The Patient Protection and Affordable Care Act (PPACA), the health reform bill signed by President Obama on March 23, 2010, included many provisions left to state governments to implement. The provisions range from keystone items such as the establishment of health insurance exchanges to short-term demonstration programs to new options for expanding Medicaid. AAFP chapters should consider engaging their state governments as they implement health reform. Many opportunities exist for the advancement of family medicine’s priorities, particularly the patient-centered medical home. Likewise, many opportunities exist for other providers to encroach on areas where family physicians do not appear engaged.
The resources provided below are informational only with the intent to help family physicians have an active voice in the implementation of health reform at the state-level. States are laying the groundwork for reform now; family medicine’s input is essential.
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State Implementation of Federal Health Reform
AAFP RESOURCES
Health Reform: State Opportunities and Responsibilities, September 2010
Health Reform: Next Steps, State Issues, presentation by Greg Martin, June 2010
Primary Care and Health Reform, presentation by Kevin Burke and Andrew Bazemore, MD, MPH, September 2010
Health Insurance Exchanges, presentation by Lori Heim, MD, August 2010
Health Insurance Exchanges: Variation in State Efforts, March 2011
Accountable Care Organizations: Can They Rein In Health Care Spending for States?, January 2011
Health Reform: Next Steps, State Issues, presentation by Greg Martin, June 2010
Primary Care and Health Reform, presentation by Kevin Burke and Andrew Bazemore, MD, MPH, September 2010
Health Insurance Exchanges, presentation by Lori Heim, MD, August 2010
Health Insurance Exchanges: Variation in State Efforts, March 2011
Accountable Care Organizations: Can They Rein In Health Care Spending for States?, January 2011
STEPS FOR STATE IMPLEMENTATION
Health System Reform and Your Practice, May 2010 (AMA)
State Roles in Delivery System Reform, July 2010 (NGA)
State Implementation of National Health Reform: Harnessing Federal Resources to Meet State Policy Goals, July 2010 (RWJF, AcademyHealth)
Delivering on the Promise: A State Guide to the Next Steps for Health Care Reform, June 2010 (U.S. PIRG Education Fund)
State Grant Opportunities in PPACA, May 2010 (NCSL)
State Legislators’ Check List for Health Reform Implementation, February 2011 (NCSL)
Potential Funding Opportunities for States, April 2010 (NAIC)
State of the States: Laying the Foundation of Health Reform, February 2011 (RWJF & AcademyHealth)
Re-Forming Health Care Delivery Systems: A Summary of a Forum for States and Health Centers, March 2011 (NASHP)
State Roles in Delivery System Reform, July 2010 (NGA)
State Implementation of National Health Reform: Harnessing Federal Resources to Meet State Policy Goals, July 2010 (RWJF, AcademyHealth)
Delivering on the Promise: A State Guide to the Next Steps for Health Care Reform, June 2010 (U.S. PIRG Education Fund)
State Grant Opportunities in PPACA, May 2010 (NCSL)
State Legislators’ Check List for Health Reform Implementation, February 2011 (NCSL)
Potential Funding Opportunities for States, April 2010 (NAIC)
State of the States: Laying the Foundation of Health Reform, February 2011 (RWJF & AcademyHealth)
Re-Forming Health Care Delivery Systems: A Summary of a Forum for States and Health Centers, March 2011 (NASHP)
STATE-SPECIFIC ACTIONS & OPPORTUNITIES
State Implementation of Federal Health Reform: Legislative & Executive Actions, (NCSL)
State Legislative Tracking Database: Federal Health Reform, (NCSL)
Health Reform State Implementation Entities, (NCSL)
Health Insurance Premium Grants: Detailed State by State Summary of Proposed Activities, (HealthCare.gov)
Staying on Top of Health Reform: An Early Look at Workforce Challenges in Five States, September 2010 (Kaiser)
State Legislative Tracking Database: Federal Health Reform, (NCSL)
Health Reform State Implementation Entities, (NCSL)
Health Insurance Premium Grants: Detailed State by State Summary of Proposed Activities, (HealthCare.gov)
Staying on Top of Health Reform: An Early Look at Workforce Challenges in Five States, September 2010 (Kaiser)
HEALTH INSURANCE EXCHANGES under PPACA
AAFP Letter to CMS on Navigator Proposed Rule, May 15, 2013
Health Insurance Marketplace FAQ for Patients, May 15, 2013
Health Insurance Marketplace Brief, May 15, 2013
Health Benefit Exchanges: An Implementation Timeline for State Policymakers, July 2010 (RWJF, AcademyHealth)
Health Insurance Exchange Basics, February 2011 (NASHP)
PPACA Requirements for Offering Health Insurance Inside Versus Outside an Exchange, June 2010 (Congressional Research Service)
Health Insurance Exchanges and the Affordable Care Act: Key Policy Issues, June 2010 (The Commonwealth Fund)
Health Insurance Exchanges (Health Reform GPS)
Health Insurance Exchanges: New Coverage Options for Children and Families, August 2010 (Health Policy Institute Georgetown University)
Insurance Exchanges Under Health Reform: Six Design Issues For The States, June 2010 (Health Affairs)
States Should Structure Insurance Exchanges to Minimize Adverse Selection, August 2010 (CBPP)
Initial Guidance to States on Exchanges, (CCIIO)
Programs and Initiatives: Health Insurance Exchanges, (CCIIO)
American Health Benefit Exchange Model Act, November 2010 (NAIC)
Committees & Activities: Exchanges (B) Subgroup, (NAIC)
Designing an Exchange: A Toolkit for State Policymakers, January 2011 (NASI)
Exchange Resources for States, (State Refor(u)m)
Be Strategic with Insurance Exchanges, (State Refor(u)m)
Health Insurance Exchange Resources, (Families USA)
Insurance Exchanges: Reports and Analysis, (RWJF State Coverage Initiatives)
Health Insurance Marketplace FAQ for Patients, May 15, 2013
Health Insurance Marketplace Brief, May 15, 2013
Health Benefit Exchanges: An Implementation Timeline for State Policymakers, July 2010 (RWJF, AcademyHealth)
Health Insurance Exchange Basics, February 2011 (NASHP)
PPACA Requirements for Offering Health Insurance Inside Versus Outside an Exchange, June 2010 (Congressional Research Service)
Health Insurance Exchanges and the Affordable Care Act: Key Policy Issues, June 2010 (The Commonwealth Fund)
Health Insurance Exchanges (Health Reform GPS)
Health Insurance Exchanges: New Coverage Options for Children and Families, August 2010 (Health Policy Institute Georgetown University)
Insurance Exchanges Under Health Reform: Six Design Issues For The States, June 2010 (Health Affairs)
States Should Structure Insurance Exchanges to Minimize Adverse Selection, August 2010 (CBPP)
Initial Guidance to States on Exchanges, (CCIIO)
Programs and Initiatives: Health Insurance Exchanges, (CCIIO)
American Health Benefit Exchange Model Act, November 2010 (NAIC)
Committees & Activities: Exchanges (B) Subgroup, (NAIC)
Designing an Exchange: A Toolkit for State Policymakers, January 2011 (NASI)
Exchange Resources for States, (State Refor(u)m)
Be Strategic with Insurance Exchanges, (State Refor(u)m)
Health Insurance Exchange Resources, (Families USA)
Insurance Exchanges: Reports and Analysis, (RWJF State Coverage Initiatives)
MEDICAID / CHIP under PPACA
Medicaid and CHIP Provisions in Health Reform Law, April 2010 (Kaiser)
Bundled Payments – Medicaid Demonstration Project, (Health Reform GPS)
Holding the Line on Medicaid and CHIP: Key Questions and Answers About Health Care Reform’s Maintenance of Effort Requirements, March 2010 (CBPP, Georgetown University Health Policy Institute)
Implementing the Medicaid Primary Care Rate Increase: A Roadmap for States, March 2011 (CHCS)
Key Questions About Medicaid And Its Role in State/Federal Budgets and Health Reform, February 2011 (Kaiser)
Medicaid and CHIP: Given the Association between Parent and Child Insurance Status, New Expansions May Benefit Families, February 2011 (GAO)
HHS Issues Additional Information to States about Medicaid Eligibility under the Affordable Care Act, February 2011 (HHS)
Report to Congress, March 2011 (MACPAC)
Bundled Payments – Medicaid Demonstration Project, (Health Reform GPS)
Holding the Line on Medicaid and CHIP: Key Questions and Answers About Health Care Reform’s Maintenance of Effort Requirements, March 2010 (CBPP, Georgetown University Health Policy Institute)
Implementing the Medicaid Primary Care Rate Increase: A Roadmap for States, March 2011 (CHCS)
Key Questions About Medicaid And Its Role in State/Federal Budgets and Health Reform, February 2011 (Kaiser)
Medicaid and CHIP: Given the Association between Parent and Child Insurance Status, New Expansions May Benefit Families, February 2011 (GAO)
HHS Issues Additional Information to States about Medicaid Eligibility under the Affordable Care Act, February 2011 (HHS)
Report to Congress, March 2011 (MACPAC)
MEDICARE under PPACA
Summary of Key Changes to Medicare in 2010 Health Reform Law, April 2010 (Kaiser)
Health Reform Changes to Medicare Advantage Strengthen Medicare and Protect Beneficiaries, July 2010 (CBPP)
Health Reform Changes to Medicare Advantage Strengthen Medicare and Protect Beneficiaries, July 2010 (CBPP)
PATIENT-CENTERED MEDICAL HOMES under PPACA
Medical Home Provisions in PPACA
Health Policy Brief: Patient-Centered Medical Homes, September 2010 (Health Affairs, RWJF)
Health Policy Brief: Patient-Centered Medical Homes, September 2010 (Health Affairs, RWJF)
ACCOUNTABLE CARE ORGANIZATIONS under PPACA
Accountable Care Provisions in PPACA
Medicaid Accountable Care Organization Demonstration Project, (Health Reform GPS)
Accountable Care Organizations – Medicare Pilot Program, (Health Reform GPS)
Clinical Integration and Accountable Care Organizations: Where Antitrust Law and Health Care Reform Converges, April 2010 (Ober Kaler)
Health Policy Brief: Accountable Care Organizations, August 2010 (Health Affairs, RWJF)
On the Road to Better Value: State Roles in Promoting Accountable Care Organizations, February 2011 (Commonwealth Fund)
Accountable Care Organizations - Health Cost Containment, February 2011 (NCSL)
Medicaid Accountable Care Organization Demonstration Project, (Health Reform GPS)
Accountable Care Organizations – Medicare Pilot Program, (Health Reform GPS)
Clinical Integration and Accountable Care Organizations: Where Antitrust Law and Health Care Reform Converges, April 2010 (Ober Kaler)
Health Policy Brief: Accountable Care Organizations, August 2010 (Health Affairs, RWJF)
On the Road to Better Value: State Roles in Promoting Accountable Care Organizations, February 2011 (Commonwealth Fund)
Accountable Care Organizations - Health Cost Containment, February 2011 (NCSL)
OTHER ISSUES under PPACA
Physician Provisions, (Arent Fox)
A Summary of Provisions Important to Rural Health Care Delivery, June 2010 (Rural Policy Research Institute)
Rural Health, March 2010 (National Rural Health Association)
Multi-shares and the Affordable Care Act, March 2011 (Healthcare Communities)
Chronic Disease Management, February 2011 (Health Reform GPS)
Making Health Insurance Cost-Sharing Clear to Consumers: Challenges in Implementing Health Reform’s Insurance Disclosure Requirements, February 2011 (Commonwealth Fund)
A Summary of Provisions Important to Rural Health Care Delivery, June 2010 (Rural Policy Research Institute)
Rural Health, March 2010 (National Rural Health Association)
Multi-shares and the Affordable Care Act, March 2011 (Healthcare Communities)
Chronic Disease Management, February 2011 (Health Reform GPS)
Making Health Insurance Cost-Sharing Clear to Consumers: Challenges in Implementing Health Reform’s Insurance Disclosure Requirements, February 2011 (Commonwealth Fund)
ABOUT PPACA
Implementation Timeline, (White House)
Regulations Pursuant to the Patient Protection and Affordable Care Act, April 2010 (Congressional Research Service)
Glossary of Terms, (NAIC)
Summary, June 2010 (Kaiser)
PPACA Bill Text
Regulations Pursuant to the Patient Protection and Affordable Care Act, April 2010 (Congressional Research Service)
Glossary of Terms, (NAIC)
Summary, June 2010 (Kaiser)
PPACA Bill Text
ADDITIONAL RESOURCES – Health Reform Websites
- U.S. Department of Health and Human Services
- Other Sources of Health Reform Information
- Association of State and Territorial Health Officials (ASTHO)
- Commonwealth Fund
- COMPARE (RAND)
- Congressional Budget Office (CBO)
- Families USA
- Health Affairs
- Health Reform GPS (George Washington University Hirsh Health Law and Policy Program & RWJF)
- Kaiser Family Foundation (KFF)
- Mathematica Policy Research, Inc.
- National Academy of Social Insurance (NASI)
- National Academy for State Health Policy (NASHP)
- National Association of Insurance Commissioners (NAIC)
- National Conference of State Legislatures (NCSL)
- National Governors Association (NGA)
- The New England Journal of Medicine
- Robert Wood Johnson Foundation (RWJF)
- State Coverage Initiatives (RWJF)
- State Health Access Program (NASHP)
- State Refor(u)m (NASHP)
- Urban Institute
For further information on the Affordable Care Act, refer to the AAFP Federal Advocacy webpage.
State Implementation of Federal Health Reform
ACA: Medicaid Expansion and Healthcare Exchanges (*PDF file)
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