Coverage


State Health Facts is a KFF project that provides free, up-to-date, and easy-to-use health data for all 50 states, the District of Columbia, and the United States. It offers data on specific types of health insurance coverage, including employer-sponsored, Medicaid, Medicare, as well as people who are uninsured by demographic characteristics, including age, race/ethnicity, work status, gender, and income. There are also data on health insurance status for a state's population overall and broken down by age, gender, and income.

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  • The ACA’s Basic Health Program Option: Federal Requirements and State Trade-Offs

    Report

    The Patient Protection and Affordable Care Act (ACA) gives states the option to implement a Basic Health Program (BHP) that covers low-income residents through state-contracting plans outside the health insurance marketplace, rather than qualified health plans (QHPs). In March 2014, the Centers for Medicare & Medicaid Services (CMS) issued final regulations on the requirements for a BHP and the methodology for calculating federal payments to states. States can choose to implement BHP beginning in 2015. This report summarizes these federal policies, including the requirements for BHP as well as the methodology for determining federal BHP payments. It then analyzes the key trade-offs facing states as they decide whether and, if so, how to implement BHP, with a particular focus on the impact of BHP on state budgets and the size, stability, and risk level of state marketplaces.

  • Medicare and Medicaid at 50 Years: Perspectives of Beneficiaries, Health Care Professionals and Institutions, and Policy Makers

    From Drew Altman

    In this article for the Journal of the American Medical Association (JAMA), Drew Altman and former U.S. Senate Majority Leader William Frist examine the roles the Medicaid and Medicare play in the health system today from the perspectives of the public and beneficiaries, providers, and policymakers, and discusses the challenges they face in the future. The article is accompanied by an audio interview with Altman and Frist, who is a member of the Foundation’s board of trustees.

  • Health and Access to Care and Coverage for Lesbian, Gay, Bisexual, and Transgender (LGBT) Individuals in the U.S.

    Issue Brief

    Lesbian, gay, bisexual, and transgender (LGBT) individuals often face challenges and barriers to accessing needed health services and, as a result, can experience worse health outcomes. These challenges can include stigma, discrimination, violence, and rejection by families and communities, as well as other barriers, such as inequality in the workplace and health insurance sectors, the provision of substandard care, and outright denial of care because of an individual’s sexual orientation or gender identity. This issue brief examines population characteristics of the LGBT community and the impacts of the Affordable Care Act (ACA), Supreme Court rulings and other policy changes related to same-sex marriage that can insurance coverage and access to health care services, and recent actions by the Trump Administration.

  • All Eyes on the Supreme Court: More than Birth Control at Stake

    Issue Brief

    On March 25th, the Supreme Court will hear two cases brought by for-profit corporations challenging the ACA’s contraceptive coverage rule on religious grounds. These two corporations are Hobby Lobby, a national chain of craft stores owned by a Christian family and Conestoga Wood Specialties, a cabinet manufacturer, owned by a Mennonite family. Beyond the impact on the ACA and contraceptive coverage, the Court’s decision may have implications for religious rights of employers and employees, as well as corporate and civil rights laws. This brief examines three fundamental questions raised by some of the 84 amicus briefs that have been submitted to the Court.

  • The ACA and People with HIV: An Update

    Issue Brief

    This report provides a second look at how the Affordable Care Act (ACA) is impacting people with HIV two years into these new coverage opportunities, based on focus groups conducted with HIV positive individuals from five states in early 2016, after the third round of open enrollment. Groups were conducted with HIV positive individuals who gained insurance coverage – through either the Marketplaces or Medicaid expansion- in California and New York and with those who remained uninsured, largely because they fell into the coverage gap, in Florida, Georgia, and Texas.

  • How are Seniors Choosing and Changing Health Insurance Plans?

    Report

    This report summarizes first-hand accounts of seniors’ Medicare private plan decision making strategies, based on focus groups conducted in four cities. Seniors found the initial plan selection process overwhelming due to the volume of information they received and their inability to organize it. Few used the government's online comparison tool, and those that did cite several shortcomings. Many relied on advice from sources they trust, including insurance agents, plan representatives, friends, family members, doctor's offices and pharmacists. After they enroll in a plan, many seniors did not revisit their initial decision or review plan options without the strong provocation of a substantial increase in cost, change in coverage, or shift in personal health care needs. Moreover, they feared that a change in plans may disrupt their care, or lead to an unforeseen increase in out-of-pocket costs, and require them to learn new rules and requirements. They are doubtful they would end up in a plan that is appreciatively different or better for them. Overall, seniors preferred to have numerous choices in plans but would like personalized help and advice from experts to ease the process.