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Although a Small Share of Medicare Part D Enrollees Take Specialty Drugs, A New Analysis Finds Those Who Do Can Face Thousands of Dollars in Out-of-Pocket Drug Costs Despite Plan Limits on Catastrophic Expenses

Some Medicare Part D enrollees can expect to pay thousands of dollars out-of-pocket for a single specialty drug in 2016, even though Part D plans provide substantial protection against catastrophic costs, according to a new analysis from the Kaiser Family Foundation. The findings illustrate how high prescription drug prices, one…

Medicare And Medicaid At 50

Medicare and Medicaid were signed into law by President Lyndon Johnson on July 30, 1965 in a bipartisan effort to provide health insurance coverage for low-income, disabled, and elderly Americans. In their 50 year history, each of these programs has come to play a key role in providing health coverage to millions of Americans today and make up a significant component of federal and state budgets. As major programs both in size and scope, their role and the ways in which they operate are often debated by policymakers and the public alike. As the programs reach their 50th year, the Kaiser Family Foundation conducted a nationally representative survey of Americans to explore the public’s views of these programs, their experiences as beneficiaries, and their opinions on proposals for future changes.

Survey of Non-Group Health Insurance Enrollees, Wave 2

The survey is the second in a series exploring the experiences and perceptions of people who purchase their own health insurance, the group perhaps most affected by the Affordable Care Act’s reforms to the individual insurance market and tax subsidies to make such coverage more affordable. It includes people in ACA-compliant plans sold both inside and outside the federal and state marketplaces, as well as those still in non-compliant plans, which took effect prior to January 2014 and in many cases do not comply with all the law’s requirements.

Abortion Coverage in Marketplace Plans, 2015

This brief analyzes state policies and insurer coverage decisions affecting the availability of abortion coverage in 2015 insurance plans offered through the Marketplaces. It finds that abortion coverage is unavailable in a total of 31 states, 24 of which have enacted laws that ban or restrict abortion coverage in plans sold through their Marketplaces and 7 of which have no abortion coverage restrictions but also have no Marketplace plans offering it.

Federal and State Standards for “Essential Community Providers” under the ACA and Implications for Women’s Health

Safety net providers such as community health centers and family planning clinics have served a significant role in the provision of primary care and reproductive health care services to low-income and uninsured people, particularly women. The Affordable Care Act (ACA) has a provision aimed at assuring that newly-insured individuals, as well as those without coverage, can continue seeing their trusted safety net providers, also called Essential Community Providers (ECPs). This brief reviews the definition of ECPs, examines the federal and state rules that govern the extent to which plans must include these providers in their networks, identifies the variation from state to state, and discusses the particular importance of these rules and providers for women’s access to care.

Consumer Assets and Patient Cost Sharing

Higher cost sharing in private insurance has been credited with helping to slow the growth of health care costs in recent years. For families with low incomes or moderate incomes, however, high deductibles, out-of-pocket limits and other cost sharing can be a potential barrier to care and may lead these families to significant financial difficulties. This issue brief uses information from the Federal Reserve Board’s 2013 Survey of Consumer Finances to look at how household resources match up against potential cost-sharing requirements for plans offered by employers or available in the individual market, including in the Affordable Care Act marketplaces.

How Much (More) Will Seniors Pay for a Doc Fix?

In this Policy Insight, the Foundation’s Cristina Boccuti and Tricia Neuman examine how Congress’ effort to permanently stave off scheduled cuts in Medicare’s physician payments could affect what Medicare beneficiaries pay for their care — both in premiums and in other potential changes — to offset the cost of the Sustainable Growth Rate (SGR) “doc fix.”

Media Briefing to Release New Survey Tracking California’s Previously Uninsured Residents Under the Affordable Care Act

Media-only web briefing that released a new survey tracking the experiences of California’s previously uninsured residents under the Affordable Care Act (ACA). New survey provides a detailed assessment of how well the ACA is working for previously uninsured residents in a state that embraced the ACA’s coverage expansion opportunities by establishing the Covered California insurance marketplace and expanding its Medi-Cal program.

California’s Previously Uninsured After The ACA’s Second Open Enrollment Period

The Kaiser Family Foundation California Longitudinal Panel Survey is a series of surveys that, over time, tracks the experiences and views of a representative, randomly selected sample of Californians who were uninsured prior to the major coverage expansions under the Affordable Care Act (ACA). The initial baseline survey was conducted with a representative sample of 2,001 nonelderly uninsured Californian adults in summer 2013, prior to the ACA’s initial open enrollment period. The second survey in the series followed up with the same group of previously uninsured Californians who participated in the baseline (a longitudinal panel survey). The third in the series, and the focus of this report, followed up with them again after the second open enrollment period in spring 2015 to find out whether more have gained coverage, lost coverage, or remained uninsured, what barriers to coverage remain, how those who now have insurance view their coverage, and to assess the impacts that gaining health insurance may have had on financial security and access to care.

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.