Affordable Care Act

This post summarizes some of the key issues related to the U.S. District Court’s March 30 ruling in Braidwood Management v. Becerra, which imposes new limits on the government’s ability to enforce preventive service requirements nationwide.

In states that do not implement the Medicaid expansion under the Affordable Care Act (ACA), many adults will fall into a “coverage gap” of earning too much to qualify for Medicaid but not enough to qualify for Marketplace premium tax credits. Nationwide, 1.9 million poor uninsured adults are in this situation. This brief presents estimates of the number of people in non-expansion states who could have been reached by Medicaid but instead fall into the coverage gap and discusses the implications of them being left out of ACA coverage expansions.

With a divided Congress expected to weigh spending cuts during its debt ceiling and budget debates, the latest KFF Health Tracking Poll finds that the public has broad concerns about Medicare’s sustainability for the future but mostly views the debate about Medicare cuts as largely politics. About eight in 10…

Large majorities of the public hold favorable views of Medicare and Medicaid. While most people worry about Medicare’s sustainability for the future, they also view the debate in Washington about Medicare cuts as largely politics.

This analysis of claims data estimates that six in ten people with private health insurance – or about 100 million people – used at least one preventive service covered without any out-of-pocket costs through a provision of the Affordable Care Act (ACA) in a typical year prior to the COVID-19…

A new analysis of health insurers’ 2021 financial data shows that insurers continue to report much higher gross margins per enrollee in the Medicare Advantage market than in other health insurance markets. The analysis examines insurers’ financial data in the Medicare Advantage, Medicaid managed care, individual (non-group), and fully insured…

Using health insurer financial data for 2021, we find that Medicare Advantage insurers reported gross margins that were at least twice as high as those reported by insurers in the individual/non-group, fully-insured group/employer, and Medicaid managed care markets. The four markets report similar simple medical-loss-ratios.

This brief presents findings from the 2022 KFF Women’s Health Survey on women’s receipt of cancer screenings and other preventive services and differences between subgroups of women. We also present data on women’s and men’s awareness of federal requirements for private insurance coverage of preventive services.

This analysis of HealthCare.gov Marketplace insurers’ transparency data finds that 17% of in-network claims were denied in 2021, with denial rates varying widely across insurers. Consumers appealed less than two-tenths of 1% of denied in-network claims.