Health Care Reform, Health Economics, and Health Policy

The purpose of this brief is to compare Medicaid payer mix in 2018 versus 2013 for CAHs in states that have and have not expanded Medicaid.

This new report uses the CalSIM model to determine the effect of new policies on the cost of and access to healthcare coverage in the state of California.

The checklist is designed to help states gather data on purchasers’ contract terms with pharmacy benefit managers (PBMs), how much is spent on drugs based on net cost and utilization, and plan benefit design.

An analysis of a proposed international reference pricing model for drugs covered under Medicare Part B, which would authorize payment based on the average price paid in a selected group of other high-income countries.

A new issue brief examines the range of costs for reimbursing hospitals for treatment of COVID-19 for the uninsured, and discusses questions about the Coronavirus Aid, Relief, and Economic Security (CARES) Act.

The U.S. health care system has long been marked by high spending, comparatively poor health outcomes, and waste and inefficiency. To address these issues, the Affordable Care Act (ACA) includes several provisions to reform how the nation organizes, structures, and pays for its health care. The law instituted several mandatory national payment reforms through the Medicare program and created the Center for Medicare and Medicaid Innovation, which was funded with $10 billion over 10 years to develop, test, and promote innovative payment and delivery models. Below is a summary of evidence from some of the major innovations tested over the past decade.

Study measured each county’s level of carrier change by adding up all exits and entries that occurred between 2015 and 2020.

Brief discusses various problems with block grants and per capita caps and why they are a flawed policy in general and especially in these times.

This brief looks at the significance of the trial results and at the experiences of a completed New Jersey Medicaid ACO demonstration that also used a hot-spotting approach, for Medicaid, the principal source of coverage for the nation’s most medically and socially complex patients.

The National Academy for State Health Policy’s (NASHP) new resource, Model PBM Contract Terms, offers specific language that states can use in their requests for proposals and contracts in order to achieve cost-saving for states.

Report evaluates the first year of the Next Generation Accountable Care Organization (NGACO) model. The NGACO model tests whether stronger financial incentives for ACOs, paired with tools to support patient engagement and care management, can improve health outcomes and lower expenditures for Medicare fee-for-service (FFS) beneficiaries

There is ongoing discussion as to whether Congress should waive COVID-19 treatment costs. To inform these discussions, this analysis examines the extent of health care cost-related problems among Medicare beneficiaries.

The US Centers for Medicare & Medicaid Services (CMS) made it easier for states to temporarily modify their Medicaid policies and programs through state 1115 demonstration, 1915(c) Appendix K home- and community-based services, and Section 1135 public health emergency waivers. States can also streamline changes through Medicaid state plan amendments. These CMS checklists and templates are helpful tools for states preparing waiver applications.

A new report provides an update on the ACA’s impacts, and examine disparities that still exist under the legislation.

Brief describes how H.R. 3 would change current drug pricing, assess manufacturers’ likely responses, and examine challenges of using prices set in other countries.

Brief examines the kinds of health insurance unemployed workers have and how coverage patterns have shifted under the Affordable Care Act (ACA).

This study aims to assess the cost of Medicaid relative to private insurance in the health insurance landscape under the Affordable Care Act (ACA).

The Accountable Health Communities Model is an interactive website, based on emerging evidence that addressing health-related social needs through enhanced clinical-community linkages can improve health outcomes and reduce costs.

Toolkit that can be used to help prepare a state Medicaid plan amendment to request reimbursement for preventive services provided by health education specialists.

This excel table contains the most up to date state-level data available related to certain provisions of the Affordable Care Act. This table includes data on the uninsured, private market reforms, employer coverage, Medicaid, the individual market (including the Health Insurance Marketplace), and Medicare.

A publicly available source of data providing researchers, payers, regulators, and innovators with metrics quantifying the temporal and regional patterns of health care spending and utilization, particularly with regard to the diffusion and exnovation of medical interventions. Website allows the public to download complete datasets of selected variables spanning decades; newer data will be posted as they become available.

Resources to help publicize the C2C initiative, aimed at connecting individuals with health coverage and to primary care and the preventive services.

Raw data and overviews on the design, affordability, and cost-sharing features of plans offered in ACA health insurance marketplaces across all 50 states.

HCCI’s annual reports examine year-over-year and 5-year cumulative trends in health care spending for individuals with employer-sponsored insurance, segmented by health care service category.

This report presents statistics on health insurance coverage in the United States in 2014, and on changes in coverage between 2013 and 2014.

This report presents statistics on health insurance coverage in the United States based on information collected in the 2014, 2015, 2016, 2017, and 2018 Current Population Survey Annual Social and Economic Supplements (CPS ASEC) and the American Community Survey (ACS).

The US Census Bureau’s collection of health insurance statistical information.

Annual scorecard rates individual states on extending healthcare coverage, lowering out-of-pocket costs, reducing low-value care, and curbing excess prices. States were also rated on outcomes in: percent of population that is uninsured, percent of population that is forgoing needed care, delaying care or struggling with medical bills, rates of known low-value care services delivered by providers, and private payer prices relative to the national median.

A continually updated repository of statistics on Medicaid and CHIP enrollment and spending, and documents with key aspects of both programs.

A tool designed to help state Medicaid agencies design and launch accountable care organizations.

Tool designed to provide pricing within ambulatory surgical centers and hospital outpatient departments of various procedures. Look up by textword or by code.

The Commonwealth Fund conducts survey of health care consumers, health professionals, and health system leaders. Site allows users to explore our data, analyses, and methods.

Interactive data hub that identifies state and national trends and allows users to take a closer look at metrics such as children’s uninsured rates, Medicaid/CHIP participation rates, access to quality care, as well as policy options to improve enrollment and retention in Medicaid/CHIP.

This interactive tracks the public’s view of a national health plan, sometimes called Medicare-for-all, since 2016. By collecting data from various public surveys of adults in the U.S. conducted by KFF and others, we show how the public’s support for the idea of a national health plan has changed since the 2016 presidential primary. The interactive nature of this tool allows users to explore how views vary by party identification as well as by differences in question wording. While KFF has included Medicare-for-all in the question wording for the past year, other organizations do not and these polls find a more divided public.