Health Care Coverage and Access

Background

ASPE conducts a variety of research and data analyses on health care coverage and access issues. Listed below by date of publication are ASPE Issue Briefs, Reports, Data Points and other research products on these issues and related topics.

Publications

2021

Health Coverage Under the Affordable Care Act: Enrollment Trends and State Estimates
Based on enrollment data from late 2020 and early 2021, approximately 31 million people are currently enrolled in Marketplace or Medicaid expansion coverage related to provisions of the Affordable Care Act (ACA), the higher total on record. This Issue Brief presents current estimates of enrollment in health insurance coverage purchased through the ACA Marketplaces and the Medicaid expansion and the subsequent reductions in state-level uninsured rates since the ACA was implemented in 2014.
Estimates of Uninsured Adults Newly Eligible for Medicaid If Remaining Non-Expansion States Expand
Approximately 4.0 million uninsured non-elderly adults would be newly eligible for Medicaid if non-expansion states were to expand eligibility for adults to 138% of the Federal Poverty Level (FPL). This Data Point presents estimates of potential Medicaid eligibility among uninsured, non-elderly adults in states that have not expanded Medicaid coverage to adults with incomes up to 138% of the Federal Poverty Level (FPL) and the demographic characteristics of this population.
Health Insurance Coverage Changes Since Implementation of the Affordable Care Act: Asian Americans and Pacific Islanders
This Issue Brief is the first in a series examining the impact of the Affordable Care Act (ACA) on health coverage rates among select racial and ethnic populations. Changes in coverage rates from 2013-2019 are examined.
Count Estimates of Zero- and Low-Premium Plan Availability in HealthCare.gov States Pre and Post ARP, by Metal Tier, Select Demographics, and State
These supplemental data tables are for the ASPE Issue Brief series, Access to Marketplace Plans with Low Premiums on the Federal Platform, that examines the availability of zero-premium and low-premium (defined as less than or equal to $50 per month) plans in states served by the federal Marketplace platform, HealthCare.gov, before and after the passage of the American Rescue Plan Act of 2021.
Access to Marketplace Plans with Low Premiums on the Federal Platform Part III: Availability Among Current HealthCare.gov Enrollees Under the American Rescue Plan
This Issue Brief is the third in a series that examines the availability of zero-premium and low-premium plans in states served by the federal Marketplace platform, HealthCare.gov. Estimates highlight the impact of the American Rescue Plan’s (ARP) enhanced and expanded Marketplace premium tax credit provisions. Specifically, the analysis compares the availability of zero-premium and low-premium health plans, pre and post ARP, among current HealthCare.gov enrollees.
Medicaid Churning and Continuity of Care: Evidence and Policy Considerations Before and After the COVID-19 Pandemic
This Issue Brief reviews evidence on churning among the Medicaid population and different policy options for states and the federal government to reduce churn, including continuous eligibility, Medicaid expansion to adults, express lane eligibility, presumptive eligibility, multimarket plans, and limiting premiums and cost-sharing.
Access to Marketplace Plans with Low Premiums on the Federal Platform, Part II: Availability Among Uninsured Non-Elderly Adults Under the American Rescue Plan
This Issue Brief is the second in a series that examines the availability of zero-premium and low-premium plans in states served by the federal Marketplace platform, HealthCare.gov. Estimates in this brief are based on the enhanced premium subsidies available under the American Rescue Plan (ARP) for 2021 coverage through HealthCare.gov. This Issue Brief compares the availability of health plans for zero- and low-premiums among uninsured non-elderly adults eligible for Marketplace coverage in HealthCare.gov states, pre- and post-ARP. The impacts of the ARP on Marketplace advanced premium tax credit (APTC) subsidies and premiums after application of APTC among currently enrolled nonelderly adults will be examined in a subsequent Issue Brief.
Access to Marketplace Plans with Low Premiums on the Federal Platform, Part I: Availability Prior to the American Rescue Plan
This Issue Brief is the first in a series that examines the availability of zero-premium and low-premium plans in states served by the federal Marketplace platform, Healthcare.gov. Estimates in this brief are based on the premium subsidies available as of March 1, 2021, which does not include the enhanced subsidies created by the American Rescue Plan (ARP). The impacts of the ARP on Marketplace advanced premium tax credit (APTC) subsidies and premiums after application of APTC will be examined in a subsequent Issue Brief.
The Remaining Uninsured: Geographic and Demographic Variation
This Issue Brief illustrates the geographic and demographic variation in the uninsured population, including those eligible to enroll in Marketplace coverage during the COVID-19 Special Enrollment Period.
State, County, and Local Estimates of the Uninsured Population: Prevalence and Key Demographic Features
To support state and local outreach efforts, ASPE has developed state and sub-state estimates of the number of uninsured, along with their demographic characteristics, who are likely to qualify for coverage through Qualified Health Plans (QHPs) in the Health Insurance Marketplace (“QHP-eligible uninsured”) using the most recent Census data available for this purpose.
Medicaid Demonstrations and Impacts on Health Coverage: A Review of the Evidence
This issue brief examines policies in four major areas of state Medicaid section 1115 demonstrations: 1) work requirements (also referred to as “community engagement” requirements), 2) healthy behavior incentive programs, 3) health savings account-like arrangements, and 4) capped federal funding and other financing changes and reviews the evidence to date on the impact of these demonstration policies on Medicaid coverage and access to care.
Trends in the U.S. Uninsured Population, 2010-2020
Newly released estimates from the National Health Interview Survey show that 11.1 percent of U.S. residents (or 30.0 million) under age 65 lacked health insurance as of January-June 2020. This number reflects a sharp decline in the number of uninsured Americans since 2010, before implementation of the Affordable Care Act's large coverage expansions. The implementation of the Affordable Care Act increased coverage especially for Blacks, Latinos, Asians, American Indians/Alaska Natives, families with lower incomes, and those living in states that expanded Medicaid. However, the uninsured rate rose between 2016-2019. The issue brief concludes with an overview of current efforts to expand health coverage.

2018

Health Plan Choice and Premiums in the 2019 Federal Health Insurance Exchange
This brief presents information on qualified health plans (QHPs) available in the Exchange for states that use the HealthCare.gov platform, including estimates for issuer participation, health plan options, premiums, and subsidies in the upcoming open enrollment period (OEP), and trends since the first OEP. National estimates and summary tables are presented in each section of the text.

2017

Health Plan Choice and Premiums in the 2018 Federal Health Insurance Exchange
This issue brief presents analysis of Qualified Health Plan (QHP) data in the individual market Exchanges for plan year 2018 for states that use the HealthCare.gov platform. It examines issuer participation, plan options and premiums for individuals enrolling in coverage through the Exchanges
Did Consumers Respond to Changes in Gross Premiums or to Changes in Premiums Net of Tax Credits When Making Health Plan Choices in the 2016 ACA Marketplaces
Medicaid Expansion Impacts on Insurance Coverage and Access to Care
Effects of the Affordable Care Act on Safety Net Hospitals
National Health Service Corps: An Extended Analysis
Evidence Indicates a Range of Challenges for Puerto Rico Health Care System
Nearly 900,000 Puerto Ricans May Lose Health Coverage When Medicaid Funds Run Out
Continuing Progress on the Opioid Epidemic: The Role of the Affordable Care Act

Health Insurance Coverage for Americans with Pre Existing Conditions The Impact of the Affordable Care Act

2016

2015

Community Action Agency Activities in Affordable Care Act Outreach and Enrollment: Insights from Case Studies, ASPE Research Brief, November 2015
Estimates of the QHP Eligible Uninsured by Designated Market Area for the Third Open Enrollment Period, ASPE Issue Brief, November 2015
Health Plan Choice and Premiums in the 2016 Health Insurance Marketplace, ASPE Issue Brief, October 2015
Consumer Decisions Regarding Health Plan Choices, in the 2014 and 2015 Marketplaces, ASPE Issue Brief, October 2015
How Many Individuals Might Have Marketplace Coverage at the End of 2016?, ASPE Issue Brief, October 2015
Health Insurance Marketplace: Uninsured Populations Eligible to Enroll for 2016, ASPE Issue Brief, October 2015
Health Insurance Coverage and the Affordable Care Act, ASPE Issue Brief, September 2015
Competition and Choice in the Health Insurance Marketplaces, 2014-2015: Impact on Premiums , ASPE Issue Brief, July 2015
Plan Selections by County in the Health Insurance Marketplace (UPDATED), July 2015
Building the Nation's Health Care Workforce (PDF-9 Pages), ASPE Issue Brief, July 2015
Outreach and Enrollment for LGBT Individuals: Promising Practices from the Field, ASPE Research Brief, June 2015
The Affordable Care Act is Improving Access to Preventive Services for Millions of Americans, ASPE Data Point, May 2015
Medicare Spending Growth Since 2009 (PDF-2 Pages), ASPE Issue Brief, April 2015
Plan Selections by ZIP Code in the Health Insurance Marketplace, April 2015
The Economic Impacts of Medicaid Expansion, Uncompensated Care Costs and the Affordable Care Act, ASPE Issue Brief, March 2015
Medicaid Enrollment and the Affordable Care Act (PDF-1 Page), ASPE Issue Brief, March 2015
Health Insurance Coverage and the Affordable Care Act, ASPE Issue Brief, March 2015
Health Insurance Marketplace 2015 Open Enrollment Period: March Enrollment Report, ASPE Issue Brief, March 2015
Integrating Health and Human Services Programs and Reaching Eligible Individuals under the Affordable Care Act: Final Report, February 2015
Health Insurance Marketplace 2015: Average Premiums After Advance Premium Tax Credits Through January 30 in 37 States Using the Healthcare.Gov Platform, ASPE Issue Brief, February 2015
Health Insurance Marketplace 2015 Open Enrollment Period: January Enrollment Report, ASPE Issue Brief, January 2015
2015 Plan Selections by ZIP Code in the Health Insurance Marketplace, January 2015
The Affordable Care Act: Advancing the Health of Women and Children, ASPE Issue Brief, January 2015

2014

Health Insurance Marketplace 2015 Open Enrollment Period: December Enrollment Report, ASPE Issue Brief, December 2014
Health Plan Choice and Premiums in the 2015 Health Insurance Marketplace, ASPE Issue Brief, December 2014
How Many Individuals Might Have Marketplace Coverage After the 2015 Open Enrollment Period?, ASPE Issue Brief, November 2014
Survey Data on Health Insurance Coverage for 2013 and 2014 (PDF-15 Pages), ASPE Issue Brief, October 2014
Impact of Insurance Expansion on Hospital Uncompensated Care Costs (PDF-26 Pages), ASPE Issue Brief, September 2014
Health Insurance Issuer Participation and New Entrants in the Health Insurance Marketplace in 2015 (PDF-8 Pages), ASPE Issue Brief, September 2014
Rate Review Annual Report for Calendar Year 2013 (PDF-9 Pages), September 2014
Plan Selections by ZIP Code in the Health Insurance Marketplace, September 2014
Increased Coverage of Preventive Services with Zero Cost Sharing under the Affordable Care Act (PDF-8 Pages), ASPE Issue Brief, June 2014
Premium Affordability, Competition, and Choice in the Health Insurance Marketplace, 2014, ASPE Research Brief, June 2014
Effects of Implementing State Insurance Market Reform, 2011-2012, June 2013
Trends in Premiums in the Small Group and Individual Insurance Markets, 2008-2011, November 2012
Health Insurance Marketplace: Summary Enrollment Report, ASPE Issue Brief, May 2014
Addendum to the Health Insurance Marketplace: March Enrollment Report, May 2014
Second Addendum to the Health Insurance Marketplace Summary Enrollment Report, May 2014
Health Insurance Marketplace: Summary Enrollment Report Infographic, May 2014
Health Insurance Marketplace: Summary Enrollment Report: State Profile, May 2014
The Medicare Advantage Program in 2014, ASPE Issue Brief, April, 2014
The Eligible Uninsured in Texas: 6 in 10 Could Receive Health Insurance Marketplace Tax Credits, Medicaid or CHIP, ASPE Research Brief, March, 2014
ASPE/OMH Research Brief - Eligible Uninsured Asian Americans, Native Hawaiians, and Pacific Islanders: 8 in 10 Could Receive Health Insurance Marketplace Tax Credits,Medicaid or CHIP, ASPE/OMH Research Brief, March, 2014
Common Sports Injuries: Incidence and Average Charges, ASPE Issue Brief, March, 2014
Health Insurance Marketplace: March Enrollment Report; For the period: October 1, 2013 - March 1, 2014 (PDF-26 Pages), ASPE Issue Brief, March, 2014
Addendum to the Health Insurance Marketplace: March Enrollment Report, ASPE Issue Brief, March, 2014
Marketplace Open Enrollment Process by the Numbers Fifth Reporting Period: October 1, 2013 through March 1, 2014, ASPE Issue Brief, March, 2014
Health Insurance Marketplace: February 2014 Enrollment Report, ASPE Issue Brief, February, 2014
Marketplace Open Enrollment Process by the Numbers Fourth Reporting Period: October 1, 2013 through February 1, 2014, ASPE Issue Brief, February, 2014
Eligible Uninsured Latinos: 8 in 10 Could Receive Health Insurance Marketplace Tax Credits, Medicaid or CHIP, ASPE Research Brief, February, 2014
Children’s Health Coverage on the 5th Anniversary of CHIPRA, ASPE Issue Brief, February, 2014 The fifth anniversary of the Children's Health Insurance Program
Health Insurance Marketplace: January 2014 Enrollment Report (PDF-29 Pages), ASPE Issue Brief, January, 2014
Marketplace Open Enrollment Process by the Numbers Third Reporting Period: October 1st through December 28th, ASPE Issue Brief, January, 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, ASPE Report, December, 2013
Health Insurance Marketplace: December Enrollment Report, ASPE Issue Brief, December, 2013
Marketplace Open Enrollment Process by the Numbers Second Reporting Period: October 1st through November 30th, ASPE Issue Brief, December, 2013
Eligible Uninsured African Americans: 6 in 10 Could Receive Health Insurance Marketplace Tax Credits, Medicaid or CHIP, ASPE Issue Brief, December, 2013
Health Insurance Marketplace: November Enrollment Report, ASPE Issue Brief, November, 2013
Marketplace Open Enrollment Process by the Numbers First Reporting Period: October 1st through November 2nd, ASPE Issue Brief, November, 2013
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
Health Insurance Marketplace Premiums for 2014, ASPE Issue Brief, September, 2013
New Census Estimates Show 3 Million more Americans had Health Insurance Coverage in 2012, ASPE Issue Brief, September, 2013
Fifty-Six Percent of The Uninsured Could Pay $100 or Less per Month for Coverage in 2014, ASPE Issue Brief, September, 2013
U.S. Department of Health and Human Services: Rate Review Annual Report September 2013, ASPE Report, September, 2013
The Affordable Care Act and Adolescents, Issue Brief, August 26, 2013
Market Competition Works: Proposed Silver Premiums in the 2014 Individual Market Are Substantially Lower than Expected Issue Brief, Updated: August 9, 2013
Market Competition Works: Proposed Silver Premiums in the 2014 Individual and Small Group Markets Are Nearly 20% Lower than Expected, Research Brief, July, 2013
Seventy-one million additional Americans are receiving preventive services coverage without cost-sharing under the Affordable Care Act, Issue Brief, March, 2013
Modified Adjusted Gross Income (MAGI) Income Conversion Methodologies, Issue Brief, March, 2013
Health Insurance Premium Increases in the Individual Market Since the Passage of the Affordable Care Act, Issue Brief, February, 2013
Affordable Care Act Expands Mental Health and Substance Use Disorder Benefits and Federal Parity Protections for 62 Million Americans, Issue Brief, February, 2013
Growth in Medicare Spending per Beneficiary Continues to Hit Historic Lows, Issue Brief, February, 2013

2012

Estimated Savings of $5,000 to Each Medicare Beneficiary from Enactment Through 2022 Under the Affordable Care Act , Issue Brief, September, 2012
Overview of the Uninsured in the United States: A Summary of the 2012 Current Population Survey Report, Issue Brief, September 2012
47 Million Women Will Have Guaranteed Access To Affordable Care, Issue Brief, July 2012
Number of Young Adults Gaining Insurance Due to the Affordable Care Act Now Tops 3 Million, Issue Brief, June 2012.
The Affordable Care Act and Asian Americans and Pacific Islanders, Research Brief, May 2012.
The Affordable Care Act and African Americans, Research Brief, April 2012.
The Affordable Care Act and Latinos, Research Brief, April 2012.
Uninsured Young Adults and the Affordable Care Act (PDF-2 Pages), Research Brief, March 2012.
The Affordable Care Act and Women, Research Brief, March 2012.
The Affordable Care Act and Participation Rates in Medicaid, Issue Brief, March 2012.
Expanded Insurance Coverage For Young Adults of All Races and Ethnicities, Issue Brief, March 2012.
105 Million Americans No Longer Face Lifetime Limits on Health Benefits, Issue Brief, March 2012.
ACA and Preventive Services Coverage Without Cost-Sharing, Issue Brief, February 2012.
The Cost of Covering Contraceptives through Health Insurance, Issue Brief, February 2012.
Medicare Beneficiary Savings and the Affordable Care Act, Issue Brief, February 2012.

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.
The Affordable Care Act and Children, Issue Brief, December 2011.
Comparing Health Benefits Across Markets, Research Brief, December 2011.
Essential Health Benefits: Individual Market Coverage, Issue Brief, December 2011.
Variation and Trends in Medigap Premiums, December 2011.
2.5 Million Young Adults Gain Health Insurance Due to the Affordable Care Act, Issue Brief, December 2011.
Actuarial Value and Employer-Sponsored Insurance, Research Brief, November 2011.
One Million Young Adults Gain Health Insurance in 2011 Because of the Affordable Care Act, Issue Brief, September 2011.
Overview of the Uninsured in the United States, Issue Brief, September 2011.
The Value of Health Insurance: Few of the Uninsured Have Adequate Resources to Pay Potential Hospital Bills, Issue Brief, May 2011