The Patient Protection and Affordable Care Act (ACA) was designed to increase health insurance quality and affordability, lower the uninsured rate by expanding insurance coverage, and reduce the costs of healthcare overall. Along with sweeping change came sweeping criticisms and issues. This book explores the pros and cons of the Affordable Care Act, and explains who benefits from the ACA. Readers will learn how the economy is affected by the ACA, and the impact of the ACA rollout.
The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.
Many of the elements of the Affordable Care Act (ACA) went into effect in 2014, and with the establishment of many new rules and regulations, there will continue to be significant changes to the United States health care system. It is not clear what impact these changes will have on medical and public health preparedness programs around the country. Although there has been tremendous progress since 2005 and Hurricane Katrina, there is still a long way to go to ensure the health security of the Country. There is a commonly held notion that preparedness is separate and distinct from everyday operations, and that it only affects emergency departments. But time and time again, catastrophic events challenge the entire health care system, from acute care and emergency medical services down to the public health and community clinic level, and the lack of preparedness of one part of the system places preventable stress on other components. The implementation of the ACA provides the opportunity to consider how to incorporate preparedness into all aspects of the health care system. The Impacts of the Affordable Care Act on Preparedness Resources and Programs is the summary of a workshop convened by the Institute of Medicine's Forum on Medical and Public Health Preparedness for Catastrophic Events in November 2013 to discuss how changes to the health system as a result of the ACA might impact medical and public health preparedness programs across the nation. This report discusses challenges and benefits of the Affordable Care Act to disaster preparedness and response efforts around the country and considers how changes to payment and reimbursement models will present opportunities and challenges to strengthen disaster preparedness and response capacities.
Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital-based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million-one in seven-working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.
Roughly 40 million Americans have no health insurance, private or public, and the number has grown steadily over the past 25 years. Who are these children, women, and men, and why do they lack coverage for essential health care services? How does the system of insurance coverage in the U.S. operate, and where does it fail? The first of six Institute of Medicine reports that will examine in detail the consequences of having a large uninsured population, Coverage Matters: Insurance and Health Care, explores the myths and realities of who is uninsured, identifies social, economic, and policy factors that contribute to the situation, and describes the likelihood faced by members of various population groups of being uninsured. It serves as a guide to a broad range of issues related to the lack of insurance coverage in America and provides background data of use to policy makers and health services researchers.
Reviews state initiatives to expand access to health insurance and control rising health care costs. Describes comprehensive plans to provide universal access to coverage, programs to extend access to specific groups, and efforts to control costs by reforming payment mechanisms. Maps and graphs.
The Arkansas premium assistance model, commonly known as the Private Option, is one of six alternative Medicaid waiver designs that have been approved in states to expand coverage for low-income adults. The waiver places adults age 19-64 and under 138% of poverty in the newly established health insurance exchange and uses Medicaid funding to purchase the premium payment for health plan coverage. The program began in January 2014. This qualitative descriptive study examined the key operational and program features of the Private Option in order to provide a formative evaluation of how well it is working at this early stage. The study also examined if this model, or similar models, might offer a promising path for the 19 states that have chosen not expand coverage for populations newly eligible for Medicaid under the Affordable Care Act. The results of the study suggest that it is a potentially promising model. Arkansas saw the largest drop in the uninsured rate in the country in the first 18 months since the program began. It has also expanded its provider networks, added new health plans to the marketplace, and the program is generating overall net state savings. Politics, policy, and state costs are factors that drive the current debate in states that have not expanded. Framing coverage as a uniquely designed state approach and not Medicaid expansion are key conditions for moving forward. Language emphasizing a private sector approach and personal responsibility are critical factors as well. There are challenges, however, between Medicaid rules and exchange rules, particularly around the issue of cost-sharing. There is a significant cliff between the two programs in terms of personal financial obligations that will likely need to be remedied in the years ahead. Studies show that as many as 50% of those under 200% of poverty are likely to transition between eligibility for these two programs in any given year, and these cost-sharing differences apply despite an integrated program. The Affordable Care Act is part of an ongoing process that has transformed Medicaid from a social welfare program to an income-based program to provide health insurance coverage to low-income populations. The integration of these two programs, Medicaid and the health insurance exchanges, through premium assistance, reflects these transformative changes and are part of the continuing evolution of our nation's health care system.
Analyzes two major approaches for substantially reducing the number of uninsured people. One would expand employment-based coverage, while the other would cover more people under Medicaid. A third approach would be a combination of the two. Covers: advantages and disadvantages of each plan, alternative specifications, and illustrations of each plan. Charts and tables.
By the end of 2015, almost forty percent of states had opted out of the Medicaid Expansion component of the Affordable Care Act, providing a unique opportunity to examine variation in health insurance coverage changes pre- and post- Medicaid expansion. Health insurance coverage has historically varied across places and groups of people. For example, rural areas and large sections of the South have been plagued with persistently low rates of coverage due to unique structural and compositional characteristics. Racial/ethnic disparities particularly among blacks and Hispanics also persist given socioeconomic and policy barriers to accessing coverage. Using county-level insurance coverage estimates for non-elderly adults from Enroll America and demographic, socioeconomic, and labor market variables from the American Community Survey, I examine a number of research questions related to the role of Medicaid expansion and county characteristics on changes in adult (ages 18 to 64) health insurance coverage rates. There are several noteworthy findings with important implications for research, policy, and practice. First, compared with counties located in states that did not expand Medicaid coverage under the ACA, counties located in states that did expand Medicaid experienced significantly larger improvements in overall adult health insurance coverage rates between 2013 and 2014, net of several other county characteristics. Second, in states that did not expand Medicaid, counties with larger shares of vulnerable residents (e.g., poor adults, foreign born residents, and adults with low educational attainment) experienced smaller improvements in coverage compared to counties with comparatively smaller shares of these vulnerable groups. However, counties in states that did expand Medicaid were protected from the disadvantage of having larger shares of vulnerable residents. Third, compared to large metropolitan counties in the South, small metropolitan and nonmetropolitan counties in the South experienced significantly smaller improvements in coverage from 2013 to 2014. Fourth, almost all counties experienced declines in racial/ethnic (white-black; white-Hispanic) disparities in coverage rates. However, counties in states that did expand Medicaid to at least 138 percent of the Federal Poverty Level experienced significantly larger declines in the white-black and white-Hispanic coverage gap compared to counties in states that adopted lower Medicaid thresholds. The findings from this study have important implications for county and state governments both in states that did and did not expand Medicaid as they are faced with the risks associated with persistently low coverage rates, including high rates of uncompensated care, declining population health and worker productivity, and struggling healthcare systems.
