1. Analysis of the 2018 U.S. Current Population Survey by Ougni Chakraborty and Sherry Glied of New York University for the Commonwealth Fund.
2. One of the ACA’s most notable provisions aimed at employers was the so-called employer mandate — the requirement that large firms offer affordable coverage to full-time employees or pay penalties.
3. Princeton Survey Research Associates International conducted the prior-year Biennial Surveys analyzed in this brief.
4. Centers for Medicare and Medicaid Services, “Effectuated Enrollment for the First Half of 2018,” fact sheet, Nov. 28, 2018.
5. Sara R. Collins and David C. Radley, The Cost of Employer Insurance Is a Growing Burden for Middle-Income Families (Commonwealth Fund, Dec. 2018).
6. Benjamin D. Sommers et al.,“Three-Year Impacts of the Affordable Care Act: Improved Medical Care and Health Among Low-Income Adults,” Health Affairs Web First, published online May 17, 2017; and Munira Z. Gunja, Sara R. Collins, and Herman K. Bhupal, Is the Affordable Care Act Helping Consumers Get Health Care? Findings from the Commonwealth Fund Affordable Care Act Tracking Survey, March–June 2017 (Commonwealth Fund, Dec. 2017).
7. Tainya C. Clarke, Tina Norris, and Jeannine S. Schiller, Early Release of Selected Estimates Based on Data From the 2016 National Health Interview Survey (National Center for Health Statistics, May 2017).
8. Robin A. Cohen and Jeannine S. Schiller, Problems Paying Medical Bills Among Persons Under Age 65: Early Release of Estimates from the National Health Interview Survey, 2011–June 2016 (National Center for Health Statistics, Dec. 2015).
9. “Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services Under the Patient Protection and Affordable Care Act,” Federal Register 75, no. 137 (July 19, 2010): 41726–60.
10. In three states — Idaho, Nebraska, and Utah — voters approved ballot initiatives to expand eligibility for Medicaid; Kansas elected a Democratic governor who has pledged to expand; Maine’s newly elected Democratic governor is expanding Medicaid one year after voters approved a ballot initiative to expand. See Donald Moulds et al., “The Midterm Election Results Have Big Implications for Health Care,” To the Point (blog), Commonwealth Fund, Nov. 7. 2018.
11. Matthew Buettgens, The Implications of Medicaid Expansion in the Remaining States: 2018 Update (Urban Institute, May 2018); and Rachel Garfield, Anthony Damico, and Kendal Orgera, The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid (Henry J. Kaiser Family Foundation, June 2018).
12. American Academy of Actuaries, Drivers of 2016 Health Insurance Premium Changes (AAA, Aug. 2015).
13. Sara R. Collins, “Consumers Shopping for Health Plans Are Left in the Dark by Trump Administration,” To the Point (blog), Commonwealth Fund, July 19, 2018.
14. Sara R. Collins, Munira Z. Gunja, and Michelle M. Doty, Following the ACA Repeal-and-Replace Effort, Where Does the U.S. Stand on Insurance Coverage? Findings from the Commonwealth Fund Affordable Care Act Tracking Survey, March–June 2017 (Commonwealth Fund, Sept. 2017).
15. Jodi Liu and Christine Eibner, Expanding Enrollment Without the Individual Mandate: Options to Bring More People into the Individual Market (Commonwealth Fund, Aug. 2018).
16. Timothy S. Jost, “Fixing Our Most Pressing Health Insurance Problems: A Bipartisan Path Forward,” To the Point (blog), Commonwealth Fund, July 13, 2017.
17. Christine Eibner, Sarah Nowak, and Jodi Liu, Hillary Clinton’s Health Care Reform Proposals: Anticipated Effects on Insurance Coverage, Out-of-Pocket Costs, and the Federal Deficit (Commonwealth Fund, Sept. 2016).
18. Matthew Buettgens, Stan Dorn, and Hannah Recht, More Than 10 Million Uninsured Could Obtain Marketplace Coverage Through Special Enrollment Periods (Robert Wood Johnson Foundation and Urban Institute, Nov. 2015).
19. Sara R. Collins, Sherry A. Glied, and Adlan Jackson, The Potential Implications of Work Requirements for the Insurance Coverage of Medicaid Beneficiaries: The Case of Kentucky (Commonwealth Fund, Oct. 2018).
20. Benjamin D. Sommers, “Loss of Health Insurance Among Non-Elderly Adults in Medicaid,” Journal of General Internal Medicine 24, no. 1 (Jan. 2009): 1–7.
21. Christina Cousart, How Elimination of Cost-Sharing Reduction Payments Changed Consumer Enrollment in State-Based Marketplaces (National Academy for State Health Policy, March 20, 2018).
22. Centers for Medicare and Medicaid Services, “CMS Issues the Proposed Payment Notice for the 2020 Coverage Year,” news release, Jan. 17, 2019.
23. Munira Z. Gunja, Sara R. Collins, and Sophie Beutel, How Deductible Exclusions in Marketplace Plans Improve Access to Many Health Care Services (Commonwealth Fund, Mar. 2016).
24. Sara R. Collins, “The Trump Administration’s New Marketplace Rules: Regulatory Simplification or More Complexity for Consumers?” To the Point (blog), Commonwealth Fund, Apr. 13, 2018.
25. Jon R. Gabel et al., Consumer Cost-Sharing in Marketplace vs. Employer Health Insurance Plans, 2015 (Commonwealth Fund, Dec. 2015).
26. Christine Eibner, Sarah Nowak, and Jodi Liu, Hillary Clinton’s Health Care Reform Proposals: Anticipated Effects on Insurance Coverage, Out-of-Pocket Costs, and the Federal Deficit (Commonwealth Fund, Sept. 2016).
27. Jack Hoadley, Kevin Lucia, and Maanasa Kona, “State Efforts to Protect Consumers from Balance Billing,” To the Point (blog), Commonwealth Fund, Jan. 18, 2019.
28. David Blumenthal, Lovisa Gustafsson, and Shawn Bishop, “To Control Health Care Costs, U.S. Employers Should Form Purchasing Alliances,” Harvard Business Review, published online Nov. 2, 2018.
29. Henry Waxman et al., Getting to the Root of High Prescription Drug Prices (Commonwealth Fund, July 2017).
30. Richard M. Scheffler, Daniel R. Arnold, and Christopher M. Whaley, “Consolidation Trends in California’s Health Care System: Impacts on ACA Premiums and Outpatient Visit Prices,” Health Affairs 37, no. 9 (Sept. 2018): 1409–16.