Nevada: Round 1 - State-Level Field Network Study of the Implementation of the Affordable Care Act

This report is part of a series of 21 state and regional studies examining the rollout of the ACA. The national network -- with 36 states and 61 researchers -- is led by the Rockefeller Institute of Government, the public policy research arm of the State University of New York, the Brookings Institution, and the Fels Institute of Government at the University of Pennsylvania.Following passage of the Affordable Care Act (ACA), Nevada became the only state with a Republican governor both to set up its own state exchange and to expand the state's Medicaid program. By all accounts, Governor Brian Sandoval's stance was pivotal. Sandoval chose to implement a law he personally opposed, with the aim of giving Nevada maximum autonomy in setting up and administering the new health insurance marketplaces. Sandoval's decision reflected in large part the circumstances of the state in the wake of a recession that hit Nevada particularly hard

State-Based Coverage Solutions: The California Health Benefit Exchange

Examines California's choices in designing an exchange to allow it to function as an active purchaser, mitigate adverse selection against and within the exchange, and not preclude community-based health plans from developing commercial offerings

Lessons from the Small Business Health Options Program: The SHOP Experience in California and Colorado

The Small Business Health Options Program (SHOP) got off to a slow start, with lower-than-expected enrollment and a public perception problem. This report examines California and Colorado's small-business marketplaces, which opened on schedule in October 2013. For business owners, employee choice was the most important reason cited for considering SHOP, with ease of administration a distant second. Several owners see SHOP as a viable alternative to the private exchanges now taking root among large and midsize employers. Interviews also revealed that business owners consider insurance brokers to be an important source of enrollment assistance. Those in the insurance and policy communities perceived small-business owners to be poorly informed about available tax credits; business owners disagreed, saying the credits were simply not key to their decision to elect SHOP. Potential growth areas for SHOP include developing alternative benefit designs, contracting with Medicaid plans, and offering ancillary products, such as wellness programs

Improving Individual Health Insurance Markets

In the U.S. health care system, the individual healthcare insurance marketplace has always been something of an afterthought. Most Americans of working age receive coverage through their employer. Older Americans and those with disabilities typically get benefits from Medicare. Fewer than one in ten Americans purchase coverage directly from statewide individual marketplaces, established through the Affordable Care Act, or purchase unsubsidized plans outside these markets. Nevertheless, this represents tens of millions of individuals who depend on the quality and choice of the products in the individual market