%) of Americans say that someone in their household has had trouble paying basic living expenses over the past three months, the latest KFF Health Tracking Poll…More

KFF Health Tracking Poll: Economic Hardship, Health Coverage, And The ACA

This poll examines the public’s assessments of the Biden administration’s handling of the coronavirus pandemic, the impact COVID-19 has had on people’s finances, and support for provisions of the latest COVID-19 relief bill. It examines the public’s views of the ACA and possible next steps.

Survey: OBGYNs Report That the Affordable Care Act Has Increased Use of Contraceptives Among Patients, but the Cost of Reproductive Health Care Still a Burden for Their Low-Income Patients

This report highlights key findings from the 2020 KFF National Physician Survey on Reproductive Health that asked a nationally representative sample of OBGYNs practicing in the United States about a wide range of issues, including their provision of contraception, abortion, and STI care.

OBGYNs and the Provision of Sexual and Reproductive Health Care: Key Findings from a National Survey

This report highlights key findings from the 2020 KFF National Physician Survey on Reproductive Health that asked a nationally representative sample of OBGYNs practicing in the United States about a wide range of issues, including their provision of contraception, abortion, and STI care.

Two New Analyses: House COVID-19 Relief Plan Would Temporarily Lower Marketplace Premiums for Millions and More than Offset Short-Term State Costs to Expand Their Medicaid Programs

The House COVID-19 relief proposal would temporarily lower what millions of Marketplace enrollees and uninsured potential enrollees would pay toward premiums and would provide states that have not expanded their Medicaid programs a financial boost that would more than offset their costs initially, two new KFF analyses find. The analyses assess two parts of the…More

Kathleen Sebelius at Health Datapalooza: To push ACA forward, forget bipartisanship

At a Health Datapalooza session, former HHS head Kathleen Sebelius looked back on lessons learned in 2009 when the Affordable Care Act was moving through Congress. She cautioned the Biden administration against leaning on bipartisanship when restoring the healthcare law.

ACA Open Enrollment Matters for Medicaid Coverage, Too

President Biden’s January 28th executive order to reopen enrollment in the federal ACA Marketplace from February 15 through May 15, combined with $50 million in federal spending on outreach and education about ACA coverage options, has the potential to reach millions of people who were uninsured prior to or have lost coverage during the pandemic. …

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Nearly 9 Million Uninsured Americans Could Get Free or Subsidized Health Insurance if the Biden Administration Re-Opens ACA Marketplace Enrollment in Response to COVID-19

Four million uninsured people could get an ACA bronze plan with no premium payment and 4.9 million others could get subsidies to offset the cost of such a plan if the Biden Administration were to re-open ACA marketplace enrollment, a KFF analysis finds. Four million uninsured people could get an ACA bronze plan with no…More

The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid

In states that do not implement the Medicaid expansion under the Affordable Care Act (ACA), many adults will fall into a “coverage gap” of earning too much to qualify for Medicaid but not enough to qualify for Marketplace premium tax credits. Nationwide, 2.2 million poor uninsured adults are in this situation. This brief presents estimates …

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Claims Denials and Appeals in ACA Marketplace Plans

Based on an analysis of transparency data released by the Centers for Medicare and Medicaid Services (CMS), this brief assess claims denials and appeals among issuers offering individual market coverage on healthcare.gov and finds that 17% of in-network claims were denied by issuers in 2019, with denial rates for specific issuers varying significantly around this …

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Poll: Large Majorities Now Say They Wear Masks Regularly and Can Continue Social Distancing for At Least Six Months if Needed, though Republicans Remain Less Likely to Take Such Precautions

As winter sets in and COVID-19 cases and deaths reach records in most parts of the country, more Americans say they wear masks every time they leave home now (73%) than said so in May (52%), a new KFF Health Tracking Poll finds. A small minority (11%) say they wear masks only some of the…More

Health Insurer Financial Performance Through September 2020

In this brief, we analyze third quarter data from 2018 to 2020 to examine how insurance markets performed financially through the end of September. Average margins remained relatively high compared to the same point in recent years, suggesting many insurers remained profitable even as non-COVID-related care returned in the summer and fall.

How Has the Pandemic Affected Health Coverage in the U.S.?

Findings from administrative data suggest that the decline in enrollment among employer-sponsored insurance was far less than overall declines in employment as of September, and that many who did lose their job-based coverage likely found a safety net in coverage through Medicaid or the ACA marketplaces.

Potential Health Policy Administrative Actions Under President Biden

This brief outlines the potential health policy actions that President Biden could take using executive authority, based on campaign pledges, and actions that would reverse or modify regulations or guidance issued by the Trump Administration.

Preventive Services Tracker

The Affordable Care Act (ACA) requires new private health insurance plans to cover many recommended preventive services without any patient cost-sharing. This tracker presents up-to-date information on the adult preventive services nongrandfathered private plans must cover, by condition, including a summary of the recommendation, the target population, the effective date of coverage, and related federal …

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New study ties pharma payments to prescription practices

Recent efforts to improve transparency haven’t made much of a difference, one author noted. But earlier reforms made a dent the “most egregious” practices.

Millions of Uninsured Americans are Eligible for Free ACA Health Insurance

Amid the ongoing pandemic and high unemployment, this poste xamines how many uninsured people would be eligible for free health insurance during in a typical year, including those who qualify for Medicaid or for tax credits that cover the full cost of an ACA Marketplace plan.

Tracking Section 1332 State Innovation Waivers

This interactive map shows the status of all Section 1332 waivers requested by states. The Affordable Care Act (ACA) allows states to apply for innovation waivers to alter key ACA requirements in the individual and small group insurance markets and can be used to shore up fragile insurance markets, address unique state insurance market issues, …

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Explaining Health Care Reform: Questions About Health Insurance Subsidies

This brief describes health insurance subsidies available through the Affordable Care Act’s marketplaces, including premium subsidies that would be provided in the form of tax credits, as well as other subsidies that would lower cost sharing to eligible Americans. It provides details on who is eligible for the assistance, the maximum repayment limits for the …

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COVID-19 Pandemic Further Exposes Systemic Racism…

Michael A Greely, Co-Founder & General Partner at Flare Capital Partners This will be ugly and sad. Racism has cost this country $16 trillion over the last twenty years according to a recent Citigroup report. Much of this loss ($13 trillion) was attributed to discriminatory lending practices and the 6.1 million fewer jobs created as a …

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What Happens to Medicaid Drug Policy if the ACA is Overturned?

The repeal of the ACA could mean loss of Medicaid coverage for up to 15 million that were enrolled in the ACA Medicaid expansion group prior to the COVID-19 pandemic; however, repeal could also mean significant changes to Medicaid prescription drug policy with implications for state and federal spending for prescription drugs for non-expansion Medicaid …

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Rural Hospital Execs Can Beat COVID-19 By Shifting From Reactive to Proactive Care

Eric Tran, Tulane School of Medicine Donald Voltz, MD, Aultman Hospital The COVID-19 virus is ravaging the planet at a scale not seen since the infamous Spanish Flu of the early 1900s, inflicting immense devastation as the U.S. loses more than 200,000 lives and counting. According to CDC statistics, 94% of patient mortalities associated with …

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Want to protect people with preexisting conditions? You need the full Affordable Care Act.

In this perspective published by the Washington Post, KFF Executive Vice President for Health Policy Larry Levitt explains why the popular Affordable Care Act provisions that ensure people with pre-existing conditions can access affordable health insurance can’t easily be preserved if other related provisions are overturned.

Careful What You Wish For: How Republican Attorneys General’s Attack on the ACA Could Trigger Medicare for All

By MIKE MAGEE Cautionary tales are timeless. Take for example Aesop’s Fables, from 620 BC, which included the advisory, “Be careful what you wish for lest it come true.” Trump and the Republicans who oppose the ACA take heed. You may be inadvertently taking the entire collusive Medical-Industrial Complex down a rabbit hole. In the …

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Health Policy Resources for Covering the 2020 Elections

As the 2020 Election Day approaches, many candidates continue to focus on health care issues, including on the public health and economic response to COVID-19, the future of the Affordable Care Act, health care costs and abortion. To help reporters understand and cover these issues, KFF offers independent, non-partisan policy analysis, polling and other research and…More

2021 Premium Changes on ACA Exchanges and the Impact of COVID-19 on Rates

A look at preliminary marketplace rate filings reveals many premium changes for 2021 are moderate thus far, with increases or decreases of a few percentage points. However, most insurers have not yet incorporated the rate impacts of the COVID-19 pandemic in their rate changes for 2021, so many of these proposed rates are likely to …

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Medicaid Covers People with Pre-Existing Conditions, Too

In recent weeks, the possible overturning of the Affordable Care Act (ACA) in court and the upcoming election have focused attention on the issue of protections for people with pre-existing conditions. While the focus has been on the ACA’s private insurance protections, Medicaid also plays a significant role in covering people with pre-existing conditions.

KFF Health Tracking Poll – October 2020: The Future of the ACA and Biden’s Advantage On Health Care

The poll examines the public’s views on the Supreme Court case to overturn the Affordable Care Act and its protections for people with pre-existing conditions. Less than a month from the results of the 2020 presidential election, this poll examines the top issues for voters (the economy, the coronavirus pandemic, health care, criminal justice and …

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A Reconfigured U.S. Supreme Court: Implications for Health Policy

U.S. Supreme Court decisions shape health policy in important ways. The nomination of Judge Amy Coney Barrett, if confirmed, is expected to establish a solid 6:3 conservative majority that could affect case outcomes in several areas. This issue brief considers the potential implications of a reconfigured Court for health policy issues, including those already on …

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Health Care and the 2020 Presidential Election

This side-by-side comparison examines President Trump’s record and former Vice President Biden’s positions across a wide range of key health issues, including the response to the pandemic, the Affordable Care Act marketplace, Medicaid, Medicare, drug prices, reproductive health, mental health and opioids, immigration and health coverage, and health care costs.

Contraception X Article: Out-of-Pocket Spending for Oral Contraceptives Among Women with Private Insurance Coverage After the Affordable Care Act

In an article for Contraception X, KFF’s Brittni Frederiksen, Matthew Rae, and Alina Salganicoff examine large employer plans to identify which types and brands of oral contraceptive pills have the largest shares of oral contraceptive users with out-of-pocket spending and which oral contraceptives have the highest average annual out-of-pocket costs after the ACA covered contraception …

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District judge blocks HHS rule that would end transgender health protections

A U.S. district judge blocked a rule by the Department of Health and Human Services that would end anti-discrimination provisions protecting transgender patients. In his decision, U.S. District Judge Frederic Block said that the rule violated a recent Supreme Court decision protecting LGBTQ workers’ rights.

An Early Look at 2021 Premium Changes on ACA Exchanges and the Impact of COVID-19 on Rates

A look at preliminary marketplace rate filings reveals many premium changes for 2021 are moderate thus far, with increases or decreases of a few percentage points. However, most insurers have not yet incorporated the rate impacts of the COVID-19 pandemic in their rate changes for 2021, so many of these proposed rates are likely to …

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Individual Insurance Market Performance in Early 2020

Individual market insurers, on average, remained profitable through the first three months of 2020 as claims costs rose only slightly compared to the same period last year. It is likely that the most significant impacts of the coronavirus on the individual market will not be evident nationally until second or third quarter data are released.

Insurance Coverage and Viral Suppression Among People with HIV in the United States, 2015-2018

Health insurance coverage and access to care improve health outcomes, including viral suppression, for people with HIV in the United States. Prior research has demonstrated that implementation of the Affordable Care Act (ACA) in 2014 increased coverage among people with HIV and that certain forms of coverage are positively correlated with sustained viral suppression. We …

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