State Health Access Reform Evaluation

Field of Work: Health reform

Problem Synopsis: Before the passage of the Affordable Care Act (ACA), many states had taken the lead in developing and implementing policies designed to expand health insurance coverage for Americans. Potentially, many of these reforms represented innovative approaches to expanding coverage. State- and federal-level policy-makers needed to understand which of these coverage strategies were most effective. Once the ACA passed, the knowledge need was for information on how the states implemented the ACA.

Synopsis of the Work: The initial projects funded under the State Health Access Reform Evaluation (SHARE) program focused on affordability, sustainability, or administrative efficiency of state-level health reform. Starting in September 2010, the program began funding research and evaluation of implementation of the ACA at the state level. The program was reauthorized in October to develop an evidence-based resource for policy-makers seeking to learn about the successes and challenges of the implementation process.

Key Results

  • As of January 2012, the program has funded 19 state evaluation proposals. Projects included an evaluation of the impact of outreach and enrollment strategies in California; an assessment of the first use of auto-enrollment for a state coverage expansion; an evaluation of reforms to cover all children in the states of Illinois, Pennsylvania, and Washington; and an evaluation of risk selection in market-based state programs.

    Six projects funded since September 2010 projects focused on implementation of federal health reform at the state level, included ones focused on its impact on coverage programs for low-income adults, or the impact of extended dependent coverage to age 26.