With the New Year well underway, a range of health and health care issues remain top-of-mind for policymakers, health system leaders, and other stakeholders across the country. The opioid crisis and prescription drug costs, for example, are among the health care issues that garnered national attention in 2017 that seem likely to remain policy priorities in the months ahead.
Another major health care issue moving forward is the future of the Affordable Care Act (ACA) and the related policies implemented since the law’s passage in 2010. Over the past several years, health services and policy research has been a vital source of information in helping decision makers at the federal, state, and local levels identify how the law is being implemented across states, intended and unintended consequences, and opportunities for revisiting the law moving forward. However, many outstanding questions remain, both in terms of the ACA’s effects to-date as well as potential implications of efforts to repeal, replace, or repair all or parts of the law. Among them is how the repeal of the ACA’s individual mandate, included in the tax bill signed into law in December, will affect insurance markets, premiums, and coverage.
The Robert Wood Johnson Foundation (RWJF) recently awarded seven grants under its Research in Transforming Health and Health Care Systems (RTHS) program with broad relevance to current health reform debates. The RTHS program, managed by AcademyHealth, funds rigorous, empirical studies that evaluate or predict the potential effects of policies or policy changes intended to transform health and health care systems.
Two of the funded projects aim to better understand instability in the individual insurance market and identify potential policy solutions. Jean Abraham at the University of Minnesota will characterize patterns of insurer exit from the individual market and affected populations, estimate the impact of insurer exit on premiums and plan offerings from 2015 to 2018, and investigate efforts in three states to use Section 1332 State Innovation Waivers to fund new state reinsurance programs. Meanwhile, Mark Hall at Wake Forest University is partnering with researchers in the ACA Implementation Research Network to conduct interviews with health insurers, regulators, and others across the country in order to identify strategies states are pursuing or considering to stabilize health insurance markets.
Other projects explore state-driven Medicaid policy changes and the resulting cost and coverage impacts. This includes work by Patrick Wightman at the University of Arizona to understand the impact of enrollment freezes instituted in Arizona during the Great Recession as well as the effects of regaining coverage on health care utilization and costs. A project led by Craig Wilson at the University of Arkansas for Medical Sciences, Arkansas Center for Health Improvement, will examine policy changes passed by the Arkansas General Assembly last year that would scale back the state’s Medicaid financial eligibility threshold.
Three projects focus specifically on the experiences of health care providers and their patients under health reform policies, both current and proposed. In a project focusing on New Jersey, Derek DeLia at MedStar Research Institute and colleagues at Rutgers University will explore the extent to which physicians have been able to meet the growing demand for services generated by Medicaid expansion. David Wallace at the University of Pittsburgh will explore trends in hospital closures in Medicaid expansion states and in states that did not expand Medicaid and assess the impact of states’ expansion decisions on at-risk populations’ access to care at safety net and acute care hospitals. Finally, Anne Markus at George Washington University is testing a model that will simulate the effect of a proposal to finance Medicaid through block grants on health centers’ revenues and capacity to serve Medicaid and medically underserved patients.
AcademyHealth is working with the grantees as they conduct their studies, and in the coming months, will help disseminate findings to relevant stakeholder audiences in Washington, D.C. and across the country. Through this work, we aim to ensure that policymakers and other decision makers have access to rigorous, relevant research as they consider potential policy changes that could transform health and health care in the U.S. for years to come.