Research: Affordable Care Act

A sampling of official and unofficial studies about the effects of the Affordable Care Act in California and nationwide.

Five-State Study of ACA Market Competition
M. Weinberg, P. Born … Center for Health Policy at Brookings. Ratings of care in California, Michigan, Florida, North Carolina and Texas. February 2017.
Quote: Based on its ability to maintain a relatively large number of insurers in its largest metropolitan areas, California has the most successful marketplace of any examined in this report. … The number of insurers offering coverage through the marketplace has remained relatively high at 11.

An Integrated Quantitative and Qualitative Study on Post-Election Attitudes Toward Enrolling in and Renewing Health Insurance Coverage
Greenberg Strategy. Results of six focus groups with uninsured Californians after the November 2016 election. January 2017.
Quote: “The cost of healthcare remains the top concern and barrier to enrollment. … Despite uncertainty, trust in the ‘California brand’ seems to be even greater.”

State Variation in Narrow Networks on the ACA Marketplaces
D. Polsky and J. Weiner, University of Pennsylvania. Study of provider networks offered on Affordable Care Act marketplaces. August 2015.
Quote: “Well-functioning narrow networks will survive only if they are made more transparent to consumers and are regulated to ensure sufficient network adequacy.”

Satisfaction With Health Coverage and Care
P. Fronstin and A. Elmlinger, Greenwald & Associates. Online survey about satisfaction with health plans. July 2015.
Quote: “In 2014, 48 percent of traditional-plan participants were extremely or very satisfied with out-of-pocket costs, (but only) 19 percent of high-deductible health plan enrollees.”

ACAView: Observations on the Affordable Care Act
Athena Research. Data from national sample of 16,000 providers. May 2015.
Quote:”Some commentators expressed concern that physicians might lack the practice capacity to treat these new (Affordable Care Act) patients, many of them with unmet medical needs. That has not happened.”

Comparison of the Prevalence of Uninsured Persons, January–April 2014
National Center for Health Statistics. National Health Interview Survey and the U.S. Census Bureau’s Current Population Survey. September 2014.
Quote: “The number of uninsured Americans fell by about 8 percent to 41 million people in the first quarter of this year, compared with 2013, a drop that represented about 3.8 million people” (NYT).

Covered California’s First Year: Strong Enrollment Numbers Mask Serious Gaps
J. Medina and C. Saporta, Greenlining Institute. “Stakeholder interviews” with outreach and education grantee organizations and certified enrollment entities in Los Angeles and Fresno counties. June 2014.
Quote: “Californians with limited English proficiency were seriously underrepresented (in the Covered California enrollment). Eighty percent of enrollees in private insurance plans spoke English, even though 40 percent of those eligible for coverage were limited-English proficiency individuals.”

Shifting the Open Enrollment Period for ACA Marketplaces Could Increase Enrollment and Improve Plan Choices
K. Swartz and J. Graves, Harvard and Vanderbilt. Study of Google trend data. June 2014.
Quote: “We found considerable seasonality in measures of financial stress and in when people seek out information on health insurance plans. … A more opportune time for scheduling open enrollment for the ACA Marketplaces may be between Feb. 15 and April 15 — weeks when low-income people typically receive income tax refunds.”

For States That Opt Out of Medicaid Expansion: 3.6 Million Fewer Insured and $8.4 Billion Less in Federal Payments
C. Price, C. Eibner. Rand Corporation. Microsimulation. June 2013.
Quote: With 14 states opting out of the Affordable Care Act’s expansion of Medicaid, “3.6 million fewer people would be insured, federal transfer payments to those states could fall by $8.4 billion, and state spending on uncompensated care could increase by $1 billion in 2016.”

Factors Affecting Individual Premium Rates in 2014 in California
Milliman on behalf of Covered California. Actuary forecasts for health insurance rates. March 2013.
Quote: “The influx of newly insured and the related Affordable Care Act provisions affect (premiums) and are spread out over all of the current and newly insured members. We estimate the amount (of increase in the individual market) to be 14 percent (instead of 9 percent). … For consumers who are eligible for subsidies, they stand to see their premiums decrease substantially.”

State-Level Trends in Employer-Sponsored Health Insurance
J. Sonier, B. Fried, C Au-Yeung, B. Auringer. Robert Wood Johnson Foundation. State-by-state analysis. April 2013.
Quote: “Health insurance coverage from employer-sponsored insurance eroded substantially from 1999/2000 to 2010/2011. … The percentage of nonelderly people with employer-sponsored insurance declined 10.2 percentage points over the period. … Single-person premium costs doubled (while) family premiums rose 125 percent.”

Health Spending Following the PPACA Adult-Dependent Mandate
P. Fronstin. Employee Benefit Research Institute. Analysis. April 2013
Quote: Overall, 31 percent of employers enrolled adult-dependent children (up to age 26) as a result of the (Affordable Care Act) mandate. … The cohort was more likely to incur claims related to mental health, substance abuse and pregnancy. … Average spending was higher than in the comparison group.”

Changes in the Estimated Budgetary Impact of the ACA’s Coverage Provisions
Congressional Budget Office. Update of March 2013.
Quote: “The net (federal) budgetary impact of the ACA’s provisions related to health insurance coverage is $1,165 billion — (an increase) within $1 billion of our estimate of August 2012. … (We expect) a larger number of people with employment-based coverage and a smaller number without insurance, compared with earlier projections.”

Medi-Cal Expansion Under the Affordable Care Act: Significant Increase in Coverage With Minimal Cost to the State.
L. Lucia, K. Jacobs, G. Watson, etc. UC Berkeley Center for Labor Research & Education, and UCLA Center for Health Policy Research. Analysis. January 2013.
Quote: “As uninsured Californians enroll in Medi-Cal under the (Affordable Care Act), the state could incur substantial savings in other areas of the budget, including other state health programs, mental health services and state prisons. … These anticipated savings would likely be more than enough to offset the $46 million to $381 million in annual state General Fund spending for the newly eligible population through 2019.”

Payments of Penalties for Being Uninsured Under the Affordable Care Act
Congressional Budget Office. Analysis of September 2012.
Quote: “About 6 million people will pay a penalty because they are uninsured in 2016. … About 30 million nonelderly residents will be uninsured, but the majority of them will not be subject to the penalty tax. Unauthorized immigrants, for example, (or) because the premium they would have to pay would exceed a specified share of their income. … (Some) individuals will try to avoid payments.”

Effects of the Affordable Care Act on Employment-Based Health Insurance
J. Banthin, P. Jacobs. Congressional Budget Office. Analysis of March 2012.
Quote: “There is clearly a tremendous amount of uncertainty about how employers and employees will respond to the set of opportunities and incentives under the ACA. … Employers’ decisions about offering employment-based health insurance will be influenced heavily by the subsidies available. … Most employers will continue to have an economic incentive to offer health insurance to their employees.”