This summary from the Kaiser Family Foundation describes key provisions of H.R. 1628, including: 1. Repeal ACA mandates, standards for health plan actuarial values, and premium and cost sharing subsidies; 2. Modify ACA premium tax credits for 2018-2019; 3. Retain private market rules; 4. Retain health insurance marketplaces, annual Open Enrollment periods, and special enrollment periods; 5. Impose late enrollment penalty for people who don’t stay continuously covered; 6. Establish State Patient and State Stability Fund with federal funding of $130 billion over 9 years, and additional funding of $8 billion over 5 years for states that elect community rating waivers; 7. Encourage use of Health Savings Accounts; 8. Convert federal Medicaid funding to a per capita allotment.
Although insurers have generally remained profitable overall since implementation of the Affordable Care Act, many companies participating in the individual market – where most of the major market reforms took place in 2014 – experienced substantial losses in this market in the early years of reform. The individual market is where just 7% of the U.S. population gets their insurance (and thus also represents a small share of most health insurers’ business), but the stability of the market and willingness of insurers to continue to participate is essential to the ACA’s success. Going into 2017, there were a number of high-profile exits and premium increases, raising concerns over the stability of the individual market. Although some local markets are likely fragile, the Congressional Budget Office expects the ACA individual market to remain stable across most part of the country.
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A majority (61 percent) of the public say that because President Trump and Republicans in Congress are in control of the government, they are now responsible for any problems with the ACA moving forward. About three in ten Americans (31 percent) say that because President Obama and Democrats in Congress passed the law, they are responsible for any problems with it.
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The latest Kaiser Health Tracking Poll finds that health care is among the top issues, with the economy and jobs and immigration, Americans want President-elect Donald Trump and the next Congress to address in 2017.
The Affordable Care Act (ACA) extends health insurance coverage to people who lack access to an affordable coverage option. Under the ACA, as of 2014, Medicaid coverage is extended to poor and near poor adults in states that have opted to expand eligibility, and tax credits are available for low and middle-income people who purchase coverage through a health insurance Marketplace. Millions of people have enrolled in these new coverage options, and the uninsured rate has dropped to the lowest level ever recorded. However, millions of others are still uninsured. Some remain ineligible for coverage, and others may be unaware of the availability of new coverage options or still find coverage unaffordable even with financial assistance.
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While health care has not been central to the 2016 Presidential campaign, the election’s outcome will be a major determining factor in the country’s future health care policy. A number of issues have garnered media attention, including the future of the Affordable Care Act (ACA), rising prescription drug costs, and the opioid epidemic.
Hillary Clinton and Donald Trump have laid out different approaches to addressing these and other health care issues. Central among these is their position on the future of the ACA. Hillary Clinton would maintain the ACA, and many of her policy proposals would build on provisions already in place. Donald Trump, in contrast, would fully repeal the ACA, and although his policy proposals and positions do not offer a full replacement plan, they do reflect an approach based on free market principles.
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As of January 1, 2014, insurers are no longer able to deny coverage or charge higher premiums based on preexisting conditions (under rules referred to as guaranteed issue and modified community rating, respectively). These aspects of the Affordable Care Act (ACA) – along with tax credits for low and middle income people buying insurance on their own in new health insurance marketplaces – make it easier for people with preexisting conditions to gain insurance coverage. However, if not accompanied by other regulatory measures, these provisions could have unintended consequences for the insurance market. Namely, insurers may try to compete by avoiding sicker enrollees rather than by providing the best value to consumers. In addition, in the early years of market reform insurers faced uncertainty as to how to price coverage as new people (including those previously considered “uninsurable”) gained coverage, potentially leading to premium volatility. This brief explains three provisions of the ACA – risk adjustment, reinsurance, and risk corridors – that were intended to promote insurer competition on the basis of quality and value and promote insurance market stability, particularly in the early years of reform.
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Many of the initial reports of premium increases for 2017 have been based on anecdotal examples or averages across insurers. This Kaiser Family Foundation brief takes a different approach, presenting an early analysis of changes in insurer participation and premiums for the lowest-cost and second-lowest silver marketplace plans in major cities in 16 states plus the District of Columbia where complete data on rates is publicly available for all insurers. Based on insurer rate requests, the cost of the second-lowest silver plan in these cities will increase by a weighted average of 9% in 2017.
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Medicaid payments to hospitals and other providers play an important role in these providers’ finances, which can affect beneficiaries’ access to care. Medicaid hospital payments include base payments set by states or health plans and supplemental payments. Estimates of overall Medicaid payment to hospitals as a share of costs vary but range from 90% to 107%. While base Medicaid payments are typically below cost, the use of supplemental payments can increase payments above costs. Changes related to expanded coverage under the Affordable Care Act as well as other changes related to Medicaid supplemental payments could have important implications for Medicaid payments to hospitals. This brief provides an overview of Medicaid payments for hospitals and explores the implications of the ACA Medicaid expansion as well as payment policy changes on hospital finances.
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Kaiser’s latest poll shows that people with ACA plans are generally satisfied with their coverage. Two-thirds say their coverage is excellent or good, but a growing number say it is only fair or poor. The poll reveals warning signs for the future: A diminishing number of participants feel their health insurance is a good value, those with high-deductible plans are most dissatisfied, and families feel it is increasingly difficult to pay off debt and save for the future.
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