Performance Improvement 2013-2014. How are States Preparing to Implement the Reforms Specified in the Affordable Care Act, Especially Those Reluctant to Move Forward?


This project tracked and analyzed state implementation of the Affordable Care Act through qualitative analysis based on site visits that included discussions with state officials, insurers, and providers. The project sought to determine what states were doing to establish State-Based Exchanges or State Partnership Exchanges, or to prepare for cooperation with Federally-Facilitated Exchanges. The study focused on what states were doing to prepare for the expansion of Medicaid eligibility and enrollment in 2014. It also sought to determine how states are integrating Medicaid, CHIP, and Exchange eligibility and enrollment processes, and whether they planned to establish Basic Health Plans).

Results of site visits indicated that for Arkansas, Florida, Ohio and Texas implementation of market reforms would be difficult with some opposition by political leaders, especially for Medicaid expansion. States indicated they have little legislative authority to enforce market rules. Feedback from issuers showed reluctance to participate in the Small-Business with Health Options Program (SHOP) with little known about the requirements. Feedback from providers demonstrated some activity with respect to medical homes but also major issues concerning physician shortages and scope of practice laws for physician extenders.

Report Title: Urban Institute Qualitative and Quantitative Deep Dive on Four States.
Agency Sponsor: OASPE, Office of the Assistant Secretary for Planning and Evaluation
Federal Contact: Thomas Musco, 202-690-7272
Performer: Urban Institute
Record ID: 9747 (September 1, 2012)

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"PerformanceImprovement2014.pdf" (pdf, 671.65Kb)

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