Private Insurance under Obama / ACA

Most Americans receive their health coverage through the private insurance market, usually through their jobs. However, many people buy insurance on their own in the individual market. Since coverage from private companies is the largest source of insurance for Americans, it is likely to be a central part of federal and state health reform efforts.

This section of our Web site keeps you up-to-date on what’s happening in the private health insurance arena.

The Latest

From Families USA:

Making the Most of Accountable Care Organizations (ACOs): What Advocates Need to Know provides an overview of ACOs; the promise they hold; and how they could change Medicare, Medicaid, and the health care landscape. It also identifies key challenges in their development and suggests how advocates can get involved in ways that benefit patients. (Updated February 2012)

Implementing the Patient Protection and Affordable Care Act: A 2012 State To-Do List for Exchanges, Private Coverage, and Medicaid gives state advocates an in-depth blueprint for action in 2012, outlining issues to start thinking about and tasks that deserve immediate attention. (February 2012)

2012 Federal Poverty Guidelines are now available from HHS, and Families USA has calculated the figures for various household sizes by percentage of the federal poverty level.

Regulations and Guidance for the Affordable Care Act: The Centers for Medicare and Medicaid Services (CMS), the Department of Health and Human Services (HHS), the Department of Labor (DOL), and the Internal Revenue Service (IRS) have issued interim final rules and requests for information on several provisions of the health reform law pertaining to private insurance. Families USA has submitted commments on many of these provisions. Click here for our Regulations and Guidance page.

From AARP and Avalere Health:

Health Law Guide allows you to enter your information and get a customized fact sheet with details about consumer protections and about new coverage options you may be eligible for under the Affordable Care Act. The guide will be updated as implementation of the law continues. (March 2012)

From the Alliance for Health Reform:

Trends in Retail Prices of Prescription Drugs Widely Used by Medicare Beneficiaries 2005 to 2009 compares the rate of change in prescription drug prices to the rate of inflation. It finds that the growth in prices for a set of commonly used drugs was almost double the rate of inflation. (March 2012)

Essential Health Benefits: Balancing Affordability and Adequacy answers the following questions: How do states select and design “benchmark” plans that are both comprehensive and affordable? How will states and HHS ensure that benefits are sufficiently standardized so that consumers and employers can choose plans based on differences in premiums and cost-sharing? And are there opportunities for using the essential health benefits to lower health spending? (February 2012)

From the California Pan-Ethnic Health Network, the UCLA Center for Health Policy Research, and the UC Berkeley Labor Center:

Achieving Equity by Building a Bridge from Eligible to Enrolled explains the importance of doing culturally and linguistically appropriate outreach and education to facilitate enrollment in health coverage. Without effective multilingual efforts in California, language barriers may mean that 110,000 fewer people with limited English proficiency enroll in coverage through the state’s exchange. (February 2012)

From the Center for Economic and Policy Research and Georgetown University:

Health-Insurance Coverage for Low-Wage Workers, 1979-2012 and Beyond discusses the steady decline in coverage for low-wage workers over the past three decades, but it also explains that the experience with health reform in Massachusetts suggests that the Affordable Care Act may reverse this trend. (February 2012)

From the Center for Health Care Strategies, the National Academy for State Health Policy, and the Robert Wood Johnson Foundation:

Implications of Health Reform for American Indian and Alaska Native Populations outlines provisions of the Affordable Care Act that uniquely affect these populations, including expanded coverage through Medicaid and the exchanges, outreach to tribal groups, and improved organization and financing of care. (February 2012)

From the Center on Budget and Policy Priorities:

Georgia’s Tax Breaks to Increase Use of Health Savings Accounts Did Not Expand Health Coverage: Plan Promoted by Gingrich Group Has Failed to Deliver explains how this approach, which was designed to reduce the number of uninsured Georgians by 500,000, has actually increased the number of uninsured people by 319,000. (February 2012)

From the Centers for Disease Control and Prevention (CDC):

Financial Burden of Medical Care: Early Release of Estimates from the National Health Interview Survey, January—June 2011 finds that, among many statistics, one in three people was in a family that experienced a financial burden because of medical bills. (March 2012)

From the Centers for Medicare and Medicaid Services (CMS):

Frequently Asked Questions on Essential Health Benefits Bulletin answers questions for advocates and policy makers who are working to define the Essential Health Benefits package in their state. Topics include funding of state-mandated benefits, selection of benchmark plans, and coverage of preventive health services. (February 2012)

From the Commonwealth Fund:

Implementing the Affordable Care Act: State Action on Early Market Reforms explains that 49 states and the District of Columbia have worked to implement certain consumer protections that took effect in 2010. It also suggests that, even if legislative action is difficult, states can still make progress with implementation by issuing sub-regulatory guidance and verifying insurers’ compliance with the law. (March 2012)

The Income Divide in Health Care: How the Affordable Care Act Will Help Restore Fairness to the U.S. Health System explains that the law will narrow the income divide in health coverage and access through expanded Medicaid eligibility, state insurance exchanges, premium tax credits, cost-sharing protections, and the individual mandate. (February 2012)

From the Department of Health and Human Services (HHS):

Under the Affordable Care Act, 105 Million Americans No Longer Face Lifetime Limits on Health Benefitsbreaks down the number of Americans who are enjoying improved coverage without lifetime limits by age group, state, and race or ethnicity. (March 2012)

Fifty-Four Million Additional Americans Are Receiving Preventive Services Coverage without Cost-Sharing under the Affordable Care Act breaks down the number of Americans who are receiving preventive services with no cost-sharing by age group, state, and race or ethnicity. (February 2012)

From Health Affairs:

Employers and the Exchanges under the Small Business Health Options Program: Examining the Potential and the Pitfalls introduces a collection of articles in the February issue of “Health Affairs” that discuss the need for small business exchanges and how they will function. It also examines the difficulties that exchanges will face and the opportunities they will offer to states, employers, and individuals. (February 2012)

From Health Affairs and the Robert Wood Johnson Foundation:

Small Business Insurance Exchanges examines issues that states have to address in designing Small Business Health Option Program (SHOP) exchanges and the challenges advocates and policy makers? are likely to face. Although exchanges for individuals and small businesses will have similar functions, they will have unique attributes reflecting the populations they serve. (February 2012)

From the Kaiser Family Foundation:

Policy and Political Implications of the Supreme Court Case on the Affordable Care Act is a webcast that includes a release of new polling data on the public’s view about the case and the health care law. It also considers the case’s potential implications for the future of the law and for federal and state health policy. (March 2012)

Mapping the Effects of the ACA’s Health Insurance Coverage Expansions allows you to enter a zip code and get an estimate of the share of the population in that region that will benefit from the Affordable Care Act through either Medicaid or tax credits for private insurance in the exchanges. (February 2012)

From the National Health Law Program:

Top Ways Health Reform Helps provides the top five ways the Affordable Care Act helps the following groups: Medicaid beneficiaries, older adults and people with disabilities, women, and children and young adults. It also explains how the health care law addresses disparities and helps people get coverage. The lists are divided into provisions that are already in effect and those that are coming soon. (March 2012)

From the National Women’s Law Center:

Turning to Fairness: Insurance Discrimination against Women Today and the Affordable Care Act discusses the practice of gender rating, in which insurance companies charge women different premiums than men. Gender rating costs women about $1 billion a year, but the Affordable Care Act will outlaw this practice in 2014. (March 2012)

From the Robert Wood Johnson Foundation and the Urban Institute:

The Individual Mandate in Perspective estimates the number of Americans who would be subject to this provision in the Affordable Care Act, identifies their insurance status without the law, and simulates their eligibility for Medicaid or premium tax credits. It finds that 94 percent of people would not be required to newly purchase coverage or pay a fine. (March 2012)

ACA Implementation in Oregon—Monitoring and Tracking is the first of 10 state reports that analyze the effects of the Affordable Care Act on coverage, health expenditures, affordability, access, and premiums. It also assesses Oregon’s progress with implementation of the law. The remaining nine reports will examine the following states: AL, CO, MD, MI, MN, NM, NY, RI, and VA. (February 2012)