Patient Protection and Affordable Care Act: Estimates of the Effect on the Prevalence of Employer-Sponsored Health Coverage

The share of employers offering health coverage has generally declined in the last decade. Researchers believe that certain provisions of PPACA could affect employers’ future willingness to offer health coverage, such as the availability of subsidized coverage through new health insurance marketplaces called “exchanges” and an “individual mandate,” which will require most people to obtain health coverage or pay a tax penalty. Certain PPACA provisions are scheduled to take effect in 2014. Researchers have provided various estimates of the effect PPACA may have on employer-sponsored coverage. GAO was asked to review the research on this topic. GAO examined (1) estimates of the effect of PPACA on the extent of employer-sponsored coverage; (2) factors that may contribute to the variation in estimates; and (3) how estimates of coverage vary by the types of employers and employees that may be affected, as well as other changes employers may be considering to the health benefits they offer. GAO reviewed studies published from January 1, 2009, through March 30, 2012 containing an original numerical estimate of the prevalence of employer-sponsored coverage at the national level. These included 5 microsimulation models and 19 employer surveys. Microsimulation models can systematically estimate the combined effects of multiple PPACA provisions in terms of both gains and losses of coverage; their results are based on multiple data sets and assumptions. Surveys reflect employer perspectives; they have limits as a predictive tool in part based on varied survey methodologies and respondent knowledge of PPACA

Health Care Coverage: Job Lock and the Potential Impact of the Patient Protection and Affordable Care Act

[Excerpt] The majority of Americans—about 55 percent in 2010—rely on employer-sponsored health care coverage, which is largely subsidized by most employers and thus less costly to employees than coverage purchased by individuals on their own. Although a valued employee benefit, many believe that having health coverage tied to employment can influence workers to stay in jobs they might otherwise leave, a phenomenon generally known as “job lock.” The Patient Protection and Affordable Care Act (PPACA), enacted in 2010, includes provisions that are designed to increase the accessibility and affordability of health coverage, particularly for individuals with preexisting health conditions. PPACA implementation is phased; though some provisions went into effect during the year of enactment, many provisions are scheduled to take effect in 2014. Some suggest that one benefit of PPACA may be a decrease in the occurrence of job lock. You asked us to examine job lock and the specific ways PPACA may affect it. Accordingly, we examined two key questions: 1. What has research shown about whether and the extent to which workers stay in jobs they might otherwise leave out of fear of losing health care coverage and the impact of those decisions on the labor market? 2. What are expert views on the ability of PPACA to mitigate job lock

Section 125 Plans in the Post-Reform Environment: Issues for Individual Insurance

Explores how the 2010 federal healthcare reform changes the legal uncertainty over the use of section 125 of the tax code to pay for individual insurance and may allow the purchase of individual insurance through section 125 outside an insurance exchange

Premium and Cost-Sharing Subsidies Under Health Reform: Implications for Coverage, Costs and Affordability

Using the Urban Institute's simulation model, estimates household financial burdens under House and Senate healthcare reform bills. Compares coverage and affordability under various reform options by source of coverage, income, healthcare needs, and age

Restoring Health to Health Reform: Integrating Medicine and Public Health to Advance the Population\u27s Wellbeing

The Patient Protection and Affordable Care Act is a major achievement in improving access to health care services. However, evidence indicates that the nation could achieve greater improvements in health outcomes, at a lower cost, by shifting its focus to public health. By focusing nearly exclusively on health care, policy makers have chronically starved public health of adequate and stable funding and political support. The lack of support for public health is exacerbated by the fact that health care and public health are generally conceptualized, organized, and funded as two separate systems. In order to maximize gains in health status and to spend scarce health resources most effectively, health care and public health should be treated as two interactive parts of a single, unified health system. The core purpose of health reform ought to be the improvement of the population’s health. We propose five criteria that would significantly advance this goal: prevention and wellness, human resources, a strong and sustainable health infrastructure, robust performance measurement, and reduction of health disparities. Although the Patient Protection and Affordable Care Act includes provisions addressing these criteria, population health is not a central focus of the reform. In order to guide health reform implementation and to inform future health reform efforts, we offer three major policy reforms: changing the environment to incentivize healthy behavioral choices, strengthening the public health infrastructure at the state and local levels, and developing a health-in-all policies strategy that would engage multiple agencies in improving health incomes. Adopting these reforms would facilitate integration and dramatically improve the population’s health, particularly when compared to the health gains likely to be realized from a continued focus on access to health care services

State Implementation of National Health Reform: Harnessing Federal Resources to Meet State Policy Goals

Discusses state options for maximizing coverage and access to care; reforming the health insurance market; holding insurers accountable for high-quality, affordable coverage; restructuring healthcare delivery and financing; and cutting budget deficits

Medicare Hospital Readmissions Reduction Program

Outlines national health reform provisions to reduce readmissions by publishing readmission data, lowering Medicare payments to hospitals with high readmission rates, and pairing such hospitals with patient safety organizations. Considers implications

Medicaid Coverage and Spending in Health Reform: National and State-by-State Results for Adults at or Below 133% FPL

Estimates state and national cost increases from the 2010 health reform law's expansion of Medicaid to adults under age 65 with incomes up to 133 percent of the federal poverty line in relation to enrollment increases under two outreach scenarios

Will the Patient Protection and Affordable Care Act Address the Problems Associated With Medical Malpractice?

Outlines the limitations of 2010 healthcare reform's medical injury and liability-related provisions; the potential for savings from malpractice reform; promising reforms, including early disclosure with compensation; and alternative approaches