Skip to main content
U.S. Department of Health & Human Services aspe.hhs.gov Office of the Assistant Secretary for Planning and Evaluation

The Affordable Care Act
Research Briefs

This project is available on the Internet at:
http://aspe.hhs.gov/health/reports/2012/ACA-Research/index.cfm

Background

The Affordable Care Act was signed into law in March of 2010.  Millions of Americans have already benefitted from many of the law’s provisions including coverage for preventive health services, ban on lifetime limits, and insurance coverage for young adults.  The expansion of Medicaid coverage and launch of Affordable Insurance Exchanges will help millions more in 2014.  ASPE created this series of research and issue briefs to analyze the impact of the Affordable Care Act.

Publications

Current publications:

2014

2013
  • Environmental Scan to Identify the Major Research Questions and Metrics for Monitoring the Effects of the Affordable Care Act on Safety Net Hospitals (PDF-34 Pages), ASPE Report, December, 2013
    The purposes of this environmental scan are to develop a conceptual framework, review and discuss the major research questions and hypotheses, and identify the “ideal” set of metrics for understanding the effects of the Affordable Care Act (ACA) on safety net hospitals. This report is part of a larger effort by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) to develop a strategy for monitoring safety net hospitals during and after implementation of the ACA. ASPE has requested The Center for Studying Health System Change to conduct this environmental scan (the focus of this report) and to prepare separate reports that assess the availability of data sources and metrics for a safety net monitoring effort, as well as a plan for conducting case studies of safety net hospitals.

  • CHIPRA Mandated Evaluation of Express Lane Eligibility: Final Findings, (PDF-200 Pages), ASPE Report, December, 2013
    The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) authorized states to use Express Lane Eligibility (ELE) to determine eligibility for Medicaid and/or the Children’s Health Insurance Program (CHIP). ELE allows a state’s Medicaid and/or CHIP program to rely on another agency’s eligibility findings to qualify children for public health coverage, despite the other programs’ different methods of assessing income or otherwise determining eligibility. CHIPRA also authorized a comprehensive, independent evaluation of ELE and required a report to Congress. This final report evaluates 13 ELE processes implemented in 8 states, as well as other (non-ELE) processes implemented in 3 states. It describes the impact of ELE on total enrollment; examines enrollment and renewal trends; compares the utilization of services by ELE enrollees vs. children enrolled through traditional processes; and reports on key cross-state lessons learned from ELE implementation and operations.

  • Health Insurance Marketplace: December Enrollment Report (PDF-15 Pages), ASPE Issue Brief, December, 2013
    This issue brief highlights national and state-level enrollment-related information for the first two months of the Health Insurance Marketplace initial open enrollment period (10-1-13 to 11-30-13).

  • Marketplace Open Enrollment Process by the Numbers Second Reporting Period: October 1st through November 30th, ASPE Issue Brief, December, 2013
    This infographic summarizes key enrollment-related information for the first two months of the Health Insurance Marketplace initial open enrollment period, as cited in “Health Insurance Marketplace: December Enrollment Report,” ASPE Issue Brief, Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation (ASPE), December 11, 2013, which can be accessed at http://aspe.hhs.gov/health/reports/2013/MarketPlaceEnrollment/Dec2013/ib_2013dec_enrollment.cfm.

  • Eligible Uninsured African Americans: 6 in 10 Could Receive Health Insurance Marketplace Tax Credits, Medicaid or CHIP, ASPE Issue Brief, December, 2013  (PDF Version, 11 pages)
    Approximately 6 in 10 eligible uninsured African Americans in the United States could obtain Health Insurance Marketplace tax credits, Medicaid, or the Children’s Health Insurance Program (CHIP). This ASPE Issue Brief discusses the demographics of the eligible uninsured African American population and new health insurance coverage options available to them under the Affordable Care Act. There are 6.8 million eligible uninsured African Americans nationwide, according to data from the 2011 American Community Survey Public Use Microdata Sample, and one-sixth of all eligible uninsured in the United States are African American. Under the Affordable Care Act, 2.2 million uninsured African Americans may be eligible for Marketplace tax credits and 2 million for Medicaid or CHIP coverage.

  • Health Insurance Marketplace: November Enrollment Report (PDF-28 Pages), ASPE Issue Brief, November, 2013
    This issue brief highlights national and state-level enrollment-related information for the first month of the Health Insurance Marketplace initial open enrollment period that began October 1, 2013.

  • Marketplace Open Enrollment Process by the Numbers First Reporting Period: October 1st through November 2nd, ASPE Issue Brief, November, 2013
    This infographic summarizes key enrollment-related information for the first month of the Health Insurance Marketplace initial open enrollment period, as cited in “Health Insurance Marketplace: November Enrollment Report,” ASPE Issue Brief, Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation (ASPE), November 13, 2013, which can be accessed at http://aspe.hhs.gov/health/reports/2013/MarketPlaceEnrollment/rpt_enrollment.pdf.

  • Nearly 5 in 10 Uninsured Single Young Adults Eligible for the Health Insurance Marketplace Could Pay $50 or Less Per month for Coverage in 2014, ASPE Research Brief, October, 2013  (PDF Version, 8 pages)
    Young adults are the age group most likely to be without health insurance coverage and, therefore, are a key target for outreach and enrollment activities. Nearly 5 in 10 (46 percent, or 1.3 million) uninsured young adults in single-person households who are eligible for the Health Insurance Marketplace may be able to purchase a bronze plan for $50 per month or less after tax credits, based on analysis of data in 34 states. In these states, a total 1.9 million young adults, representing nearly 7 in 10 (66 percent) of the Marketplace-eligible uninsured ages 18 to 34, may be able to pay $100 or less for coverage in 2014.

  • Health Insurance Marketplace Premiums for 2014 , ASPE Issue Brief, September, 2013  (PDF Version, 15 pages)
    This report summarizes the health plan choices and premiums that will be available in the Health Insurance Marketplace. It contains new information, current as of September 18, 2013, on qualified health plans in the 36 states in which the Department of Health and Human Services (HHS) will support or fully run the Health Insurance Marketplace in 2014. Plan data is in final stages but is still under review as of September 18 and may be revised in HHS systems before being displayed for consumers, so this information is subject to change. This analysis also includes similar information that is publicly available from 11 states and the District of Columbia that are implementing their own Marketplace. This report focuses on the plans with the lowest premiums in each state, as consumers are expected to shop for low-cost plans. Nearly all consumers (about 95%) will have a choice of 2 or more health insurance issuers (often many more) and nearly all consumers (about 95%) live in states with average premiums below earlier estimates.

  • New Census Estimates Show 3 Million more Americans had Health Insurance Coverage in 2012, ASPE Issue Brief, September, 2013  (PDF Version, 7 pages)
    Estimates from Current Population Survey Annual Social and Economic Supplement (CPS-ASEC) data for calendar year 2012, released on September 17, show that 3 million more Americans had health insurance coverage than in 2011. This ASPE Issue Brief includes estimates of the uninsured by age, race and ethnicity, employment status, and household income. It also traces trends in sources of health insurance coverage from 1999 to 2012 and discusses the implications of the findings in the context of the expansion of affordable coverage options under the Affordable Care Act.

  • Fifty-Six Percent of The Uninsured Could Pay $100 or Less per Month for Coverage in 2014, ASPE Issue Brief, September, 2013  (PDF Version, 6 pages)
    Under the Affordable Care Act, advanced premium tax credits will be available to help individuals and families afford insurance coverage through the Health Insurance Marketplace, and states will be able to expand Medicaid eligibility for low-income adults. Of the estimated 18.6 million uninsured Americans eligible for Marketplace tax credits, 10.8 million Americans, nearly half (49 percent) of the uninsured eligible for the Marketplace, may be able to pay $100 or less per person for coverage in 2014. In addition, 12.4 million uninsured Americans will be eligible for Medicaid or CHIP and pay no premium or only a nominal premium in 2014 to date. Nationwide, 23.2 million or 56% of the 41.3 million eligible uninsured may qualify for Medicaid, CHIP, or tax credits to purchase coverage for $100 or less.

  • U.S. Department of Health and Human Services: Rate Review Annual Report September 2013, ASPE Report, September, 2013  (PDF Version, 16 pages)
    The Affordable Care Act continues to bring transparency and scrutiny to health insurance rate increases by holding insurance companies accountable for rate increases of 10 percent or more and providing states with rate review grants to enhance state efforts to review proposed increases in health insurance rates. This report finds that these programs saved consumers approximately $1.2 billion in 2012 on their premiums when compared to the amount initially requested by insurers.

  • The Affordable Care Act and Adolescents , Issue Brief, August 26, 2013  (PDF Version, 8 pages)
    This ASPE Issue Brief describes provisions in the Affordable Care Act that impact adolescents such as the prohibition on pre-existing conditions denials and expansion of Medicaid coverage. The brief also includes data on the eligible uninsured adolescent population ages 10-19. The brief was developed collaboratively between ASPE and the Office of Adolescent Health.

  • Market Competition Works: Proposed Silver Premiums in the 2014 Individual Market Are Substantially Lower than Expected , Issue Brief, Updated: August 9, 2013  (PDF Version, 6 pages)
    A goal of the Affordable Care Act is to increase competition and transparency in the markets for individual and small group insurance, leading to higher quality, more affordable products. As of August 2013, sixteen states have released information on proposed or final premiums for the Marketplaces in 2014. This research brief analyzes those proposed and final rates and compares them to those estimated by the Congressional Budget Office (CBO). Overall, silver premiums in the 2014 individual market are substantially lower than expected.

  • Market Competition Works: Proposed Silver Premiums in the 2014 Individual and Small Group Markets Are Nearly 20% Lower than Expected, Research Brief, July, 2013  (PDF Version, 12 pages)
    A goal of the Affordable Care Act is to increase competition and transparency in the markets for individual and small group insurance, leading to higher quality, more affordable products. Information on proposed premiums in the individual and small group markets has recently been made available by selected states, and it is now possible to move from theoretical arguments to data-driven analysis.

  • Seventy-one million additional Americans are receiving preventive services coverage without cost-sharing under the Affordable Care Act, Issue Brief, March, 2013  (PDF Version, 4 pages)
    The Affordable Care Act ensures that most insurance plans (so-called ‘non-grandfathered’ plans) provide coverage for and eliminate cost-sharing on certain recommended preventive health services, beginning on or after September 23, 2010. This includes services such as colonoscopy screening for colon cancer, Pap smears and mammograms for women, well-child visits, flu shots for all children and adults, and many more.

  • Modified Adjusted Gross Income (MAGI) Income Conversion Methodologies, Issue Brief, March, 2013  (PDF Version, 49 pages)
    Section 2002 of the Affordable Care Act makes the tax concept of Modified Adjusted Gross Income (MAGI) the basis for determining Medicaid and CHIP eligibility for nondisabled, nonelderly individuals, effective January 1, 2014.

  • Health Insurance Premium Increases in the Individual Market Since the Passage of the Affordable Care Act, Issue Brief, February, 2013  (PDF Version, 8 pages)
    The Affordable Care Act brings an unprecedented level of scrutiny and transparency to health insurance rate increases. Evidence suggests that the Affordable Care Act contributed to a reduction in the rate of increase in premiums in the individual market since 2010. The proportion of rate filings in which the requested increase was 10 percent or more declined from 75 percent in 2010 to 34 percent in 2012, consistent with the increased scrutiny that such requests now receive.

  • Affordable Care Act Expands Mental Health and Substance Use Disorder Benefits and Federal Parity Protections for 62 Million Americans, Issue Brief, February, 2013  (PDF Version, 4 pages)
    The Affordable Care Act builds on the Mental Health Parity and Addiction Equity Act of 2008 to extend federal parity protections to 62 million Americans. The parity law aims to ensure that when coverage for mental health and substance use conditions is provided, it is generally comparable to coverage for medical and surgical care.

  • Growth in Medicare Spending per Beneficiary Continues to Hit Historic Lows,, Issue Brief, February, 2013  (PDF Version, 6 pages)
    Medicare spending per beneficiary grew just 0.4% per capita in fiscal year 2012, continuing a pattern of very low growth in 2010 and 2011. Together with historically low projections of per capita growth from both the Congressional Budget Office and the Centers for Medicare and Medicaid Services (CMS) Office of the Actuary, these statistics show that the Affordable Care Act has helped to set Medicare on a more sustainable path to keep its commitment to seniors and persons with disabilities today and well into the future.

2012
  • Estimated Savings of $5,000 to Each Medicare Beneficiary from Enactment Through 2022 Under the Affordable Care Act, Issue Brief, September, 2012  (PDF Version, 5 pages)
    This report provides estimates of Medicare Parts A, B, and D savings from the Affordable Care Act to seniors and people living with disabilities enrolled in traditional Medicare. The Affordable Care Act will favorably affect beneficiary expenditures in four ways: lowering part B premiums growth, lowering beneficiary copayments and coinsurance growth under Part A and B, closing the Medicare prescription drug coverage gap, and providing many preventive services to seniors at no additional cost.

  • Overview of the Uninsured in the United States: A Summary of the 2012 Current Population Survey Report, Issue Brief, September 2012  (PDF Version, 6 pages)
    The Census Bureau released data on health insurance coverage and the uninsured for 2011 on September 12, 2012. Although there are four major government surveys that produce estimates of health insurance coverage, the Current Population Survey (CPS) is the most widely cited and receives national media attention.

  • 47 Million Women Will Have Guaranteed Access To Women's Preventive Services With Zero Cost-Sharing Under The Affordable Care Act, Issue Brief, July 2012  (PDF Version, 5 pages)
    The Affordable Care Act requires many insurance plans to provide coverage for and eliminate cost-sharing on certain recommended preventive health services. In August 2011, the Department of Health and Human Services published guidelines on women's preventive services that require non-grandfathered health insurance plans to cover certain recommended preventive services specifically for women without charging a co-pay, co-insurance or a deductible beginning in plan years starting on or after August 1, 2012.

  • Number of Young Adults Gaining Insurance Due to the Affordable Care Act Now Tops 3 Million, Issue Brief, June 2012.  (PDF version, 2 pages)
    New survey findings released today by the National Center for Health Statistics show that the extension of dependent health coverage up to age 26 continues to lead to greater rates of insurance coverage among young adults. This policy is one part of the Affordable Care Act, and it took effect for insurance plan renewals beginning on September 23, 2010.

  • The Affordable Care Act and Asian Americans and Pacific Islanders, Research Brief, May 2012.  (PDF version, 8 pages)
    New estimates from RAND suggest that 2.0 million out of the 2.5 million Asian Americans who would otherwise be uninsured will gain or be eligible for coverage in 2016 through the Affordable Care Act. Asian Americans and Pacific Islanders are already benefitting from the expansion of preventive services with no cost-sharing in both private health insurance and Medicare.

  • The Affordable Care Act and African Americans, Research Brief, April 2012.  (PDF version, 6 pages)
    New estimates from RAND suggest that 3.8 million African Americans who would otherwise be uninsured will gain coverage by 2016 through the Affordable Care Act.  African Americans will gain improved access to preventive health services and community health centers and improved maintenance of chronic diseases.

  • The Affordable Care Act and Latinos, Research Brief, April 2012.  (PDF version, 7 pages).
    En español  (Versión en PDF, 7 Páginas)
    An estimated 30.7% of Latinos are uninsured, compared with 16.3% of all Americans.  The Affordable Care Act includes several provisions to significantly improve the health outcomes of Latinos.

  • Uninsured Young Adults and the Affordable Care Act, Research Brief, March 2012.  (PDF version, 2 pages)
    The Affordable Care Act is beneficial for young adults aged 19-25 who previously were more than twice as likely as other adults to lose private health insurance coverage.  The law helps to provide stable health insurance.

  • The Affordable Care Act and Women, Research Brief, March 2012.  (PDF version, 7 pages)
    The Affordable Care Act ensures that women will not pay more for the same insurance coverage as men and will provide insurance to an estimated 13 million more women by 2016.  Women also gain improved access to maternity coverage, preventative health services, and Medicaid coverage.

  • The Affordable Care Act and Participation Rates in Medicaid, Issue Brief, March 2012.  (PDF version, 7 pages)
    The Affordable Care Act extends Medicaid eligibility to all US citizens and other qualified residents with family incomes at or below 133% of the federal poverty level.  This brief provides estimates of projected Medicaid enrollment rates under the ACA.

  • Expanded Insurance Coverage For Young Adults of All Races and Ethnicities, Issue Brief, March 2012.  (PDF version, 2 pages)
    The Affordable Care Act allows young adults to remain on their parents’ insurance plans until the age of 26.  A JAMA research study finds that an additional 2.9% of all young adults gained access to health care, with larger increases for minority groups.

  • 105 Million Americans No Longer Face Lifetime Limits on Health Benefits, Issue Brief, March 2012.  (PDF version, 6 pages)
    The Affordable Care Act prohibits health plans from imposing a lifetime dollar limit on most benefits received by Americans in any health plan renewing on or after September 23, 2010.  Lifetime limits had previously affected 105 million Americans.

  • ACA and Preventive Services Coverage Without Cost-Sharing, Issue Brief, February 2012.  (PDF version, 4 pages)
    The Affordable Care Act requires insurance companies to provide coverage and eliminate cost-sharing for preventive services such as colonoscopies, Pap smears, and flu shots.  More than 54 million American men, women, and children of all ages may now receive such services without cost sharing.

  • The Cost of Covering Contraceptives through Health Insurance, Issue Brief, February 2012.
    This brief reviews existing research on providing contraceptives through public and private health insurance.  It finds that providing contraception through public programs is actually cost-saving.

  • Medicare Beneficiary Savings and the Affordable Care Act, Issue Brief, February 2012.  (PDF Version, 4 pages)
    The Affordable Care Act strengthens Medicare coverage for seniors while containing Medicare spending growth.  This brief details how Medicare beneficiaries will save.

2011
  • At Risk:  Pre-Existing Conditions Could Affect 1 in 2 Americans, 129 Million People Could Be Denied Affordable Coverage Without Health Reform, November 2011.  (PDF version, 10 pages)
    A new analysis from the Department of Health and Human Services predicts that 50-129 million non-elderly Americans have a pre-existing condition.  The Affordable Care Act would prohibit insurance companies from dropping coverage for Americans with pre-existing conditions.

  • The Affordable Care Act and Children, Issue Brief, December 2011.  (PDF version, 7 pages)
    Recent results from the National Center for Health Statistics show that 1.2 million additional children have access to health insurance after the reauthorization of the Children’s Health Insurance Program (CHIP).  The percentage of insured children has increased for three years since CHIP’s reauthorization in February 2009.

  • Comparing Health Benefits Across Markets, Research Brief, December 2011.  (PDF version, 7 pages)
    This brief examines benefit coverage in employer-sponsored insurance for the small group market and State and Federal employee plans.  Overall, it appears that small group options and State and Federal employee plans cover similar services.

  • Essential Health Benefits:  Individual Market Coverage, Issue Brief, December 2011.  (PDF version, 2 pages)
    The Affordable Care Act identifies ten categories of services and items as essential health benefits (EHBs) that will include services not frequently covered in the individual market now.  For example, more than 8.7 million Americans will gain maternity coverage when EHBs are effective in 2014.

  • Variation and Trends in Medigap Premiums, December 2011.  (PDF version, 38 pages)
    This brief shows that Medigap premiums have increased on average 3.8% a year, compared to a 5.4% average annual increase for total Medicare spending per beneficiary (excluding Part D spending) over the 2001 to 2010 period.  Medigap premiums vary by plan type and vary significantly among states.

  • 2.5 Million Young Adults Gain Health Insurance Due to the Affordable Care Act, Issue Brief, December 2011.  (PDF version, 2 pages)
    The extension of health insurance dependent coverage until the age of 26 has increased the number of insured young adults by a larger than anticipated 2.5 million Americans.  Allowing young adults between the ages of 19-25 the option to remain on their parents’ insurance was enacted as part of the Affordable Care Act.

  • Actuarial Value and Employer-Sponsored Insurance, Research Brief, November 2011.  (PDF version, 12 pages)
    This brief explores the distribution of plan actuarial values for individuals enrolled in employer-sponsored insurance.  It finds that an overwhelming percentage of employer-sponsored insurance plans have an actuarial value above 60%.

  • One Million Young Adults Gain Health Insurance in 2011 Because of the Affordable Care Act, Issue Brief, September 2011.  (PDF version, 3 pages)
    The National Center for Health Statistics finds that 1 million young adults gained insurance coverage through the Affordable Care Act’s policy of allowing young adults to remain on their parents’ insurance.  These estimates are consistent with other data sources such as the Current Population Survey.

  • Overview of the Uninsured in the United States, Issue Brief, September 2011.  (PDF version, 5 pages)
    The Current Population Survey finds that 49.9 million Americans were without health insurance coverage in 2010.  This brief provides overview statistics on insurance for children, young adults, and minorities.

  • The Value of Health Insurance:  Few of the Uninsured Have Adequate Resources to Pay Potential Hospital Bills, Research Brief, May 2011.  (PDF version, 10 pages)
    When the uninsured cannot afford the care they receive, the cost must be absorbed by other payers.  This brief estimates that uninsured families can only afford to pay in full 12% of hospitalizations they might experience.