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  • No Easy Choices: 5 Options to Respond to Per Capita Caps

    Issue Brief

    Under a per capita cap, per enrollee spending would be capped, but the total amount of federal dollars to states could vary with enrollment changes and states would not be able to impose enrollment caps. Faced with restrictions in federal financing, states would have to make hard choices. This brief outlines the key measures states could use to manage their budgets and the associated challenges under a per capita cap: raise taxes or make other…

  • Analysis: Before ACA Benefits Rules, Care for Maternity, Mental Health, Substance Abuse Most Often Uncovered by Non-Group Health Plans

    News Release

    Three in four health plans in the non-group insurance market did not cover delivery and inpatient maternity care in 2013, before the Affordable Care Act (ACA) essential health benefits requirement took effect, finds a new Kaiser Family Foundation analysis. Other major benefits most often left uncovered before the ACA include substance abuse disorder services (inpatient and outpatient services each not covered by 45% of 2013 non-group plans) and mental/behavioral health services (inpatient and outpatient services…

  • Would States Eliminate Key Benefits if AHCA Waivers are Enacted?

    Issue Brief

    This analysis offers a window into how insurers could respond if the Affordable Care Act's essential health benefits requirement is rolled back, a change being considered by Congressional leaders and allowed through state waivers by the House-passed American Health Care Act as a potential way for lowering premiums.

  • New England Journal of Medicine: Undermining Genetic Privacy? Employee Wellness Programs and the Law

    Perspective

    In this May 2017 post, Karen Pollitz and co-author Kathy L. Hudson discuss how H.R. 1313, the Preserving Employee Wellness Programs Act, could substantially change current legal protections for the collection and treatment of genetic information and other personal health information under workplace wellness programs. The post is now available from the New England Journal of Medicine.

  • Brief Examines Per Enrollee Medicaid Spending for Seniors and People with Disabilities, Which Varies Greatly By State

    News Release

    Medicaid coverage of acute and long-term care for more than 6 million low-income seniors and 10 million nonelderly people with disabilities accounts for nearly two-thirds of overall Medicaid spending, although such enrollees represent less than a quarter of people on Medicaid.  Much of Medicaid’s spending on seniors and people with disabilities also depends on state decisions about whom to cover and which services to pay for, which is a big reason why Medicaid spending per…

  • State Variation in Medicaid Per Enrollee Spending for Seniors and People with Disabilities

    Issue Brief

    This issue brief explains the variation in Medicaid spending per enrollee for seniors, nonelderly adults with disabilities, and children with disabilities compared to other populations as well as the variation in per enrollee spending for these populations among states. It also provides a snapshot of state choices about optional eligibility pathways and services important to many seniors and people with disabilities.

  • Data Note: 5 Misconceptions Surrounding the ACA

    Feature

    On the seventh anniversary of the passing of the Affordable Care Act, this Data Note highlights five of the most common misconceptions surrounding the 2010 health care law.

  • Current Flexibility in Medicaid: An Overview of Federal Standards and State Options

    Issue Brief

    The Trump Administration and new Congress have indicated that they will seek to cap Medicaid financing through a block grant or per capita cap, reduce federal funding for the program, and offer states increased flexibility to manage their programs within this more limited financing structure. The size of the federal reductions as well as which federal program standards would remain in place and what increased flexibility might be provided to states under such proposals would…