scholarly journals Sources of Success in California's Individual Marketplace under the Affordable Care Act

2019 ◽  
Vol 44 (4) ◽  
pp. 679-706
Author(s):  
Petra W. Rasmussen ◽  
Gerald F. Kominski
Keyword(s):  
Affordable Care Act ◽  
The United States ◽  
Community Partners ◽  
Early Adoption ◽  
Individual Market ◽  
The Affordable Care Act ◽  
The Law ◽  
The Stability ◽  
The Individual ◽  
Trump Administration

Abstract When passed in 2010, the Affordable Care Act (ACA) became the greatest piece of health care reform in the United States since the creation of Medicare and Medicaid. In the 9 years since its passage, the law has ushered in a drastic decrease in the number of uninsured Americans and has encouraged delivery system innovation. However, the ACA has not been uniformly embraced, and states differ in their implementation of the law and in their individual health insurance marketplace's successfulness. Furthermore, under the Trump administration the law's future and the stability of the individual market have been uncertain. Throughout, however, California has been a leader. Today, the state's marketplace, known as Covered California, offers comprehensive, standardized health plans to over 1.3 million consumers. California's success with the ACA is largely attributable to its historical receptiveness to health reform; its early adoption of the law; its decision to have Covered California operate as an active purchaser, help shape the plans sold through the marketplace, and design a consumer-friendly enrollment experience; its engagement with stakeholders and community partners to encourage enrollment; and Covered California's commitment to continually innovate, improve, and anticipate the needs of the individual market as the law moves forward.

Mental Health and Substance Use Disorder Benefits Parity

2018 ◽  
Vol 50 (2) ◽  
pp. 95-106
Author(s):  
John G. Kilgour
Keyword(s):  
Mental Health ◽  
United States ◽  
Affordable Care Act ◽  
The United States ◽  
Health Plans ◽  
Mental Health Parity ◽  
Insurance Contracts ◽  
Substance Abuse Disorders ◽  
The Affordable Care Act ◽  
Trump Administration

Traditionally mental health and substance abuse disorders have been treated less generously than medical/surgical benefits in employment-provided health plans and health insurance contracts. That changed with the Mental Health Parity and Addiction Equity Act of 2008 as amended and extended by the Affordable Care Act of 2010 (Obamacare). It has been found that parity has not added significantly to health plan cost. The parity concept now applies to health plans and insurance contracts throughout the United States. This article examines that legislative development and the attending regulations and enforcement efforts. The Trump administration has vowed to repeal the Affordable Care Act, and it has already weakened it. If it succeeds, it will also weaken the Mental Health Parity and Addiction Equity Act and its parity requirements. That would be regrettable requirements.

State Regulation of Coverage Options Outside of the Affordable Care Act: Limiting the Risk to the Individual Market

2018 ◽  
Author(s):  
JoAnn Volk Volk ◽  
Sabrina Corlette Corlette ◽  
Kevin W. Lucia Lucia ◽  
Justin Giovannelli Giovannelli ◽  
Dania Palanker Palanker ◽  
...  
Keyword(s):  
Affordable Care Act ◽  
State Regulation ◽  
Individual Market ◽  
The Affordable Care Act ◽  
The Individual

Expanding Choice through Defined Contributions: Overcoming a Non-Participatory Health Care Economy

2012 ◽  
Vol 40 (3) ◽  
pp. 558-573 ◽  
Author(s):  
Robert E. Moffit
Keyword(s):  
Affordable Care Act ◽  
House Of Representatives ◽  
The United States ◽  
Ballot Initiatives ◽  
Individual Mandate ◽  
The Affordable Care Act ◽  
Care Economy ◽  
Defined Contributions ◽  
Uncertain Future ◽  
The Individual

The Patient Protection and Affordable Care Act of 2010 (the Affordable Care Act) is the law of the land. But it faces an uncertain future.During congressional deliberations on the 2,700-page legislation leading up to its enactment, from February to March 2010, not one major survey recorded majority support for the legislation. Since its enactment, popular opposition to the Affordable Care Act has hardened, and was a significant factor in the 2010 congressional election, in which Democrats lost 63 seats and Republicans regained the majority in the House of Representatives. Ballot initiatives in Missouri and Ohio, showcasing popular opposition to the individual mandate, passed in 2010 with overwhelming majorities. While the United States Supreme Court in National Federation of Independent Business et al. v. Sebelius, 132 S. Ct. 2566 ( 2012), declared the mandate on the states to expand Medicaid unconstitutionally coercive, the majority of the Justices also upheld the individual mandate as a permissible tax. The new law thus emerged as a central topic in the 2012 election.

scholarly journals Health Insurance Coverage before and after the Affordable Care Act in the USA

Sci ◽  
2021 ◽  
Vol 3 (2) ◽  
pp. 25
Author(s):  
Jesse Patrick ◽  
Philip Q. Yang
Keyword(s):  
Health Insurance ◽  
National Health ◽  
Affordable Care Act ◽  
The United States ◽  
Insurance Status ◽  
Health Insurance Status ◽  
Full Implementation ◽  
Before And After ◽  
The Affordable Care Act ◽  
Partial Implementation

The Affordable Care Act (ACA) is at the crossroads. It is important to evaluate the effectiveness of the ACA in order to make rational decisions about the ongoing healthcare reform, but existing research into its effect on health insurance status in the United States is insufficient and descriptive. Using data from the National Health Interview Surveys from 2009 to 2015, this study examines changes in health insurance status and its determinants before the ACA in 2009, during its partial implementation in 2010–2013, and after its full implementation in 2014 and 2015. The results of trend analysis indicate a significant increase in national health insurance rate from 82.2% in 2009 to 89.4% in 2015. Logistic regression analyses confirm the similar impact of age, gender, race, marital status, nativity, citizenship, education, and poverty on health insurance status before and after the ACA. Despite similar effects across years, controlling for other variables, youth aged 26 or below, the foreign-born, Asians, and other races had a greater probability of gaining health insurance after the ACA than before the ACA; however, the odds of obtaining health insurance for Hispanics and the impoverished rose slightly during the partial implementation of the ACA, but somewhat declined after the full implementation of the ACA starting in 2014. These findings should be taken into account by the U.S. Government in deciding the fate of the ACA.

The Impact of the Affordable Care Act Medicaid Expansions on the Sources of Health Insurance Coverage of Undergraduate Students in the United States

2021 ◽  
pp. 107755872110158
Author(s):  
Priyanka Anand ◽  
Dora Gicheva
Keyword(s):  
United States ◽  
Health Insurance ◽  
Undergraduate Students ◽  
Affordable Care Act ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Percentage Points ◽  
The Affordable Care Act ◽  
Medicaid Expansions

This article examines how the Affordable Care Act Medicaid expansions affected the sources of health insurance coverage of undergraduate students in the United States. We show that the Affordable Care Act expansions increased the Medicaid coverage of undergraduate students by 5 to 7 percentage points more in expansion states than in nonexpansion states, resulting in 17% of undergraduate students in expansion states being covered by Medicaid postexpansion (up from 9% prior to the expansion). In contrast, the growth in employer and private direct coverage was 1 to 2 percentage points lower postexpansion for students in expansion states compared with nonexpansion states. Our findings demonstrate that policy efforts to expand Medicaid eligibility have been successful in increasing the Medicaid coverage rates for undergraduate students in the United States, but there is evidence of some crowd out after the expansions—that is, some students substituted their private and employer-sponsored coverage for Medicaid.

The great Chinese surprise: the rupture with the United States is real and is happening

2020 ◽  
Vol 96 (2) ◽  
pp. 419-437
Author(s):  
Xiangfeng Yang
Keyword(s):  
United States ◽  
The United States ◽  
Donald Trump ◽  
Ample Evidence ◽  
Pendulum Swing ◽  
The Us ◽  
Methodological Problems ◽  
Trade War ◽  
The Stability ◽  
The Individual

Abstract Ample evidence exists that China was caught off guard by the Trump administration's onslaught of punishing acts—the trade war being a prime, but far from the only, example. This article, in addition to contextualizing their earlier optimism about the relations with the United States under President Trump, examines why Chinese leaders and analysts were surprised by the turn of events. It argues that three main factors contributed to the lapse of judgment. First, Chinese officials and analysts grossly misunderstood Donald Trump the individual. By overemphasizing his pragmatism while downplaying his unpredictability, they ended up underprepared for the policies he unleashed. Second, some ingrained Chinese beliefs, manifested in the analogies of the pendulum swing and the ‘bickering couple’, as well as the narrative of the ‘ballast’, lulled officials and scholars into undue optimism about the stability of the broader relationship. Third, analytical and methodological problems as well as political considerations prevented them from fully grasping the strategic shift against China in the US.

Association of Medicaid expansion under the Affordable Care Act with access to elective spine surgical care

2021 ◽  
pp. 1-9
Author(s):  
Jacob K. Greenberg ◽  
Derek S. Brown ◽  
Margaret A. Olsen ◽  
Wilson Z. Ray
Keyword(s):  
United States ◽  
Spine Surgery ◽  
Surgical Procedures ◽  
Affordable Care Act ◽  
Surgical Care ◽  
The United States ◽  
Medicaid Expansion ◽  
Percentage Points ◽  
The Affordable Care Act ◽  
The Impact

OBJECTIVE The Affordable Care Act expanded Medicaid eligibility in many states, improving access to some forms of elective healthcare in the United States. Whether this effort increased access to elective spine surgical care is unknown. This study’s objective was to evaluate the impact of Medicaid expansion under the Affordable Care Act on the volume and payer mix of elective spine surgery in the United States. METHODS This study evaluated elective spine surgical procedures performed from 2011 to 2016 and included in the all-payer State Inpatient Databases of 10 states that expanded Medicaid access in 2014, as well as 4 states that did not expand Medicaid access. Adult patients aged 18–64 years who underwent elective spine surgery were included. The authors used a quasi-experimental difference-in-difference design to evaluate the impact of Medicaid expansion on hospital procedure volume and payer mix, independent of time-dependent trends. Subgroup analysis was conducted that stratified results according to cervical fusion, thoracolumbar fusion, and noninstrumented surgery. RESULTS The authors identified 218,648 surgical procedures performed in 10 Medicaid expansion states and 118,693 procedures performed in 4 nonexpansion states. Medicaid expansion was associated with a 17% (95% CI 2%–35%, p = 0.03) increase in mean hospital spine surgical volume and a 23% (95% CI −0.3% to 52%, p = 0.054) increase in Medicaid volume. Privately insured surgical volumes did not change significantly (incidence rate ratio 1.13, 95% CI −5% to 34%, p = 0.18). The increase in Medicaid volume led to a shift in payer mix, with the proportion of Medicaid patients increasing by 6.0 percentage points (95% CI 4.1–7.0, p < 0.001) and the proportion of private payers decreasing by 6.7 percentage points (95% CI 4.5–8.8, p < 0.001). Although the magnitude of effects varied, these trends were similar across procedure subgroups. CONCLUSIONS Medicaid expansion under the Affordable Care Act was associated with an economically and statistically significant increase in spine surgery volume and the proportion of surgical patients with Medicaid insurance, indicating improved access to care.

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