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From Health Affairs:


Less Known Aspects Of The ACA:  Marketplace Entry Outside Open Enrollment For Qualifying Life Events; And The Impact Of Potential Medicaid Rollbacks After 2019



Bethesda, MD--Recently the Affordable Care Act (ACA) passed its fifth birthday, with its many effects rippling through the entire health care system. Two new studies, being released by Health Affairs as Web Firsts, examine some of the ACA's features that have received less attention. Both studies will also appear in the journal's May issue.

Millions Of Americans May Be Eligible For Marketplace Coverage Outside Open Enrollment As A Result Of Qualifying Life Events


By Lacey Hartman, Giovann Alarcon Espinoza, Brett Fried, and Julie Sonier


Hartman, Alarcon Espinoza, and Fried are with the State Health Access Data Assistance Center (SHADAC) at the University of Minnesota; Sonier, SHADAC's former deputy director, is now with the Employee Insurance Division of Minnesota Management and Budget.


This study was supported by a grant from the Robert Wood Johnson Foundation.

The study estimated the numbers of Americans potentially eligible to enroll for health insurance in a Marketplace outside open enrollment periods as a result of experiencing "qualifying life events," such as a change in marital status, the number of dependents, or loss of other health coverage. Such events are not uncommon. However, no peer-reviewed research to date has examined how these events could affect eligibility for special enrollment periods. The authors used three waves (April 2012 through January 2013) of Survey of Income and Program Participation data, administered by the Census Bureau. They projected that 16.7 million people experienced a qualifying life event during that time, 8.4 million of whom may have enrolled in Marketplace coverage as a result of a qualifying life event because they were uninsured or with nongroup coverage. When looking at the results separately for states that expanded Medicaid and states that did not, they found that 4.9 million of the 8.4 million people lived in expansion states, with 3.5 million residing in nonexpansion states. "Our findings suggest that a large number of people are potentially eligible for special enrollment periods, and the majority of them are uninsured," the authors concluded. "There is a strong case to be made for continuing outreach efforts outside of open enrollment periods to expand access to coverage and strengthen the Marketplace risk pools."


If Rollbacks Go Forward, Up To 14 Million Children Could Become Ineligible For Public Or Subsidized Coverage By 2019


By Julie L. Hudson, Steven C. Hill, and Thomas M. Selden


The authors are affiliated with the Division of Modeling and Simulation, Center for Financing, Access, and Cost Trends, at the Agency for Healthcare Research and Quality (AHRQ).


This study investigated the potential health insurance options available to low-income children in the future if two changes were to happen: The Children's Health Insurance Program (CHIP) is not renewed after fiscal year 2017; and the Affordable Care Act's (ACA) maintenance-of-effort requirements are allowed to expire after 2019, thereby authorizing states to roll back Medicaid- and CHIP-eligibility thresholds. The authors examined data for the years 2005-10 from the Medical Expenditure Panel Survey, which is sponsored by the AHRQ. Based on these data and a simulation model, they found that 10.9 million children in the United States would lose eligibility for the separate CHIP if the program's funding was allowed to expire in 2017. If the ACA maintenance-of-effort requirements end in 2019, the authors found that an additional seven million children who were eligible for Medicaid, but lived in families with incomes above the statuary minimum thresholds, would lose eligibility for Medicaid. Among the 17.9 million children losing eligibility for public coverage, the authors simulate 4.0 million would be eligible for Marketplace subsidies. However, the remaining fourteen million children would not be eligible for Marketplace subsidies. "While not all states are likely to reduce eligibility to federal Medicaid statutory minimums, these estimates highlight the fact that many children who do lose public coverage eligibility will not become eligible for subsidized Marketplace coverage," the authors conclude. "Our study highlights the potential impacts on children's pathways to affordable coverage if CHIP funding is not renewed in 2017 and again after 2019 as ACA maintenance-of-effort requirements expire."


About Health Affairs

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print, with additional Web First papers published periodically at The full text of each Health Affairs Web First paper is available free of charge to all website visitors for a one-week period following posting, after which it switches to pay-per-view for nonsubscribers. Web First papers are supported in part by a grant from The Commonwealth Fund. You can also find the journal on Facebook and Twitter. Read daily perspectives on Health Affairs Blog. Download our podcasts, including monthly Narrative Matters essays, on iTunes. Tap into Health Affairs content with the new iPad app.