Big East Leads Going into March Madness

Mar 26, 2014, 8:57 AM, Posted by

Because every state has approached health reform differently, the Affordable Care Act (ACA) provides us with a unique opportunity to observe federalism in action. We now have 51 unique environments in which to assess the implementation of health reform.

Given the magnitude of the policy intervention, this variation provokes great interest in understanding the state’s role in health reform, and in disentangling policy and governance factors from other state characteristics.

A new report from the University of Pennsylvania’s Leonard Davis Institute looks at Marketplace enrollment and state exchange characteristics, and shows that states that created their own exchange have enrolled a higher percent of their eligible population in Marketplace plans than states that had the federal government partly or completely manage their exchange.

Last week, the Rockefeller Institute of Government suggested that the traditionally independent and pragmatic Western states are as a result “out front” in terms of ACA implementation.

However, a comparison of enrollment as a percent of the eligible population by region shows that, at least so far, the Western states may not actually be out front. That honor appears to go to the Northeast, which is home to many state exchanges (Massachusetts, Rhode Island, New York, Connecticut, and Vermont). Massachusetts aside, all have been relatively good performers—enrolling about 20 percent of eligible residents. In addition, Maine and New Hampshire, which have plan management and partnership arrangements, respectively, are also performing quite well relative to their peers, leaving only New Jersey and Pennsylvania faring about the same as the average federally facilitated Marketplaces (read report).

There are many interesting state or regional differences in enrollment patterns so far. They may reflect variation in current or past state policy decisions, the characteristics of eligible residents, the insurance or health care market, or some combination of these factors. For example, the West appears to be out front in terms of enrollment in bronze plans relative to other metal tiers, receipt of financial assistance is least common in the Northeast, and enrollment by females is highest in the South.

Understanding the nature of these differences will be important as we assess the impact of health reform and discover what conditions are associated with greater or lesser degrees of success in coverage expansion.

We are pleased today to introduce a new dataset that will make a significant contribution to efforts to understand these factors that drive state differences in ACA implementation. HIX 2.0, with funding from the Robert Wood Johnson Foundation (RWJF) and the Alfred P. Sloan Foundation, is a project of the HIX Research Group based at the University of Pennsylvania's Leonard Davis Institute of Health Economics. HIX 2.0 examines variation in implementation of the ACA across all 50 states and consists of multiple datasets that track each state’s key implementation decisions.

Four distinct datasets are being made available. They cover Exchange Governance Structure, Medicaid Expansion decisions, State Insurance Departments and SHOP Participation Rules.

Many questions regarding state variation in ACA implementation can be researched using HIX 2.0. These files will be regularly updated, and additional collections will be available here in the future. I hope you will enjoy exploring HIX 2.0 and the other new data sources that we will post here in weeks to come. Please send me comments or questions regarding the data via Twitter and join the conversation by using #ACAnumbers.