Private Insurance: Availability
Availability of Coverage looks at the special problems that people with pre-existing conditions or who are otherwise at high risk face in getting and keeping insurance, along with the protections that are necessary to help such people obtain coverage that meets their needs.
From Families USA
Worry No More: Americans with Pre-Existing Conditions Are Protected by the Health Care Law provides estimates of how many people will be protected from discrimination based on their health status thanks to the health care law. For the first time, the state reports include county-level data, and they include state-level data that are broken down by age, income, and racial or ethnic group. (July 2012)
Wellness Programs: Evaluating the Promises and Pitfalls presents an overview of current programs, identifies how their role could soon change, explains how certain programs can limit access to coverage and care, and provides recommendations for policies that will help prevent these programs from limiting access. (June 2012)
Good Business Sense: The Small Business Health Care Tax Credit in the Affordable Care Act provides national and state-level estimates of the number of small businesses that will be eligible for this tax credit and of how much the credits will be worth. It also includes data on how many workers could benefit as a result, broken down according to racial and ethnic group. (Done in collaboration with Small Business Majority, May 2012)
When a Health Insurer Leaves the Individual Market: What States Can Do before Certain Affordable Care Act Changes Take Effect in 2014 discusses specific actions states can take to protect consumers who need to buy coverage in the individual market. It examines existing protections and explains how states can supplement them. (May 2012)
Getting Covered: Finding Health Insurance When You Lose Your Job is designed to help consumers who've lost their health coverage sort through possible options for new coverage, including COBRA, Medicaid, CHIP, other federal and state programs, and the individual market. (Updated February 2012)
The Bottom Line: How the Affordable Care Act Helps America's Families shows the net financial effects of the Affordable Care Act on family budgets. We found that lower- and middle-income families, both uninsured and insured, will be financial winners. | State Reports (October 2011)
The Basic Health Option: Will It Work for Low-Income Consumers? provides a framework for advocates to think about whether this option, created by the health care law, will work for their state. It covers program basics, discusses the problems it might address, and raises key issues that can affect the direction such a program might take. (July 2011)
Why We Need a Health Insurance Exchange is a one-page handout that cites several reasons why consumers will benefit from the new exchanges, including competition, affordability, and quality. Advocates can modify this version to fit their needs. (June 2011)
The Affordable Care Act: Patients' Bill of Rights and Other Protections is a compilation of all of our fact sheets to date on consumer rights and protections. (April 2011)
States Are Benefitting from Provisions of the Affordable Care Act lists the number of people in each state who are already benefiting from each of five provisions. The provisions include measures that are helping small businesses provide coverage to their workers, helping seniors get free preventive care, and protecting children with pre-existing conditions. | Table (March 2011)
How States Are Making Sure Coverage Is Available to Children notes that, under health reform, insurers are required to accept children regardless of any pre-existing conditions in all group plans and in newly sold individual plans, and it examines what several states are doing to make sure that child-only policies are still available. (October 2010)
Families USA had prepared a series of fact sheets on the Patients' Bill of Rights and other consumer protections in the Affordable Care Act that took effect on September 23. (September 2010)
Families USA's Comments on the Genetic Information and Nondiscrimination Act (GINA) Interim Final Rules: We applaud the rules' strong protections against insurance discrimination based on genetic information. Our comments detail the protections against underwriting based on genetic information, which will help make coverage more accessible and affordable for Americans. (December 22, 2009)
What Is a "Special Enrollment Opportunity" and Why Should I Care about It? discusses who may have the option of signing up for job-based health coverage when it isn't open season. (June 2009)
Why Employers Should Share the Responsibility of Paying for Health Care discusses five reasons why it makes sense to require employers to contribute to the cost of health coverage, known as an "employer responsibility requirement." (June 2009)
Empty Promise: Searching for Health Insurance in an Unfair Market discusses how the individual health insurance market differs from the employer market and examines what happens to consumers who seek coverage in the individual market. Problems in the individual market include policies that don't provide quality coverage; policies that are very expensive or that cost more than advertised; and the fact that many applicants cannot obtain a policy at any price. (August 2008)
Fighting Revocations and Limitations of Health Insurance Policies addresses the insurance company practice of revoking an individual's health insurance or suddenly eliminating coverage for health services long after the person has enrolled (known as "post-claims underwriting"). It also discusses what consumers and advocates can do about the practice. (July 2008)
Failing Grades: State Consumer Protections in the Individual Health Insurance Market. Laws protecting consumers purchasing health coverage in the individual market vary across the country. In many states, insurance companies can deny coverage, raise premiums significantly, refuse to cover treatment for certain conditions, and even revoke the coverage of policyholders who have been paying premiums for years. (June 2008)
Post-Claims Underwriting Survey presents the findings of a survey we conducted in April and May 2008 of all state insurance departments regarding laws in their states that prohibit insurers from limiting or rescinding health insurance policies after they have been issued. (June 2008)
High-Risk Health Insurance Pools provides answers to key questions about high-risk pools, including who they help and how they are financed. The report also includes a list of questions consumers should ask if they are considering joining a high-risk pool, as well as a checklist for advocates. (May 2006)
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From Other Organizations
A Comparison of the Availability and Cost of Coverage for Workers in Small Firms and Large Firms: A View from the 2012 Employer Health Benefits Survey compares whether firms offer coverage, how much plans cost, and how much cost-sharing workers are responsible for. It finds that workers in small firms generally pay a higher share of premiums and higher cost-sharing than workers in large firms. (Kaiser Family Foundation, December 2012)
Jobs without Benefits: The Health Insurance Crisis Faced by Small Businesses and Their Workers explains how the Affordable Care Act will help small business employees, who are more likely to be uninsured than workers in large firms, with new coverage options, tax credits, the medical loss ratio rule, and protection from coverage denials for pre-existing conditions. (Commonwealth Fund, November 2012)
Selling Health Insurance across State Lines: An Assessment of State Laws and Implications for Improving Choice and Affordability of Coverage analyzes the implementation of laws in six states (GA, KY, ME, RI, WA, and WY) that allow the sale of insurance across state lines. Although these laws were designed to enhance consumer choice, to increase competition, and to make insurance more affordable, the complexities of how insurance is sold and regulated have deterred insurance companies from entering new markets, thereby undermining the laws’ goals. (Center on Health Insurance Reforms, October 2012)
Putting Men’s Health Care Disparities on the Map: Examining Racial and Ethnic Disparities at the State Level documents the persistence of health disparities among men by providing extensive state-level data, broken down by racial and ethnic group, on three factors: health status, access to and use of care, and social determinants of health. (Kaiser Family Foundation, September 2012)
Employer Health Benefits: 2012 Summary of Findings provides a detailed look at trends in job-based health coverage, including premiums, employee contributions, and cost-sharing. It includes data that are broken down by firm size and plan type, and it also includes information on participation in wellness programs. (Kaiser Family Foundation and the Health Research and Educational Trust, September 2012)
After the Ruling: A Consumer’s Guide is a user-friendly explanation of how the Supreme Court’s decision will affect people without insurance, consumers who get insurance through their jobs, people who want insurance but cannot afford it, people with health problems, small business owners, and seniors. It also explains parts of the law that are already in place. (Kaiser Family Foundation, June 2012)
Number of Young Adults Gaining Insurance Due to the Affordable Care Act Now Tops 3 Million finds that the gains in coverage for young adults were almost entirely from increases in private insurance. It also notes that coverage gains for young men, who previously had the highest rates of uninsurance of any gender-age group combination, were particularly large. (Department of Health and Human Services, June 2012)
Young, Uninsured, and in Debt: Why Young Adults Lack Health Insurance and How the Affordable Care Act Is Helping finds that, between September 2010 and June 2011, the number of insured young adults increased by 2.5 million as a result of the dependent coverage provision. It also finds that most young adults do enroll in coverage when it is accessible and affordable, and only 6 percent of those surveyed said they do not need coverage. (Commonwealth Fund, June 2012)
Employment-Based Health Benefits: Trends in Access and Coverage, 1997—2010 provides data on the offer, coverage, and take-up rates among workers. It also examines why many workers are not covered, and it includes breakdowns by age, gender, and race/ethnicity. (Employee Benefit Research Institute, April 2012)
Gaps in Health Insurance: Why So Many Americans Experience Breaks in Coverage and How the Affordable Care Act Will Help finds that one-quarter of adults aged 19 to 64 experienced a gap in their health insurance in 2011, with a majority remaining uninsured for one year or more. It also explains how the Affordable Care Act’s Medicaid expansion and exchanges will help people maintain coverage. (Commonwealth Fund, April 2012)
States and the Affordable Care Act is a series of state reports that analyze the effects of the Affordable Care Act on coverage, health expenditures, affordability, access, and premiums. It also assesses state’s progress with implementation of the law. The reports examine the following states: CO, MD, NY, OR, and RI. (Urban Institute, April 2012)
Health Law Guide allows you to enter your information and get a customized fact sheet with details about consumer protections and about new coverage options you may be eligible for under the Affordable Care Act. The guide will be updated as implementation of the law continues. (AARP and Avalere Health, March 2012)
Top Ways Health Reform Helps provides the top five ways the Affordable Care Act helps the following groups: Medicaid beneficiaries, older adults and people with disabilities, women, and children and young adults. It also explains how the health care law addresses disparities and helps people get coverage. The lists are divided into provisions that are already in effect and those that are coming soon. (National Health Law Program, March 2012)
Achieving Equity by Building a Bridge from Eligible to Enrolled explains the importance of doing culturally and linguistically appropriate outreach and education to facilitate enrollment in health coverage. Without effective multilingual efforts in California, language barriers may mean that 110,000 fewer people with limited English proficiency enroll in coverage through the state’s exchange. (California Pan-Ethnic Health Network, the UCLA Center for Health Policy Research, and the UC Berkeley Labor Center, February 2012)
Health-Insurance Coverage for Low-Wage Workers, 1979-2012 and Beyond discusses the steady decline in coverage for low-wage workers over the past three decades, but it also explains that the experience with health reform in Massachusetts suggests that the Affordable Care Act may reverse this trend. (Center for Economic and Policy Research and Georgetown University, February 2012)
Implications of Health Reform for American Indian and Alaska Native Populations outlines provisions of the Affordable Care Act that uniquely affect these populations, including expanded coverage through Medicaid and the exchanges, outreach to tribal groups, and improved organization and financing of care. (Center for Health Care Strategies, the National Academy for State Health Policy, and the Robert Wood Johnson Foundation, February 2012)
Mapping the Effects of the ACA’s Health Insurance Coverage Expansions allows you to enter a zip code and get an estimate of the share of the population in that region that will benefit from the Affordable Care Act through either Medicaid or tax credits for private insurance in the exchanges. (Kaiser Family Foundation, February 2012)
Small Business Insurance Exchanges examines issues that states have to address in designing Small Business Health Option Program (SHOP) exchanges and the challenges advocates and policy makers? are likely to face. Although exchanges for individuals and small businesses will have similar functions, they will have unique attributes reflecting the populations they serve. (Health Affairs and the Robert Wood Johnson Foundation, February 2012)
ACA Implementation in Oregon—Monitoring and Tracking is the first of 10 state reports that analyze the effects of the Affordable Care Act on coverage, health expenditures, affordability, access, and premiums. It also assesses Oregon’s progress with implementation of the law. The remaining nine reports will examine the following states: AL, CO, MD, MI, MN, NM, NY, RI, and VA. (Robert Wood Johnson Foundation and the Urban Institute, February 2012)
Employers and the Exchanges under the Small Business Health Options Program: Examining the Potential and the Pitfalls introduces a collection of articles in the February issue of “Health Affairs” that discuss the need for small business exchanges and how they will function. It also examines the difficulties that exchanges will face and the opportunities they will offer to states, employers, and individuals. (Health Affairs, February 2012)
The Income Divide in Health Care: How the Affordable Care Act Will Help Restore Fairness to the U.S. Health System explains that the law will narrow the income divide in health coverage and access through expanded Medicaid eligibility, state insurance exchanges, premium tax credits, cost-sharing protections, and the individual mandate. (Commonwealth Fund, February 2012)
Building a Relationship between Medicaid, the Exchange, and the Individual Insurance Market focuses on the following key areas where states can focus their efforts to promote continuity of coverage: establishing a joint strategy to align health plan policies across markets, aligning the eligibility determination and redetermination process, and coordinating benefit design across multiple markets. (National Academy of Social Insurance and the Robert Wood Johnson Foundation, January 2012)
Should States Integrate Health Insurance Exchanges and Medicaid? discusses the benefits of integration for both states and consumers, such as reduced costs and continuity of coverage. (Robert Wood Johnson Foundation, January 2012)
Federally-Facilitated Exchanges and the Continuum of State Options reviews how the core functions of an exchange will work depending on where it falls on the continuum from entirely state-based to entirely federally operated. It also discusses the implications for states as they choose exchange formats as interim or permanent solutions. (National Academy of Social Insurance and the Robert Wood Johnson Foundation, December 2011)
Women’s Health Insurance Coverage describes the different sources of health insurance for women and discusses how the Affordable Care Act will help the 20 percent of women ages 18 to 64 who are uninsured. (Kaiser Family Foundation, December 2011)
Changes in Health Insurance Coverage in the Great Recession, 2007-2010 notes a severe decline in job-based coverage during this time period. Public coverage through Medicaid or the Children’s Health Insurance Program (CHIP) has offset some loss of coverage, but the overall uninsurance rate has risen. (Kaiser Commission on Medicaid and the Uninsured and the Urban Institute, December 2011)
Addressing Barriers to Online Applications: Can Public Enrollment Stations Increase Access to Health Coverage? discusses the use of computers or kiosk stations in public places to make online applications more accessible. It identifies challenges and opportunities that policy makers need to understand as they design effective online application systems. (Consumers Union, November 2011)
Massachusetts Health Reform: A Five-Year Progress Report examines major components of the law, such as expanding eligibility for Medicaid and CHIP, requiring all adults to obtain health insurance, and creating a health insurance exchange. It looks at how these provisions are working, the challenge of rising health care costs, and how health reform has affected coverage and access to care. (The Blue Cross Blue Shield of Massachusetts Foundation, November 2011)
The State of Young America: Health Care and Coverage describes the difficulties young adults face in obtaining health insurance and paying for medical services. It notes that provisions of the Affordable Care Act have started to reverse the trend of rising uninsurance among young adults. (Demos and Young Invincibles, November 2011)
Tracking Health Insurance Coverage by Month: Trends in Employment-Based Coverage among Workers, and Access to Coverage among Uninsured Workers, 1995-2010 examines trends in job-based health benefits to show the effects of recessions and unemployment on health coverage. (The Employee Benefit Research Institute, October 2011)
Healthy People 2010 Final Review assesses progress in achieving the objectives that were set by the Department of Health and Human Services 10 years ago, including improving access to high-quality care, eliminating health disparities, and increasing the quality and years of healthy life. (The Centers for Disease Control and Prevention, October 2011)
Implementing Health Insurance Exchanges: State Profiles examines each state’s progress in setting up the exchanges that were mandated by the Affordable Care Act. The state-specific briefs cover where states are in the legislative process, whether states have received federal funding, and their next steps. (The Kaiser Family Foundation, October 2011)
2011 Health Confidence Survey: Most Americans Unfamiliar with Key Aspect of Health Reform summarizes attitudes toward the health care system. It found that 62 percent of Americans are not at all familiar with the insurance exchanges that are a part of the Affordable Care Act, and it found that overall confidence regarding the health care system has not changed since the law was passed last year. (The Employee Benefit Research Insitute, September 2011)
Health Insurers Deny Coverage to Many Who Apply for Individual Policies discusses state-specific denial rates that are now available on www.healthcare.gov. In 2014, insurers will no longer be allowed to deny consumers based on health status, but until then, the denial rates are useful tools for consumers who are selecting an insurer. (Kaiser Health News and USA Today, September 2011)
When Unemployed Means Uninsured: The Toll of Job Loss on Health Coverage, and How the Affordable Care Act Will Help discusses the difficulty people face finding and paying for insurance if they lose their jobs. Although the Affordable Care Act will provide affordable insurance in 2014, this report suggests that policy makers should help the recently unemployed now by offering COBRA subsidies or extending unemployment benefits. (Commonwealth Fund, August 2011)
State Action towards Creating a Health Insurance Exchange is an easy-to-read table that includes regularly updated information on the status of states’ work on implementing exchanges. The chart also notes the structure and type of exchange that each state seeks to enact. (statehealthfacts.org, August 2011)
The Effects of Health Reform on Small Businesses and Their Workers estimates the impact on offers of health coverage, the coverage itself, and the costs to the employers. (Urban Institute and the Robert Wood Johnson Foundation, June 2011)
Employer-Based Health Coverage Declined Sharply over Past Decade discusses how the health reform law will reverse this trend by giving tax credits to small businesses to help them provide coverage, fining large employers that do not offer affordable coverage to their employees, and encouraging workers to take up employer coverage through the individual responsibility provision. (Center on Budget and Policy Priorities, December 2010)
The 2007-09 Recession and Health Insurance Coverage finds that 5 million Americans lost job-based health insurance during the recession, particularly residents of the Midwest and South. Adults bore the burden of this decline in insurance, while children were largely protected by public insurance programs. (Health Affairs, December 2010) Subscription Required
Early Retiree Insurance describes the temporary Early Retiree Reinsurance Program, which reimburses retiree health plans for high-cost medical claims. The program is intended to slow the decline in job-based coverage for retirees until the health insurance exchanges are up and running in 2014. (Health Affairs, November 2010)
Coverage Denials for Pre-Existing Conditions in the Individual Health Insurance Market reports on Congress’s investigation into the extent of coverage denials and exclusions for pre-existing conditions. The investigation found that, in the three years before health reform was passed, the four largest for-profit insurers denied coverage to more than 600,000 individuals because of pre-existing conditions, and the number of coverage denials increased significantly each year. (The House of Representatives Committee on Energy and Commerce, October 2010)
Young Adults and the Affordable Care Act of 2010 discusses the provisions that will benefit young adults, including the ability to stay on a parent’s health plan until age 26, the Medicaid expansion, and subsidies in the exchanges. More than 12 million young adults may gain subsidized coverage by 2014, and 7.2 million may gain coverage under Medicaid. (Commonwealth Fund, October 2010)
Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, January-March 2010 estimates rates of health insurance coverage, including private versus public coverage. Lack of health insurance is measured in three ways: whether a person was uninsured at the time of the interview, uninsured for at least part of the year, or uninsured for more than a year. (The Centers for Disease Control and Prevention, September 2010)
How Will the Patient Protection and Affordable Care Act Affect Small, Medium, and Large Businesses?provides an overview of the requirements and options for businesses under the new law, including the new Small Business Health Options Program (SHOP) exchanges that will be available to small (
How Will the Patient Protection and Affordable Care Act of 2010 Affect Young Adults? describes how different elements of health reform will help young adults, specifically the Medicaid expansion, subsidies for private insurance, the expansion of dependent coverage, and insurance market reforms. (Urban Institute and the Robert Wood Johnson Foundation, July 2010)
Realizing Health Reform’s Potential: Women and the Affordable Care Act of 2010 looks at how women will benefit from provisions that improve coverage and reduce premiums, eliminate pre-existing condition exclusions, eliminate gender rating, and others. Given that women, on average, use more health services over their lifetimes, the new law is likely to greatly improve women’s experience with the health care system. (The Commonwealth Fund, July 2010)
What Women Need to Know about Health Reform: Improving Access to Affordable Preventive Care looks at how women will benefit from provisions in health reform that expand coverage for preventive care in private plans, Medicare, and Medicaid, and that eliminate cost-sharing for those services. (National Women’s Law Center, June 2010)
Early Benefits from the Affordable Care Act of 2010 Reinsurance Program for Early Retirees explains why early retiree insurance is important, how the program will work, and answers some frequently asked questions, including about what types of plans are eligible and what types of services will qualify for reimbursement. (White House, May 2010)
Rite of Passage: Young Adults and the Affordable Care Act of 2010 discusses provisions in the new law that will help young adults gain health coverage. Key provisions include dependent coverage up to age 26, a Medicaid expansion, new health insurance “exchanges,” and subsidies to help people purchase private insurance. (Commonwealth Fund, May 2010)
Focus on Health Reform: Issues for Structuring Interim High-Risk Pools discusses the creation of high-risk pools in federal health reform legislation for people who are denied private coverage based on their health status. The brief examines the current role of high-risk pools as a safety net for coverage and reviews key issues involved in implementing a national high-risk pool. (Kaiser Family Foundation, January 2010)
Ask the Experts: High-Risk Pools is a webcast in which panelists discuss how high-risk pools work, including their funding, the benefits they provide, and the premiums that are charged to enrollees. Panelists also discussed how high-risk pools are a factor in helping stabilize the individual insurance market, as well as what role they might play in a reformed health care system. (Kaiser Family Foundation, July 2008)
On Their Own: Far from a Remedy, Individual Health Insurance Is a World of Pain details an investigation of individual health insurance and found that regulation of this market varies from state to state. Expenses normally run higher than insurance available through an employer. The investigation also found that 76 percent of uninsured adults said that they could not afford individual insurance. (Consumer Reports, January 2008)
The Illusion of Coverage: How Health Insurance Fails People when They Get Sick describes how private insurance fails to protect people from financial hardship when they become ill or are injured. The report discusses the aspects of insurance that lead to medical debt and that hamper people's ability to make meaningful choices when purchasing health plans, as well as the consequences of medical debt. It also provides recommendations on how to provide people with access to comprehensive and affordable insurance products. (The Access Project, March 2007)
Falling Through the Cracks: Stories of How Health Insurance Can Fail People with Diabetes l Executive Summary Obtaining and keeping quality, affordable health insurance is a challenge for people with diabetes. The culmination of 14 months of research on how people with diabetes fare in the health insurance market, this report shares the challenges and stories of more than 850 people from all 50 states and the District of Columbia. (The American Diabetes Association and the Georgetown Health Policy Institute, February 2005)
The market for people who buy their own coverage has long been a troubled segment of the health insurance industry. Many states have attempted to reform their individual health insurance market by requiring carriers to sell coverage to all applicants regardless of age or health; creating high-risk pools for those with preexisting conditions; and placing limits on the extent to which premiums can vary by age, sex, or health status. Insuring the Healthy or Insuring the Sick? The Dilemma of Regulating the Individual Health Insurance Market assesses the effectiveness of such regulatory reforms in seven states. (The Commonwealth Fund, February 2005)
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