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Featured Research

Supreme-Court-Caduceus2 Reports: The Implications of a Supreme Court Finding for the Plaintiff in King vs. Burwell
Linda J. Blumberg, Matthew Buettgens, John Holahan

The Supreme Court will hear the King v. Burwell case, in which the plaintiff argues that the Affordable Care Act (ACA) prohibits payment of premium tax credits and cost-sharing reductions to people in states without state-managed Marketplaces.  We estimate that a victory for the plaintiff would increase the number of uninsured by 8.2 million people and eliminate $28.8 billion in tax credits and cost-sharing reductions in 2016 for 9.3 million people, two-thirds of which would become uninsured. Most of these are adults who are low and middle income but not poor, most are white, non-Hispanic, and most reside in the South. With lower cost individuals leaving the market, average nongroup premiums in 34 states would increase by 35 percent, thus substantially increasing financial burdens for those wishing to continue buying the same coverage they would have under current implementation of the ACA.
Read more:
Impact of King vs. Burwell on the number of uninsured and premium costs
Characteristics of those who would be affected by loss of tax credits

health care moneyTransitioning from Medicaid Expansion Programs to Medicare: Making Sure Low-Income Medicare Beneficiaries Get Financial Help
Matthew Buettgens, Lynda Flowers, Jay Dev

The Affordable Care Act allows states to offer Medicaid coverage to low-income adults who would not have qualified under previous law. This population will face higher cost-sharing requirements when they transition to Medicare, although some may be eligible for traditional Medicaid benefits and/or Medicare Savings Programs (MSPs) that will reduce their costs. This report discusses how Medicare beneficiaries can qualify for traditional Medicaid and MSPs, provides new estimates of the number and characteristics of eligible individuals, and outlines policy options that would make it easier for Medicare beneficiaries to qualify for traditional Medicaid benefits and MSPs. Read More

time-481445_640Appointment Availability after Increases in Medicaid Payments for Primary Care
Daniel Polsky, Michael Richards, Simon Basseyn, Douglas Wissoker, Genevieve M. Kenney, Stephen Zuckerman, Karin V. Rhodes

This study examines the effect of increased Medicaid reimbursements for primary care services in 2013 and 2014, a key provision of Affordable Care Act, on access to primary care. The researchers measured the availability of and waiting times for appointments for Medicaid enrollees and privately insured individuals in 10 states during two periods: from November 2012 through March 2013 and from May 2014 through July 2014. Between the two time periods, the availability of primary care appointments for Medicaid beneficiaries increased from 58.7 percent to 66.4 percent, while no changes were observed for the privately insured. During the same periods, waiting times to a scheduled new-patient appointment remained stable. These results suggest that increased Medicaid reimbursement to primary care providers was associated with improved appointment availability for Medicaid enrollees without generating longer waiting times. Read More

usa_mapMarketplace Renewals: State Efforts to Maximize Enrollment into Affordable Health Plan Options
Sabrina Corlette, Jack Hoadley, Sandy Ahn

This report outlines efforts of six state-based insurance marketplaces (California, Colorado, Kentucky, Maryland, Rhode Island and Washington) to re-enroll consumers into coverage for 2015. The report highlights key changes that consumers need to be aware of, most importantly that 2014 plans may not be the same as those participating in 2015. Due to changes, many consumers could be auto-enrolled in a plan that does not maximize their premium tax credit. Researchers found, however, that some state-based marketplaces have used their flexibility under federal rules to improve consumers' experiences and ensure they get a more accurate determination of premium tax credits. Read More



Immediate Issues
The Urban Institute has launched a powerful new research tool, the Health Reform Monitoring Survey (HRMS), to provide timely insights into the Affordable Care Act. From coverage to access to affordability, the HRMS delivers critical data before federal government surveys are available. Read more

Immediate Issues
The Urban Institute is undertaking a comprehensive monitoring and tracking project to examine the implementation and effects of the ACA in ten states. Derived from extensive interviews with state officials and health care stakeholders, this series of reports documents each state’s progress in establishing a health insurance marketplace, implementing insurance reforms, and preparing for an expansion of Medicaid. Read more

New interactive map shows wide local variation in numbers of poor uninsured Americans who would be eligible for Medicaid under the ACA

mapState plans for expanding Medicaid under the ACA

Immediate Issues
The reforms implemented in Massachusetts in 2006 became the template for the Affordable Care Act. The Urban Institute has conducted numerous studies of Massachusetts' ambitious effort to transform its health care system. Read more

Health Reform Modeling Capacity

The UI Health Policy Center staff has developed a sophisticated microsimulation model that is used to estimate the impacts of health reforms and to inform policy design choices at the state and national levels.  Learn more about the HIPSM model.
All HPC Research
The ACA's Basic Health Program Option: Federal Requirements and State Trade-Offs (Policy Briefs/Health Policy Briefs)
Stan Dorn, Jennifer Tolbert
Publication Date: December 12, 2014
Public Education, Outreach and Application Assistance (Research Report)
Stan Dorn
Publication Date: December 11, 2014

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