Potential Impact of California v. Texas Decision on Key Provisions of the Affordable Care Act

Appendix Tables

Notes:

Medicaid Expansion Enrollment includes the total number of individuals who are enrolled in the ACA expansion group. This total includes 12 million individuals who are newly-eligible under the ACA pathways. State decisions about adopting the Medicaid expansion are as of August 17, 2020. More information is available at KFF’s Medicaid Expansion Tracker.

Marketplace Enrollment includes the number of individuals who had an active marketplace policy as of February 2020, and who paid their premium (thus effecutating their coverage) as of March 15, 2020.

Consumers with household incomes 100-400% of the federal poverty level may qualify for an Advance Premium Tax Credit (APTC), which helps make their coverage more affordable throughout the year by lowering their share of monthly premium costs.

CSRs are available to people who have incomes 100-250% of the federal poverty level and who enroll in a silver plan through the Marketplace.

*Coverage under Medicaid expansion became effective January 1, 2020 in Utah. Three states (Missouri, Nebraska and Oklahoma) have adopted Medicaid expansion but not yet implemented it. More details available at KFF’s Medicaid Expansion Tracker.

Sources:

Medicaid Expansion Enrollment: Kaiser Family Foundation analysis of Medicaid enrollment data collected from the Centers for Medicare and Medicaid Services (CMS) Medicaid Budget and Expenditure System (MBES).

Marketplace Enrollment and Financial Assistance: Early 2020 Effectuated Enrollment Snapshot, Centers for Medicaid and Medicare Services (CMS), July 23, 2020.

Notes:

States totals may not sum to national total due to rounding.

Employer Sponsored Insurance Enrollment includes those covered through a current or former employer or union, either as a policyholder or as a dependent.

Marketplace Enrollment includes the number of individuals who had an active marketplace policy as of February 2020, and who paid their premium (thus effecutating their coverage) as of March 15, 2020.

Medicaid Expansion Enrollment includes the total number of individuals who are enrolled in the ACA expansion group. This total includes 12 million individuals who are newly-eligible under the ACA pathways. State decisions about adopting the Medicaid expansion are as of August 17, 2020. More information is available at KFF’s Medicaid Expansion Tracker.

Cells labelled ‘Insufficient Data’ in the rebates column indicate that insurers representing more than 10% of state enrollment have not filed MLR data.

*Coverage under Medicaid expansion became effective January 1, 2020 in Utah. Three states (Missouri, Nebraska and Oklahoma) have adopted Medicaid expansion but not yet implemented it. More details available at KFF’s Medicaid Expansion Tracker.

Sources:

Prevalence of Pre-Existing Conditions: Kaiser Family Foundation analysis of data from National Health Interview Survey and the Behavioral Risk Factor Surveillance System.

Employer Sponsored Insurance Enrollment: Kaiser Family Foundation estimates based on the Census Bureau’s American Community Survey, 2018.

Marketplace Enrollment: Early 2020 Effectuated Enrollment Snapshot, Centers for Medicaid and Medicare Services (CMS), July 23, 2020.

Medicaid Expansion Enrollment: Kaiser Family Foundation analysis of Medicaid enrollment data collected from the Centers for Medicare and Medicaid Services (CMS) Medicaid Budget and Expenditure System (MBES).

MLR: Kaiser Family Foundation analysis of rebate submissions by insurers to CMS.

Notes:

Medicaid Expansion Enrollment includes the total number of individuals who are enrolled in the ACA expansion group. This total includes 12 million individuals who are newly-eligible under the ACA pathways. State decisions about adopting the Medicaid expansion are as of August 17, 2020. More information is available at KFF’s Medicaid Expansion Tracker.

NR indicates state did not report data. Included in 1115 indicates that state was unable to report state plan services separately from Section 1115 waiver services. Blank cell indicates state does not elect option.

*Coverage under Medicaid expansion became effective January 1, 2020 in Utah. Three states (Missouri, Nebraska and Oklahoma) have adopted Medicaid expansion but not yet implemented it. More details available at KFF’s Medicaid Expansion Tracker.

**Data is from 2016.

Sources:

Medicaid Expansion Enrollment: Kaiser Family Foundation analysis of Medicaid enrollment data collected from the Centers for Medicare and Medicaid Services (CMS) Medicaid Budget and Expenditure System (MBES).

HCBS Enrollment: KFF Medicaid HCBS Program Surveys, FY 2018.

Notes:

U.S. totals exclude territories.

Sources:

Medicare Advantage Enrollment: CMS Enrollment Dashboard Data File 08-19-2020, “Hospital and Med Monthly Counts”, data for March 2020.

Part D Coverage Gap Spending: KFF analysis of 2018 Medicare prescription drug event claims for a 20 percent sample of Medicare beneficiaries from the CMS Chronic Conditions Data Warehouse.
ACO Assigned Beneficiaries: KFF analysis of Medicare Shared Savings Program data from CMS, 2018.

Part B Income Related Premiums: CMS Program Statistics, Centers for Medicare & Medicaid Services, Office of Enterprise Data and Analytics, Chronic Conditions Data Warehouse, 2018.

Issue Brief

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