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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

  • The American Rescue Plan and the Unemployed: Making Health Coverage More Affordable After Job Loss
    This Issue Brief examines the UC premium tax credit and cost-sharing reduction provisions under the ARP, describes the populations likely to benefit from these new temporary provisions, and provides illustrative examples to highlight the possible household impacts of these provisions.

  • Health Insurance Coverage and Access to Care for American Indians and Alaska Natives: Current Trends and Key Challenges
    The uninsured rate among American Indian and Alaska Native (AI/AN) working age adults decreased 16 percentage points since the passage of the ACA, from 44 percent in 2010 to 28 percent in 2018. This Issue Brief describes changes in the uninsured rate, health coverage, and access to care for AI/ANs since 2013 and discusses key policies for this population, including how the American Rescue Plan Act of 2021 (ARP) builds on the Affordable Care Act (ACA) and invests additional resources in the Indian health care system.

  • State Medicaid Telehealth Policies Before and During the COVID-19 Public Health Emergency
    States have embraced Medicaid telehealth flexibilities during the COVID-19 Public Health Emergency (PHE), enhancing beneficiary access to services delivered via telehealth. All states now cover primary care and behavioral health services delivered via telehealth. Many states have expanded coverage for telehealth modalities to include telephone-only, text-based communication, and remote patient monitoring, as well as authorizing patients’ homes as an originating site. This Issue Brief examines state Medicaid telehealth coverage and policies before and after the COVID-19 PHE was declared in January 2020.

  • 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

2016

2015

2014

2013

2012

2011