President Donald Trump and Republicans in Congress pursued several major efforts to repeal and replace the Affordable Care Act (ACA) but were unable to get a bill through the U.S. Senate in 2017. In 2018, Congress did pass a tax bill that eliminated the ACA’s tax penalty for not obtaining health coverage beginning in 2019.

In December 2019, a federal appeals court panel ruled that the law’s individual mandate is unconstitutional since Congress has set the mandate tax penalty to zero and sent the case back to a lower court to determine how much of the rest of the ACA should be invalidated. The case was first brought by a number of Republican state attorneys general, and the Trump administration now argues that nearly all of the ACA should be overturned. The U.S. Supreme Court has now agreed to review the case.

For information about ACA Marketplace Open Enrollment, including fact sheets and 300+ FAQs, visit our collection of resources on Understanding Health Insurance.

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Surprise Medical Bills

This brief explores the problem of “surprise medical bills” — charges arising when an insured individual inadvertently receives care from an out-of-network provider. It reviews studies on the extent of the issue, including Kaiser Family Foundation polling data, and outlines state and federal policy responses, including rules and proposed rules for Medicare and plans in Affordable Care Act marketplaces.

How has the ACA Medicaid Expansion Affected Providers Serving the Homeless Population: Analysis of Coverage, Revenues, and Costs

To further understand how the first full year of Medicaid expansion has affected patients who are homeless and the providers who care for them, this analysis uses data from the Uniform Data System (UDS) for health centers to examine changes in insurance coverage, revenues and costs among Health Care for the Homeless (HCH) projects serving the homeless population.

Patient Cost-Sharing in Marketplace Plans, 2016

This brief and accompanying slides examine cost sharing – deductibles, copayments and coinsurance – in 2016 insurance plans sold on the Affordable Care Act’s (ACA) federally-facilitated marketplaces. The analysis looks at out-of-pocket limits, as well as cost sharing for hospital stays, physician visits, emergency room visits, and prescription drugs, for plans across the metal levels (platinum, gold, silver and bronze).

Medicare Advantage Hospital Networks: How Much Do They Vary?

This report takes an in-depth look at Medicare Advantage plans’ hospital networks. The analysis draws upon data from 409 Medicare Advantage plans serving beneficiaries in 20 diverse counties that together accounted for about one in seven (14%) Medicare Advantage enrollees nationwide in 2015. The report examines the size and composition of plans’ hospital networks, the variation across counties, the inclusion of Academic Medical Centers and NCI-Designated Cancer Centers, and the relationship between network size and other plan features, including premiums, quality star ratings, per capita Medicare spending, parent organization, and plan tax status.

Two Substantive Sides to Debate Over Obamacare’s ‘Cadillac Tax’

In this column for The Wall Street Journal’s Think Tank, Drew Altman says debate about whether to keep or repeal the Cadillac tax is more than a debate between sound policy and good politics, there are strong substantive arguments on both sides.

Analysis of UnitedHealth Group’s Premiums and Participation in ACA Marketplaces

This analysis looks at how a potential withdrawal by UnitedHealth Group from the Affordable Care Act (ACA) marketplaces in 2017 could impact insurer competition and premiums, finding a significant impact in some markets, though it would have a minimal effect on the average benchmark premium nationwide, The impacts of a UnitedHealth withdrawal would vary considerably by state and market area, with a more pronounced effect in rural areas. Since UnitedHealth often is not one of the lower cost plans, the effect nationally on premiums of an exit by the insurer would be modest.

JAMA Forum: Reports of Obamacare’s Demise Are Greatly Exaggerated

In this post for The JAMA Forum, the Kaiser Family Foundation’s Larry Levitt discusses UnitedHealth’s exit from Affordable Care Act marketplaces, the possibility of bigger premium increases in 2017, and why these challenges are unlikely to significantly affect long-term sustainability of the market and the law.