Background and Research on Healthcare Reform

Please click or scroll down for:
Reports, Articles, and Briefs
Infographics and Tools
Region VIII PCA Websites
Post-Open Enrollment
Other Websites


Patient Protection and Affordable Care Act (ACA)
The Patient Protection and Affordable Care Act legislation was signed into law March 23, 2010. Some of the main features of the law that affect Health Centers and Primary Care Associations (PCAs) are the health insurance marketplaces and the expansion of Medicaid, which came into effect in January 2014.
Full Text of the Patient Protection and Affordable Care Act Legislation


Center on Budget and Policy Priorities
Document that describes how enrollment in Medicaid and the new health insurance marketplaces will likely follow the early experience with CHIP enrollment (November 2013)
CHIP Experience Shows That Health Reform Enrollment Will Take Time to Ramp Up

Report that concludes health reform is not significantly causing employers to move employees to part-time or hire part-time employees as critics claim (October 2013)
Health Reform Not Causing Significant Shift to Part-Time Work

Centers for Medicare and Medicaid Services (CMS)
Document that describes the provision in the ACA that 80% of health insurance premiums must go to actual healthcare and not overhead (2012)
80/20 Rule Delivers More Value to Consumers in 2012

Colorado Health Institute
Report that gives a detailed picture of Colorado’s uninsured population (May 2014)
The Colorado Eligibility Atlas

The Commonwealth Fund
List of states that are implementing or rejecting the policy cancellations fix and implications of the decisions (January 2014)
State Decisions on the Health Insurance Policy Cancellations Fix

Article that analyzes the president’s policy fix for canceled health insurance plans (November 2013)
Pros and Cons of the President’s Policy Fix for Health Plan Cancellations

Issue brief that discusses provisions of the ACA that will benefit low-income individuals and challenges that lie ahead (October 2013)
The Affordable Care Act’s New Tools and Resources to Improve Health and Care for Low-Income Families Across the Country

Report that compares health indicators in different states, analyzes health disparities among states, and discusses how with national health reform, the states have a historic opportunity to improve healthcare (2013)
Health Care in the Two Americas: Findings from the Scorecard on State Health System Performance for Low-Income Populations, 2013

Conversations on Health Care
Podcast which examines how efforts to derail health coverage for Americans has become political ‘kryptonite’ and how there must be bipartisan solutions to expanding coverage, reducing drug costs and addressing health disparities in this country (November 2019)
United States of Care Founder Andy Slavitt on the ACA, Expanding Coverage, and Fixing US Health Care

Enroll America
Analysis of effectuated enrollment data from CMS including SEP activity through March 31, 2016 (July 2016)
ICYMI: Effectuated Enrollment Snapshot Released with New Special Enrollment Period (SEP) Data

Families USA
Report on how the open enrollment periods can be improved in the future (April 2014)
Accelerating the ACA’s Enrollment Momentum: 10 Recommendations for Future Enrollment Periods

U.S. Department of Health and Human Services (HHS)
Interim rule from March 2014 on requiring issuers of QHPs to accept third-party payments (March 2014)
Patient Protection and Affordable Care Act; Third Party Payment of Qualified Health Plan Premiums

Internal Revenue Service (IRS)
Website that describes the impact of the ACA on various kinds of taxes
Affordable Care Act Tax Provisions

Kaiser Health News
Article that lists ten things that many people do not know are part of the ACA (July 2012)
Ten Things You Didn’t Know Were in the Affordable Care Act

The Kaiser Family Foundation
A report detailing who is still eligible for Medicaid/CHIP but is uninsured after OE3 (February 2016)
A Closer Look at the Remaining Uninsured Population Eligible for Medicaid and CHIP

Fact sheet on how the ACA will expand coverage to the uninsured in every state (April 2014)
How Will the Uninsured Fare Under the Affordable Care Act?

Report on how insurance coverage changed during the first open enrollment period (April 2014)
Measuring Changes in Insurance Coverage Under the Affordable Care Act

National Academy for State Health Policy
Snapshot of ACA Marketplace Enrollment 2014-2018, including information on policies and investment in outreach and application assistance for consumers (December 2018)
Why Is Affordable Care Act Marketplace Enrollment Declining?

National Health Law Program
Document that explains how to calculate Modified Adjusted Gross Income (MAGI), the new methodology used to evaluate income to determine eligibility for Medicaid, CHIP, and the health insurance marketplaces under the ACA (Updated for 2018)
The Advocate’s Guide to MAGI

The New England Journal of Medicine
Assessment of the impact of the Affordable Care Act on health indicators and on coverage patterns post-open enrollment 2013-2014 (July 2014)
Health Care Coverage under the Affordable Care Act — A Progress Report

Urban Institute Health Policy Center
Document on the coordination and integration of enrollment and retention procedures (December 2013)
Overlapping Eligibility and Enrollment: Human Services and Health Programs Under the Affordable Care Act


Community Catalyst
A toolkit that focuses on pushing back against new requirements in Medicaid. This toolkit is based on focus group research that Community Catalyst conducted with PerryUndem Research/Communication and GMMB in late February 2018.
Medicaid Makes the Difference Toolkit

The Commonwealth Fund
Interactive representation of a July 2014 survey showing the effects of the ACA on reducing uninsured rates in key groups (July 2014)
Gaining Ground: Americans’ Health Insurance Coverage and Access to Care After the Affordable Care Act’s First Open Enrollment Period

Families USA
Infographic on who is receiving financial assistance under the ACA (March 2014)
Financial Assistance and the Affordable Care Act: Who Benefits

Infographic on who is benefiting from the ACA provision on pre-existing conditions (March 2014)
Pre-existing Health Conditions and the Affordable Care Act: Who Benefits

Graphic and timeline of the key features of the ACA
Key Features of the Affordable Care Act

Flowchart that illustrates employer responsibilities for health insurance under the ACA (July 2013)
Employer Responsibility under the Affordable Care Act

Flowchart that illustrates how the requirement to buy health insurance, the “individual mandate”, works (April 2013)
The Requirement to Buy Coverage under the Affordable Care Act

Thorough list of questions about the ACA that can easily be searched
Frequently Asked Questions

Interactive tool designed to explain how and when the provisions of the ACA will be implemented over the next several years
Health Reform Implementation Timeline

State Health Access Data Assistance Center (SHADAC)
An interactive graphic outlining state level trends in CHIP enrollments as of 2016 (February 2016)
State Level Trends in Children’s Health Insurance Coverage (2016 Report)


Association for Utah Community Health (AUCH)
AUCH is part of the Take Care Utah Collaborative:
Take Care Utah

Colorado Community Health Network (CCHN)
The Covering Kids and Families project is a branch of CCHN, Colorado’s Primary Care Association. The website has information about health care reform and outreach and enrollment
Covering Kids and Families

Community HealthCare Association of the Dakotas (CHAD)
In October 2014, CHAD launched two new websites dedicated to providing information about the ACA and helping consumers find in-person assistance. These websites will serve as the primary resource for information on Marketplace and Medicaid eligibility and enrollment in the Dakotas
Get Covered North Dakota
Get Covered South Dakota

Montana Primary Care Association (MPCA)
In May 2015, MPCA launched a new website providing information about the ACA and Montana-specific resources. This website will serve as the primary resource for information on Marketplace and Medicaid enrollment in Montana
Cover Montana


2015-2016 Reports

Enroll America
Report detailing the changes in coverage from OE2 to OE3 in all 50 states (March 2016)
How the Health Insurance Landscape has Changed for 2016

Kaiser Family Foundation
The third annual survey from KFF that seeks to shed light on the experiences and opinions of those purchasing their own health insurance in the non-group market (May 2016)
Survey of Non-Group Health Insurance Enrollees, Wave 3

A survey highlighting the successes and challenges the in-person assistance community is facing as they continue to enroll consumers in coverage for OE4 (June 2016)
2016 Survey of Health Insurance June 2016 Marketplace Assister Programs and Brokers

Report providing an update on the demographics of uninsured adults in non-expansion states (January 2016)
The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid – An Update

Report providing an update on who is eligible for insurance under the ACA but still uninsured (January 2016)
New Estimates of Eligibility for ACA Coverage among the Uninsured

2014-2015 Reports

National Academy for State Health Policy
Brief examining states’ early experiences implementing ACA’s eligibility and enrollment requirements; highlighting promising practices and lessons learned; provides some context on the state experience; and concluding with possible areas of focus for future enrollment and implementation efforts
State Enrollment Experience: Implementing Health Coverage Eligibility and Enrollment Systems Under the ACA

Enroll America
Annual report detailing successful messaging and outreach strategies in the second open enrollment period
State of Enrollment: Helping America Get Covered and Stay Covered, 2014 – 2015

Kaiser Family Foundation
Report discussing the effects of health coverage on perceptions of financial security
How Does Gaining Coverage Affect People’s Lives? Access, Utilization, and Financial Security among Newly Insured Adults

2013-2014 Reports

The Commonwealth Fund
Study evaluating the efficacy of the ACA in reducing uninsured rates in key groups (July 2014)
Gaining Ground: Americans’ Health Insurance Coverage and Access to Care After the Affordable Care Act’s First Open Enrollment Period

Enroll America
Report estimating the number of individuals still eligible for Special Enrollment Periods (SEPs) who have not enrolled, as of August 2014 (August 2014)
State Estimates of the Number of Uninsured Adults Eligible for a Special Enrollment Period in 2014

Kaiser Family Foundation
A report comparing the effects of Medicaid expansion decisions on community health centers (September 2014)
Community Health Centers: A 2013 Profile and Spotlight on Implications of State Medicaid Expansion Decisions

Gallup Healthways Survey
Survey showing the differences in uninsurance rates in states with state-based exchanges and expanded Medicaid versus FFM and non-expansion states (August 2014)
Medicaid expansion, state exchanges linked to faster reduction in uninsured rate

Survey tracking percentage of uninsured adults across the U.S. from the third quarter of 2013 to the second quarter of 2014 (July 2014)
In U.S., Uninsured Rate Sinks to 13.4% in Second Quarter

Urban Institute
Report detailing changes in provider networks for Marketplace plans offered by private insurance companies (September 2014)
Implementation of the Affordable Care Act: Cross-Cutting Issues Six-State Case Study on Network Adequacy

Report detailing the effect of not expanding Medicaid on state budgets and hospitals (August 2014)
What Is the Result of States Not Expanding Medicaid?

Broad study tracking numbers of uninsured consumers nationally from September 2013 to June 2014 (July 2014)
Number of Uninsured Adults Continues to Fall under the ACA: Down by 8.0 Million in June 2014


Substance Abuse and Mental Health Services Administration (SAMHSA)
Website that provides information about the ACA
Health Reform