Through a number of provisions — such as individual and employer mandates, health insurance exchanges, and the expansion of Medicaid — the Patient Protection and Affordable Care Act (ACA) aims to expand access to health care for uninsured Americans. RAND has examined implementation challenges, cost and coverage implications, Medicaid expansion, state health insurance exchanges, and reforms to both care delivery and payment.
With the complex process of implementing the ACA underway, RAND research is tracking the progress of implementation and assessing the potential consequences of choices facing federal and state governments, employers, families, and individuals.
The growing number of Americans newly-insured under the ACA will undoubtedly lead to a surge in demand for care, whether through Medicaid or insurance exchanges. But, if predictions hold, the increase won’t be as dramatic as some may fear, writes David I. Auerbach.
COMMENTARY
The bottom line is that the employer mandate does not provide a large inducement for firms to change their health insurance offerings, but it does raise a substantial amount of money to pay for the ACA’s coverage provisions over time.
REPORT
An analysis of 10 states and the United States overall predicts that there will be no widespread premium increase in the individual health insurance market under the ACA. However, the cost of policies will vary among states and will be influenced by individual factors such as a person’s age and whether they smoke.
NEWS RELEASE
An analysis of 10 states and the United States overall predicts that there will be no widespread premium increase in the individual health insurance market under the ACA. However, the cost of policies will vary among states and will be influenced by individual factors such as a person’s age and whether they smoke.
NEWS RELEASE
A one-year delay in requiring large employers to provide health insurance to their workers will not significantly hurt the goals of the Affordable Care Act, but a repeal of the requirement would seriously undermine financial support for the law.
REPORT
A one-year delay in requiring large employers to provide health insurance to their workers will not significantly hurt the goals of the Affordable Care Act, but a repeal of the requirement would seriously undermine financial support for the law.
MULTIMEDIA
Mathematician Carter Price discusses the potential impacts to low-income populations and local economies in states that choose not to expand Medicaid under the Affordable Care Act.
COMMENTARY
Resolving the question of whether or not the U.S. has finally gotten a handle on health care spending is vitally important, because the choices we make going forward will have profound implications for our economy, the financial wellbeing of millions of American families, and ultimately America’s standing in the world.
REPORT
The Affordable Care Act (ACA) contains many Medicaid-related provisions. RAND is working closely with decisionmakers at the federal and state levels to help resolve challenges associated with implementing the ACA’s sweeping reforms.
CONTENT
RAND’s work for the Centers for Medicare & Medicaid Services reflects the diverse, widespread nature of CMS’s programs. Major topics examined by our health policy experts include improving Medicare payment policies, implementation of the ACA’s Medicaid provisions, Medicare demonstration projects, measuring quality of care, and assessing patients experience.
JOURNAL ARTICLE
Alignment with best P4P practices varies across Medicare programs; the program for Medicare Advantage aligns most strongly. It is unclear which P4P design elements are critical for quality improvement. Unintended consequences of design features are poorly understood.
REPORT
While the expansion of Medicaid under the Affordable Care Act will require additional spending by the Commonwealth of Pennsylvania, these costs will be more than offset by additional revenue or reductions in other spending in the 2014-2020 timeframe.
COMMENTARY
Because of the ACA’s regulations, some smaller employers with young and healthy workers are considering avoiding the purchase of health care coverage in the regulated market, opting instead to self-insure their employees.
RESEARCH BRIEF
RAND researchers have analyzed how opting out of Medicaid expansion would affect insurance coverage and spending and whether alternative policy options—such as partial Medicaid expansion—could cover as many people at lower costs to states.
BLOG
The dependent coverage provision of the Affordable Care Act is working as intended, say Andrew Mulcahy and Katherine Harris. In 2011, it spared individuals and hospitals from $147 million in emergency room costs.
CONTENT
Some governors have stated publicly that their states will not participate in Medicaid expansion. A recent RAND study explores how this could affect government costs and coverage.
NEWS RELEASE
States that choose not to expand Medicaid under federal health care reform will leave millions of their residents without health insurance and increase spending on the cost of treating uninsured residents, at least in the short term.
JOURNAL ARTICLE
States that choose not to expand Medicaid under federal health care reform will leave millions of their residents without health insurance and increase spending on the cost of treating uninsured residents, at least in the short term.
REPORT
A series of studies on sources of variation in individual valuation of employer-provided group health care found that the effects of bundling health insurance with employment in the U.S. can vary significantly within different population groups.
NEWS RELEASE
A new federal law allowing young adults to remain on their parents’ medical insurance through age 25 has shielded them, their families, and hospitals from the full financial consequences of serious medical emergencies.
Through a number of provisions — such as individual and employer mandates, health insurance exchanges, and the expansion of Medicaid — the Patient Protection and Affordable Care Act (ACA) aims to expand access to health care for uninsured Americans. RAND has examined implementation challenges, cost and coverage implications, Medicaid expansion, state health insurance exchanges, and reforms to both care delivery and payment.
Featured at RAND
The RAND Health Reform Opinion Study tracks public opinion of the Affordable Care Act by surveying the same people over time. This allows us to observe true changes in public opinion, rather than changes based on who was surveyed randomly.
With the complex process of implementing the ACA underway, RAND research is tracking the progress of implementation and assessing the potential consequences of choices facing federal and state governments, employers, families, and individuals.
This infographic presents findings from a RAND analysis of the economic and other effects of Medicaid expansion on the commonwealth of Pennsylvania.
COMMENTARY
While a governor or legislator may disagree with Medicaid expansion for philosophical reasons, the claims that the expansion will be a burden on states’ economies seem misguided given the full range of projected economic impacts on the states, writes Carter C. Price.
RESEARCH BRIEF
This infographic presents findings from a RAND analysis of the economic and other effects of the Affordable Care Act on the state of Arkansas.
COMMENTARY
Multistate plans are most likely to appeal to out-of-state students, interstate migrants, out-of-state workers, seasonal movers (e.g., “snowbirds”), and similar groups that require improved access to health care across state lines.
NEWS RELEASE
Expanding Medicaid in Pennsylvania under the Affordable Care Act would boost federal revenue to the state by more than $2 billion annually and provide 340,000 residents with health insurance.
REPORT
If Pennsylvania opts into Medicaid expansion under the Affordable Care Act, more residents would have health coverage and the state would enjoy a positive economic effect. However, benefits would have a long-term cost, with uneven regional results.
REPORT
The ACA requires the government to work with insurance issuers to establish at least two multistate plans (MSPs) in each state’s health insurance exchange. MSPs may be especially attractive to those interested in issuers that operate in multiple states, such as out-of-state students or temporary workers.
REPORT
Public and private sector purchasers are actively working to design value-based payment programs to achieve the goals of improved quality and more efficient use of health care resources. How these programs are designed is a complex undertaking and one that will determine the likelihood of their success.
BLOG
In this video, Amelia Haviland presents the results of several new RAND studies on cost and quality in consumer-directed health plans, and explores how switching plans affects the quality of care.
BLOG
The Medicaid expansion under the ACA will result in about 400,000 people newly insured in Arkansas by 2016. Of these, about 190,000 would be newly enrolled in Medicaid and the rest would be newly insured through the new insurance exchanges. The state is likely to save about $67 million for reduced uncompensated care costs for the uninsured.
REPORT
For Arkansas, the Affordable Care Act will result in an increase in GDP of around $550 million and the creation of about 6,200 jobs. The new law will also increase health insurance coverage by 400,000 newly insured individuals.
JOURNAL ARTICLE
Many physician practices will face a set of critical decisions in the coming years that may contribute to the ultimate success or failure of the ACA.
CONTENT
In its second term, the Obama Administration can restrain further health care spending growth—without compromising quality—by employing four broad strategies: fostering efficient and accountable providers, engaging and empowering consumers, promoting population health, and facilitating high-value innovation.
COMMENTARY
Regardless of which candidate wins in November, and regardless of whether “Obamacare” is repealed, amended, or defended by the next Congress, the next president will have to contend with the spiraling cost of health care in the United States—a problem that is growing more acute with each passing year, writes Arthur Kellermann.
COMMENTARY
As we look for ways to provide efficient, high-quality and cost-effective healthcare to more Americans, states may study California as a potential model for how to do more to deliver on what the Affordable Care Act has to offer women, while saving money at the same time, writes Chloe Bird.
PERIODICAL
Whether the Affordable Care Act is repealed, defended, or weakened will hinge on who holds the balance of power next January. Regardless of what happens with the ACA, the spiraling cost of health care in the United States will remain a huge challenge.
CONTENT
Retail health care clinics provide treatment for acute conditions like bronchitis as well as vaccinations and other preventive care. With the role of retail clinics expanding and U.S. health care entering a dynamic period of change, it is important to consider what we know about this emerging health care setting.
COMMENTARY
As we look for ways to provide efficient, high-quality, and cost-effective health care to more Americans, we can’t afford to ignore women’s health issues, including reproductive health care and the cost savings that contraceptive access provides, writes Chloe Bird.
JOURNAL ARTICLE
ACA-mandated payment reforms need to achieve more than a one-time cost saving.
COMMENTARY
A problem with using surveys to predict behavior is that they measure employer sentiment toward the ACA today, rather than the economic decisions employers typically make when the time comes, writes Art Kellermann.
COMMENTARY
The bottom line is this: With or without the Affordable Care Act, the nation can no longer kick the can down the road on costs, writes Arthur Kellermann.
CONTENT
Now that the Supreme Court has upheld key provisions of the Affordable Care Act, what lies ahead for health care in America? RAND experts sound off in the wake of this momentous decision.
COMMENTARY
The U.S. Supreme Court’s ruling on the Affordable Care Act is unquestionably historic, but there is a critical aspect of health care reform that still needs to be fixed. The nation needs to take decisive action to address the rising costs of health care, writes Arthur Kellermann.
RESEARCH BRIEF
Switching to a consumer-directed health plan (CDHP) could save families 20 percent or more on their health care costs. Families with CDHPs initiate less episodes of care and spend less per episode, however, they also tend to scale back on high-value preventive care, such as child vaccinations.
PERIODICAL
If the individual mandate requiring all Americans to have health insurance were eliminated, it would sharply reduce the number of people gaining coverage and slightly increase the cost for those who do buy policies through the new insurance exchanges.
JOURNAL ARTICLE
If consumer-directed health plans grow to account for half of all employer-sponsored insurance in the United States, health costs could drop by $57 billion annually—about 4 percent of all health care spending among the nonelderly.
BLOG
As the U.S. Supreme Court considers the constitutionality of the Affordable Care Act’s (ACA) individual mandate, one of the questions being debated is what effect the mandate would have on employer-sponsored health insurance coverage. A factor to consider in this is the effect the ACA would have on small businesses, which employ the majority of America’s private-sector workforce.
COMMENTARY
If the individual mandate were ruled unconstitutional, subsidies and the age structure of premiums should keep enough healthy people in the insurance exchanges to prevent huge spikes in premiums, write Carter C. Price and Christine Eibner.
PAST EVENT
RAND economist Christine Eibner spoke at a Bloomberg Government and RAND Corporation event in Washington, D.C. Eibner briefed the attendees on the results of her recent study, How Would Eliminating the Individual Mandate Affect Health Coverage and Premium Costs?
PROJECT
As the Affordable Care Act expands health insurance coverage in the U.S., the “cost” of applying for SSDI will decline for many. Studying the effect of Massachusetts health care reform in 2006 may provide insights into the impact the ACA may have on SSDI applications and awards.
NEWS RELEASE
Eliminating a key part of health care reform that requires all Americans to have health insurance would sharply lower the number of people gaining coverage, but would not dramatically increase the cost of buying policies through new insurance exchanges.
RESEARCH BRIEF
An analysis of the effects of implementing the Affordable Care Act without an individual mandate found that over 12 million people who would have otherwise signed up for coverage will be uninsured and premium prices will increase by 2.4 percent.
REPORT
Eliminating a key part of health care reform that requires all Americans to have health insurance would sharply lower the number of people gaining coverage, but would not dramatically increase the cost of buying policies through new insurance exchanges.
CONTENT
The individual mandate of the Patient Protection and Affordable Care Act of 2010 (ACA) requires that most Americans either obtain health coverage or pay an annual fine. How much will overturning the individual mandate affect costs and coverage?
JOURNAL ARTICLE
Rules that allow some small employers to avoid regulation under the federal Affordable Care Act are unlikely to have a major impact on the future cost of health insurance unless those rules are relaxed to allow more businesses to opt out.
NEWS RELEASE
Rules that allow some small employers to avoid regulation under the federal Affordable Care Act are unlikely to have a major impact on the future cost of health insurance unless those rules are relaxed to allow more businesses to opt out.
COMMENTARY
Most will agree with the undeniable fact that a new era in US medicine and US health care begins in less than two years. The key question is what potential measures should be monitored to determine both anticipated and unanticipated effects of the new law on the health of the US population, writes Robert H. Brook.
OURNAL ARTICLE
The Affordable Care Act marks a new era in US health care and US medicine. This commentary suggests ways to monitor the act’s effect on the health of the US population.
RESEARCH BRIEF
Since Massachusetts enacted health reform legislation in 2006, health care employment in the state has grown more rapidly than in the rest of the United States, primarily in administrative positions.
CONTENT
California, the state with the nation’s largest prison population, is releasing increased numbers of inmates under its 2011 Public Safety Realignment Plan. RAND was asked to study the public health implications of returning prisoners for the communities they return to and has found both challenges and opportunities.
REPORT
Medicare’s payment for physician work and malpractice liability expenses is the same regardless of where a service is provided, but payments differ for facility-related components of care.
REPORT
The Patient Protection and Affordable Care Act has piqued employers’ interest in new benefit designs. This paper reviews consumer-controlled personal health management systems that could help individuals control and manage their health care.
JOURNAL ARTICLE
Analysis of the Massachusetts Health Care Reform Plan suggests national health care reform may require larger numbers of support personnel, rather than requiring greater numbers of physicians and nurses themselves.
PROJECT
Policymakers are facing new challenges as they implement the Patient Protection and Affordable Care Act (ACA). RAND COMPARE is a modeling tool that simulates the impact of implementation decisions on insurance coverage, premiums, and health care spending.
REPORT
Implications of the Patient Protection and Affordable Care Act of 2010 (as Modified by the Health Care and Education Reconciliation Act) for small firms’ decisions to offer self-insured health plans and consequences of self-insurance for enrollees.
REPORT
Content for a toolkit was designed to help community and faith-based organizations take advantage of opportunities presented in the Patient Protection and Affordable Care Act and engage leaders in promoting health in their communities.
NEWS RELEASE
A series of new reports by the RAND Corporation outlines the impact that national health care reform will have on individual states, estimating the increased costs and coverage that are expected in five diverse states once reform is fully implemented in 2016.
NEWS RELEASE
National health care reform will help 6 million California residents obtain health insurance and increase health care spending by state government by about 7 percent when it is fully implemented in 2016.
NEWS RELEASE
National health care reform will help 170,000 Connecticut residents obtain health insurance and decrease health care spending by state government by about 10 percent when it is fully implemented in 2016.
NEWS RELEASE
National health care reform will help 1.3 million Illinois residents obtain health insurance and increase health care spending by state government by about 10 percent when it is fully implemented in 2016.
NEWS RELEASE
National health care reform will help 125,000 Montana residents obtain health insurance and increase health care spending by state government by about 3 percent when it is fully implemented in 2016.
NEWS RELEASE
National health care reform will help 5 million Texas residents obtain health insurance and increase health care spending by state government by about 10 percent when it is fully implemented in 2016.
RESEARCH BRIEF
High-deductible plans significantly reduce health care spending but also lead consumers to cut back on their use of preventive health care — even though high-deductible plans waive the deductible for such care.
RESEARCH BRIEF
Projects how the coverage-related provisions of the Patient Protection and Affordable Care Act will affect health insurance coverage and state government spending on health care in five states.
REPORT
Projects how the coverage-related provisions of the Patient Protection and Affordable Care Act will affect health insurance coverage and state government spending on health care in Illinois through 2020.
REPORT
Projects how the coverage-related provisions of the Patient Protection and Affordable Care Act will affect health insurance coverage and state government spending on health care in Texas through 2020.
REPORT
Projects how the coverage-related provisions of the Patient Protection and Affordable Care Act will affect health insurance coverage and state government spending on health care in California through 2020.
REPORT
Projects how the coverage-related provisions of the Patient Protection and Affordable Care Act will affect health insurance coverage and state government spending on health care in Montana through 2020.
REPORT
Projects how the coverage-related provisions of the Patient Protection and Affordable Care Act will affect health insurance coverage and state government spending on health care in Connecticut through 2020.
REPORT
Health care spending reforms should be met with new efforts to develop and refine quality of care and other performance measures in order to assure that any changes will improve medical care and not harm patients.
JOURNAL ARTICLE
An analysis of two rules that allow small businesses to avoid participating in health reform concludes they will have only a minor impact because relatively few businesses are likely to take advantage of the options.
RESEARCH BRIEF
Finds that the Affordable Care Act will increase the percentage of employers that offer health coverage to workers: from 57 percent to 80 percent for firms with 50 or fewer workers, and from 90 percent to 98 percent for firms with 51 to 100 workers.
JOURNAL ARTICLE
The nature of employer-sponsored coverage may change substantially after implementation of the Patient Protection and Affordable Care Act, with an increase in the number of workers offered coverage through the health insurance exchanges.
REPORT
The Patient Protection and Affordable Care Act will increase insurance offer rates at small businesses. By 2016, rates would increase from 53 to 77 percent at firms with ten or fewer workers and from 71 to 90 percent at firms with 11 to 25 workers.
REPORT
To avoid changes in current health coverage, the Patient Protection and Affordable Care Act exempts existing plans from some regulations. These exemptions may lead to higher employer-sponsored insurance enrollment and lower government spending.
JOURNAL ARTICLE
This article discusses the range of health information technology initiatives included in the 2009 economic stimulus legislation that collectively are known as the Health Information Technology for Economic and Clinical Health (HITECH) initiative; these include proposed regulations on
RESEARCH BRIEF
Compares President Obama’s Proposal for Health Reform, the U.S. House and Senate health care reform bills, and the status quo on changes in number of uninsured and government and national costs, as estimated by the RAND COMPARE microsimulation model.
RESEARCH BRIEF
Compares how two health care reform bills, HR. 3962 and H.R. 3590, passed by the U.S. House and Senate, respectively, in late 2009 compare on a variety of projections made using the RAND COMPARE microsimulation model.
RESEARCH BRIEF
Using the COMPARE microsimulation model, estimates the effects of the Patient Protection and Affordable Care Act (H.R. 3590) on the number of uninsured, the costs to the federal government and the nation, and consumers’ health care spending.
NEWS RELEASE
Health reform as set forth in legislation passed by the U.S. House of Representatives in November would cut the number of uninsured Americans to 24 million by 2019 (a 56 percent decrease) and increase personal spending on health care by about 3.3 percent cumulatively between 2013 and 2019.
RESEARCH BRIEF
Using the COMPARE microsimulation model, estimates proposed health care reform legislation’s effects on the number of uninsured, the costs to the federal government and the nation, revenues from penalty payments, and consumers’ health care spending.
JOURNAL ARTICLE
Cost savings can be achieved while improving health care quality by speeding payment reforms, implementing insurance reforms, and reforming coverage.
JOURNAL ARTICLE
Using the COMPARE (Comprehensive Assessment of Reform Efforts) microsimulation model, this study evaluated how the recently enacted health reform law performed compared with alternative designs on measures of effectiveness and efficiency and found that only a few different approaches would cover more individuals at a lower cost to the government; however, these appeared politically untenable because they included substantially higher penalties, lower subsidies, or less generous Medicaid expansion.
JOURNAL ARTICLE
Another health policy window has opened; through it will stream proposals to reform the US health care system. President Obama has demanded that reform proposals improve both coverage and quality of care and make health care more affordable for all Americans. Extending coverage without worrying about costs would be relatively easy. Improving quality of care without worrying about costs might also be achievable. But extending coverage and improving quality while also making coverage more affordable will be difficult.
PEOPLE
Policy Researcher; Professor, Pardee RAND Graduate School
Ph.D. in health economics, Harvard University; M.S. in environmental science & policy, MIT; M.S. in chemistry, University of California, Berkeley; B.S. in chemistry, MIT
PEOPLE
Economist
Ph.D. in economics, University of Maryland, College Park
PEOPLE
Policy Researcher; Professor, Pardee RAND Graduate School
Ph.D. in health policy and management, Johns Hopkins Bloomberg School of Public Health
PEOPLE
Associate Physical Scientist; Professor, Pardee RAND Graduate School
Ph.D. and M.S. in biomathematics, University of California, Los Angeles; B.S. in physics, MIT
PEOPLE
Director, Public Health Systems and Preparedness Initiative, RAND Health; Senior Economist; Professor, Pardee RAND Graduate School
Ph.D. in economics, University of Maryland, College Park; M.A. in economics, University of Maryland, College Park
PEOPLE
Project Associate, Behavioral & Policy Sciences
M.P.A. in health policy analysis, New York University; B.A., Butler University
SOURCE
http://www.rand.org/topics/patient-protection-and-affordable-care-act.all.0.html
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