"The ACA Medicaid expansion has significantly increased Medicaid enrollment and federal Medicaid expenditures. In FY2017, an estimated 12 million individuals were newly eligible for Medicaid through the ACA Medicaid expansion (i.e., expansion adults), and total Medicaid expenditures for the expansion adults were an estimated $71 billion. Enrollment for the expansion adults is projected to be 13 million in FY2026, and expenditures for the expansion adults are projected to be $120 billion in FY2026 (with the federal government paying $108 billion and states paying $12 billion)."Between FY2014 and FY2015, the average per enrollee costs for expansion adults is projected to have…
How People With Pre-Existing Conditions Were Handled By Insurers Prior to Passage of the ACA
"Before the ACA, individual insurers in the vast majority of states could collect information on demographic characteristics and medical history, and then deny coverage, charge higher premiums, and/or limit benefits to individuals based on pre-existing conditions. An industry survey found that 34 percent of individual market applicants were charged higher-than-standard rates based on demographic characteristics or medical history.4 Similarly, a 2009 survey found that, among adults who had individual market coverage or shopped for it in the previous three years, 36 percent were denied coverage, charged more, or had exclusions placed on their policy due to pre-existing conditions.5 A report…
Impact of the ACA on Health Insurance Coverage for People with Pre-Existing Conditions
"• Up to 133 million non-elderly Americans—just over half (51 percent) of the non-elderly population—may have a pre-existing condition. This includes 67 million women and girls and 66 million men and boys. "• The likelihood of having a pre-existing condition increases with age: up to 84 percent of those ages 55 to 64—31 million individuals—have at least one pre-existing condition. "• Among the most common pre-existing conditions are high blood pressure (46 million people), behavioral health disorders (45 million people), high cholesterol (44 million people); asthma/chronic lung disease (34 million people), heart conditions (16 million people), diabetes (13 million people),…
Financial Impact of the ACA on Safety Net Hospitals
"Patient service revenue grew. Largely linked to the growth in patient volumes from insured patients, operating revenues increased for expansion state hospitals (by an average of 17 percent) and, to a lesser extent, for non-expansion state hospitals (11 percent on average) between 2013 and 2015. For expansion state hospitals, this increase came largely from Medicaid. Revenue growth was especially large for the study hospitals that receive cost-based Medicaid reimbursement (for at least some patients and/or services) from their states; these hospitals include the rural critical access hospitals and LAC+USC (Appendix 2). For others, Medicaid reimbursement is less than the costs…
Effects of the ACA on Safety Net Hospitals
"Study hospitals (Appendix 2) in states that expanded eligibility for the Medicaid program experienced considerable patient volume increases from Medicaid enrollment expansions, whereas they experienced little volume change from the ACA’s expansion of commercial coverage through the federal and state Marketplaces. Despite concerns that they might lose many newly insured patients to other providers, these study hospitals largely retained existing patients and gained new ones. The growth in patient volume was especially notable for outpatient care, and there were corresponding marked increases in the proportion of their patients with insurance coverage. The growth in outpatient visits reflects in part safety…
Major Provisions of the Affordable Care Act
• Established “health exchanges” or “marketplaces” on a statewide basis that sold community-rated individual and family insurance policies that were required to cover ten sets of “essential health benefits.” Policies could be sold in four “metal tiers”, Bronze, Silver, Gold, and Platinum, which cover 60%, 70%, 80%, and 90%, respectively, of typical health expenses. The tiers with the more comprehensive coverage generally have higher premiums.•Provided income-based subsidies to purchase insurance policies on the exchanges. Families earning up to four times the FPL were eligible for at least some financial assistance to pay for insurance. Various restrictions applied; for example, people…
Medicaid Expansion Under the ACA
"Since January 1, 2014, states have had the option to extend Medicaid coverage to most non-elderly, nonpregnant adults with income up to 133% of FPL. Twenty-four states and the District of Columbia implemented the ACA Medicaid expansion at that time. Since then, the following seven states have implemented the expansion: Michigan (April 1, 2014), New Hampshire (July 1, 2014), Pennsylvania (January 1, 2015), Indiana (February 1, 2015), Alaska (September 1, 2015), Montana (January 1, 2016), and Louisiana (July 1, 2016). (See Figure 1.)"Virginia is expected to begin coverage of the ACA Medicaid expansion on January 1, 2019. Maine adopted the…
Affordable Care Act and “Shared Responsibility”
"The Affordable Care Act (ACA), enacted in 2010, established “shared responsibility” between the government, employers, and individuals for ensuring that all Americans have access to affordable and good-quality health insurance. However, health coverage remains fragmented, with numerous private and public sources, as well as wide gaps in insured rates across the U.S. population. The Centers for Medicare and Medicaid Services (CMS) administers Medicare, a federal program for adults 65 and older and some people with disabilities, and works in partnership with state governments to administer both Medicaid and the Children’s Health Insurance Program (CHIP), a conglomeration of federal–state programs for…
Health Insurance Coverage In the US Before the ACA
"Until the major provisions of the ACA went into effect in January 2014, health insurance coverage was always voluntary. About 30% of the population was covered through the two major public programs enacted in 1965: Medicare for seniors (later extended to the disabled) and Medicaid for poorer Americans [2]. Most others received coverage through their employment, either as employees or dependents, but such coverage was always voluntary: employers did not have to provide it, and individuals were not required to buy it. Less than 10% purchased coverage on their own."As far back as the 1950s those with pre-existing illnesses generally found…
Problems That Hampered Implementation of ACA’s Coverage Provisions
"Several major problems have hampered the implementation of the coverage provisions of the ACA. First was the troubled debut of the federally run insurance marketplaces and a number of state-run programs. The federal marketplaces now seem to be functioning adequately, and most states with problems have either fixed them or imported solutions from other states or the federal government. Second, a number of insured Americans were upset and surprised when companies canceled policies that did not meet minimum standards under the ACA. The numbers of canceled policies have declined over time, and cancellations have become less troublesome as better-functioning marketplaces…
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