"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…
Health Insurance Coverage By Type In The US
"In 2017, most people (91.2 percent) had health insurance coverage at some point during the calendar year (Table 1 and Figure 1). More people had private health insurance (67.2 percent) than government coverage (37.7 percent).10"Employer-based insurance was the most common subtype of health insurance in the civilian, noninstitutionalized population (56.0 percent), followed by Medicaid (19.3 percent), Medicare (17.2 percent), direct-purchase insurance (16.0 percent), and military health care (4.8 percent) (Table 1)."The percentage of people covered by any type of health insurance in 2017 was not statistically different from the percentage in 2016. The percentage of people covered by private health…
People Without Health Insurance Coverage In the US
"Examining age across childhood and young adulthood, uninsured rates in 2017 were generally lower for children than for young adults, from 3.5 percent for infants to 17.8 percent for 26-year-olds. Two sharp differences existed between single-year ages. The percentage of 19-year-olds without coverage (13.2 percent) was 4.6 percentage points higher than the percentage for people 1 year younger. Likewise, the uninsured rate for 26-year-olds, the highest among all single years of age in 2017, was distinctly higher than for 25-yearolds (17.8 percent and 14.9 percent, respectively)."From ages 26 to 64, the uninsured rate generally declined with age. Between the ages…
Children and Adults in the US Without Health Insurance Coverage
"In 2017, 5.4 percent of children under the age of 19 and 12.2 percent of adults aged 19 to 64 did not have health insurance coverage. For all selected characteristics, the percentage of adults without health insurance coverage was significantly higher than for children (under 19 years of age) (Figure 6). Additionally, differences in the uninsured rates between demographic and socioeconomic groups were generally larger among adults than among children.39 "For example, the difference in the uninsured rate by poverty status was larger among adults than among children. In 2017, 7.8 percent of children in poverty were uninsured, compared with…
Why is the US at a Health Disadvantage Relative to Other Countries?
"One explanation for the health disadvantage of the United States relative to other high-income countries might be deficiencies in health services. Although the United States is renowned for its leadership in biomedical research, its cutting-edge medical technology, and its hospitals and specialists, problems with ensuring Americans’ access to the system and providing quality care have been a long-standing concern of policy makers and the public (Berwick et al., 2008; Brook, 2011b; Fineberg, 2012). Higher mortality rates from diseases, and even from transportation-related injuries and homicides, may be traceable in part to failings in the health care system."The United States stands out from…
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…