Publications: Health Insurance

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America's Underinsured: A State-by-State Look at Health Insurance Affordability Prior to the New Coverage Expansions

March 25, 2014 - Thirty-two million people under age 65 were underinsured in the U.S. in 2012, meaning they had health coverage but it provided inadequate protection against high health care costs relative to their income. This report finds that the rate of underinsured ranged from a low of 8 percent in New Hampshire to highs of 17 percent in Idaho and Utah.

Fund Report

Implementing the Affordable Care Act: State Action to Establish SHOP Marketplaces

March 14, 2014 - This brief examines state decisions to enhance the value of the small-business marketplaces for small employers and finds that most have set predictable participation and eligibility requirements and will offer a competitive choice of insurers and plans.

Issue Brief

"Now I Can Sleep at Night": Stories of Finding Health Insurance in the Affordable Care Act's Marketplaces

March 4, 2014 - This new, photo-rich Commonwealth Fund feature, "'Now I Can Sleep at Night': Stories of Finding Health Coverage in the Affordable Care Act's Marketplaces," shares the stories of Americans who have found peace of mind and stronger financial security through the new insurance marketplaces.


Trends in the Financial Burden of Medical Care for Nonelderly Adults with Diabetes, 2001 to 2009

February 28, 2014 - The financial burden borne by patients for treatment of diabetes has decreased. Patients' out-of-pocket spending on prescription medications dropped from $1,095 over the period 2001 to 2003 to $763 over 2007 to 2009, largely because of a shift from brand-name drugs to generics.

In the Literature

Young Adult Participation in the Health Insurance Marketplaces:
Just How Important Is It?

February 12, 2014 - The participation of young adults may not be as critical to the success of the Affordable Care Act's health insurance marketplaces as is widely believed, according to this report based on the perspectives of prominent actuaries, insurers selling plans in the marketplaces, policy researchers, and federal officials.

Fund Report

Implementing the Affordable Care Act: The State of the States

January 31, 2014 - Although their approaches may vary, most states have taken steps to prepare for the Affordable Care Act's health insurance market reforms, marketplaces, and Medicaid expansion, a new Commonwealth Fund report finds.

Fund Report

Improvements in Health Status After Massachusetts Health Care Reform

January 10, 2014 - In Milbank Quarterly, former Commonwealth Fund Harkness Fellow Philip J. Van der Wees and coauthors examine whether the Massachusetts coverage expansions resulted in better health status and increased access to preventive health services for residents.

In Brief

Americans' Experiences in the Health Insurance Marketplaces: Results from the First Three Months

January 9, 2014 - A new Commonwealth Fund survey finds that 24 percent of Americans who are potentially eligible for health insurance coverage under the Affordable Care Act had visited one of the new insurance marketplaces by the end of December to find a health plan.

Data Brief

What's Behind Health Insurance Rate Increases? An Examination of What Insurers Reported to the Federal Government in 2012–2013

December 19, 2013 - This issue brief analyzes filings for rate increases of 10 percent or more that took effect between July 2012 and June 2013, and were for products covering at least 150 people. The findings indicate that medical costs were the main drivers of these larger increases, based both on increasing use of medical services and higher unit prices.

Issue Brief

What States Are Doing to Simplify Health Plan Choice in the Insurance Marketplaces

December 18, 2013 - This issue brief examines the policies set by some state-based marketplaces to simplify plan choices: adopting a meaningful difference standard, limiting the number of plans or benefit designs insurers
may offer, or requiring standardized benefit designs.

Issue Brief

How Are State Insurance Marketplaces Shaping Health Plan Design?

December 17, 2013 - Part of states' roles in administering the new health insurance marketplaces is to certify the health plans available for purchase. This analysis focuses on how state-based and state partnership marketplaces are using their flexibility in setting certification standards to shape plan design in the individual market.

Issue Brief

How States Stand to Gain or Lose Federal Funds by Opting In or Out of the Medicaid Expansion

December 5, 2013 - The 20 states choosing not to expand their Medicaid programs under the Affordable Care Act are forgoing billions of dollars in federal funds, while residents in their states are contributing to the cost of the expansions in other states, according to a new Commonwealth Fund study.

Issue Brief

Americans' Experiences in the Health Insurance Marketplaces: Results from the First Month

November 4, 2013 - This Commonwealth Fund survey found that more than half of U.S. adults who are potentially eligible for health coverage under the Affordable Care Act, but who have not yet signed up for a plan, say they will likely try to enroll or to find out about financial help by the end of March 2014, the close of the open enrollment period.

Data Brief

Small Employer Perspectives on the Affordable Care Act's Premiums, SHOP Exchanges, and Self-Insurance

October 16, 2013 - This Commonwealth Fund-supported study in Health Affairs finds that several features of the small-businesses insurance marketplaces appeal to small-business owners, but that affordability will be a key consideration in their decision to purchase coverage from the marketplaces.

In the Literature

A Tale of Two States: The Health Care Income Divide Visualized

September 18, 2013 - Watch this interactive explainer featuring highlights from The Commonwealth Fund Scorecard on State Health System Performance for Low-Income Populations, 2013.