The Affordable Care Act. Part II. October 17, 2014 Ross K. Airington, MPA VCU Office of Health Innovation. Background. Why Is Health Reform Needed?. In 2012, there were nearly 48 million uninsured Americans
October 17, 2014
Ross K. Airington, MPA
VCU Office of Health Innovation
Source: The Kaiser Family Foundation and Health Research & Educational Trust, “Employer Health Benefits: 2013 - Summary of Findings.”
Work Status of the Nonelderly Uninsured
Source: Macri, J. Lynch, V., Kenney, G., Profile of Virginia’s Uninsured, 2010, The Urban Institute, Prepared for the Virginia Health Care Foundation, March 2012.
less likely to have an unpaid medical bill
decrease in average health care costs per year
relative reduction in mortality rates
less likely to borrow money or fail to pay other bills because of medical debt
Sources: Health Affairs, The New England Journal of Medicine, National Bureau of Economic Research
Enacted in March, 2010 with the goals of:
Ensuring access to quality health care
Providing affordable health insurance to the uninsured
By 2024 will expand coverage to ≈ 26 million currently uninsured Americans
Net cost of coverage expansion is $1.383 trillion over 10 years (2015-2024)
Source: Congressional Budget Office, Updated Estimates of the Effects of the Insurance Coverage Provisions of the Affordable Care Act, April, 2014
due to a pre-existing condition
lifetime benefit limits
Source: The Kaiser Family Foundation
The White House. FACT SHEET: Affordable Care Act by the Numbers. April 17, 2014.
HHS. Health Insurance Marketplace: Summary Enrollment Report for the Initial Annual Open Enrollment Period. May 1, 2014
Source: Kaiser Family Foundation, State Health Facts: Medicaid & CHIP
Federal Poverty Level
*Medicaid DSH and Indigent Care, Presentation to the Senate Finance Committee, Health and Human Resources Subcommittee, Scott Crawford, Department of Medical Assistance Services, January 27, 2014,
Source: “Medicaid DSH and Indigent Care”, Presentation to the Senate Finance Committee, Health and Human Resources Subcommittee, Scott Crawford, Department of Medical Assistance Services, January 27, 2014,
Medicaid DSH and Indigent Care, Presentation to the Senate Finance Committee, Health and Human Resources Subcommittee, Scott Crawford, Department of Medical Assistance Services, January 27, 2014,
“The growth in Medicaid expansion states starkly contrasts the experience in the 24 states that did not expand the joint federal-state health program. In those states, hospitals continued to see flat or sagging admission rates and little reduction in the number of uninsured, largely non-paying patients.”
“While these trends were expected, the gap in Medicaid enrollment between expansion and non-expansion states is greater than most industry analysts predicted.After a strong start to the year, health systems have recalculated their previous estimates to adjust for higher than expected enrollment and revenues. Many have projected a strong finish to the year.”
In Medicaid expansion states, the shifts between Medicaid and self-pay admissions were dramatic through the first half of 2014
Source: PwC Health Research Institute. Medicaid 2.0: Health systems have and have notsof ACA expansion. September 2014.
Key Facts about the Uninsured Population, The Henry J. Kaiser Foundation, http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/
The Coverage Gap
190,000 Adults in VA
5.2 Million Nationwide
Source: Kaiser Family Foundation, The Coverage Gap: Uninsured Poor Adults in States that Do No Expand Medicaid, October 2013
Budget adopted by the 2013 VA General Assembly included language allowing for Medicaid expansion up to 138% FPL, if and only if certain reforms are made to the existing Medicaid program
…wait for it…
Source: House of Delegates Clerk’s Office
Source: Trish, E, Damico, A., Claxton, G., Levitt, L., & Garfield, R. (2011). A profile of health insurance exchange enrollees. Retrieved from www.kff.org/healthreform/upload/8147.pdf
1. Goodson, J.D. (2010). Patient protection and affordable care act: Promise and peril for primary care. Annals of Internal Medicine, 152(11), 742-744.
2. Schwartz, M.D. (2012). The US primary care workforce and graduate medical education policy. Journal of American Medical Association, 308, 2252-3.
3. Inglehart, J.K. (2012). Expanding the role of advanced nurse practitioners-risks and rewards. New England Journal of Medicine, 368 (20), 1935-1941.
Source: American Association of Nurse Practioners. Retrieved at http://www.aanp.org/images/documents/state-leg-reg/stateregulatorymap.pdf