Insurers are in the process of filing proposed premiums for ACA-compliant nongroup plans that will be available inside and outside of Marketplaces in 2017.

Recent reports by insurers about their experiences during the first two years under the ACA suggest that some assumed that enrollees would be healthier than they turned out to be and set their premiums too low, leading in some cases to significant financial losses for ACA-compliant plans and an expectation that premiums could rise faster in 2017. Some insurers took relatively large premium increases for 2016 to better match premium levels with the costs of their enrollees — which would help to offset the need for 2017 premium increases — but it is too soon to know if these efforts were generally successful or whether losses have continued into 2016.

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Key Findings:

  • Health care is one of the top four issues mentioned by voters when asked which issues they most want to hear candidates discuss in the campaign, but half as many cite health care as mention the economy and jobs.
  • When asked specifically what health care issues voters would most like to hear the presidential candidates discuss, the 2010 health care law (ACA) and health care costs top the list.
  • Overall ratings of the ACA lean negative this month, with 38 percent saying they have a favorable view and 49 percent saying they have an unfavorable view.
  • The percentage of Democrats who have an unfavorable opinion of the law increased 6 percentage points from last month. Of the Democrats who did not express a favorable opinion, 40 percent want to expand what the law does.

The March Kaiser Health Tracking Poll finds that health care is one of many issues that will be important to voters in the Presidential election, trailing concerns about the economy and jobs and leading concerns about another hot issue, immigration. Health care ranks higher for Democratic voters than for Republican and independent voters and is a higher priority for women than for men.

Both the percentage of employers who offer insurance and the percentage of people covered will be important to watch as the changes brought about by the Affordable Care Act (ACA) continue to unfold. New coverage provisions and financial assistance provided in the ACA affect employers’ decision to offer coverage and employees’ decisions to take up any coverage they are offered at work. The employer shared responsibility provision, for example, requires employers with 50 or more full-time equivalent employees to offer coverage to full-time employees and their dependent children or face a financial penalty.

As of the end of the third open enrollment under the Affordable Care Act, 12.7 million people had signed up for coverage in the health insurance marketplaces, up from 11.7 million last year and 8.0 million in 2014.

Actual enrollment will end up somewhat lower than this because some people will not pay their premiums or will have their coverage terminated due to inconsistencies on their applications, and there is typically additional attrition as the year progresses (e.g., as some enrollees get jobs with health benefits).

While enrollment is in line with the HHS target announced in advance of this year’s open enrollment, it is short of earlier projections by the Congressional Budget Office, which became an implicit yardstick for judging the law. In March 2015, CBO projected average monthly marketplace enrollment of 21 million in calendar year 2016, though recently lowered that forecast to 13 million.

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Six of the 32 states implementing the Affordable Care Act’s Medicaid expansion to date have done so through Section 1115 waivers. Using these waivers, the Centers for Medicare and Medicaid Services has approved terms that extend beyond the flexibility provided by federal law. Section 1115 waivers authorize research and demonstration projects that, in the view of the Health and Human Services Secretary, further the purposes of the Medicaid program. The ACA implemented new requirements for these waivers, including that states must have a publicly available, approved evaluation strategy. States also must submit an annual report to HHS that describes the changes occurring under the waiver and their impact on access, quality, and outcomes.

While health care ranks fourth as an important voting issue, presidential hopefuls have proposed a range of visions for the future of the health care system, from the full repeal of the Affordable Care Act to the adoption of a universal government plan. The survey finds that when given four broad approaches for the future of the health care system that are currently being discussed, Americans opinions are split.

Despite the ongoing debate between Republican lawmakers and President Obama on the future of the 2010 health care law, the January Kaiser Health Tracking Poll finds the Affordable Care Act is only one of many issues that may impact voting decisions, with nearly a quarter (23%) saying it’s extremely important.

When asked specifically about how some health care issues may impact their vote for president, at this point in the campaign, there’s not a single health care issue that voters coalesce around with more than 4 in 10 saying a number of different health care issues may be important to their vote.

This Kaiser Family Foundation/New York Times survey provides an in-depth look at the experiences of Americans ages 18-64 who say they or someone in their household had problems paying medical bills in the past year. The survey explores the causes of medical bill problems and the impacts they have on individuals and their families, finances, and access to health care. To provide context, a shorter companion survey was conducted among those who do not report having medical bill problems.

Only 7% of the uninsured correctly identify this as the deadline to enroll in coverage and 20% say they have been contacted by someone about signing up for coverage. When asked why they have not purchased health insurance this year, nearly half of the uninsured (46%) say they have tried to get coverage but that it was too expensive.