Transforming Health Care Through Evidence and Collaboration
Transforming Health Care Through Evidence and Collaboration
The NIHCM Foundation is a nonprofit, nonpartisan organization dedicated to improving the effectiveness, efficiency and quality of America's health care system.
  • Awards

    NIHCM Foundation is pleased to welcome Dr. Karen DeSalvo, Dr. Aaron E. Carroll and Eliza Barclay to the independent judges panel of the NIHCM Awards. All three bring considerable expertise to the prestigious panel.

    Press Release Judges Panels The NIHCM Awards
  • Data Insights

    Mental illness has become more common over the last decade, particularly among 18- to 25-year-olds. This Data Insights looks at trends in mental health and their implications for the future.

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  • Briefing

    NIHCM Foundation led a briefing on Capitol Hill to discuss social determinants of health and the opioid crisis with Founding President and CEO Nancy Chockley, former CMS Administrator Don Berwick, Curtis Barnett of Arkansas Blue Cross Blue Shield, Craig Samitt of Blue Cross and Blue Shield of Minnesota, and Grant Baldwin from the CDC.

    Press Release Watch the Video
  • Data Insights

    As urbanization increases, an older, sicker and poorer population remains in rural America. Despite the health care challenges posed by these changes, promising initiatives can improve rural health.

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  • Advisory Board

    NIHCM Foundation is pleased to welcome Dr. Scott Gottlieb, Sherry Glied, PhD, and Katherine Baicker, PhD, to its distinguished Advisory Board. Their ideas and insights will advance NIHCM's mission to improve health care for millions of Americans.

    Press Release Advisory Board
  • News

    NIHCM welcomed Secretary Azar to a meeting in March to discuss efforts by the Department of Health and Human Services to transform health care by lowering costs and improving value for patients.

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Events

January 27, 2020
SDOH-webinar-graphic-012720

This webinar will explore public and private sector efforts to improve health outcomes by addressing social determinants of health.

December 19, 2019
shutterstock_560761723_1

Part of the Beyond the Beltway: Health Policy Webinars for Journalists series, this rapid response webinar explained the December 18th ruling from the Fifth Circuit on the Affordable Care Act.

Watch the Recording

In the News

January 2020
Population Health Spotlight
newsletter-loneliness-kas_10

Small Business Health Insurance Coverage Under the ACA

Sabrina Corlette, JD, Senior Research Fellow and Project Director, Center on Health Insurance Reforms, Georgetown University

Small business owners have long struggled to provide health insurance to their workers, facing high and often volatile premiums relative to large businesses, a lack of market power for negotiating premiums, and high administrative costs associated with covering a small number of workers. In addition, minimum participation requirements used to safeguard against adverse selection mean that small employers often can offer only one plan and must cover a hefty portion of employees’ premiums in order to get enough employees to enroll. These pressures have contributed to a steady decline in the number of small businesses offering coverage and left their employees more likely to be uninsured. Furthermore, even small business workers who received insurance have historically had less generous coverage, with much higher deductibles and lower employer contributions for dependent coverage.1

The ACA and the Small Group Market

While much of the focus of the Patient Protection and Affordable Care Act (ACA) was on addressing a dysfunctional health insurance market for individuals, policymakers also wanted to help more small businesses offer adequate and affordable coverage. Key pillars included revised insurance rules and new marketplaces to facilitate shopping.

Insurance Reforms

The ACA established a set of national minimum standards that took aim at the most glaring problems in the small group market. Consistent with the changes effected for the individual market, the small group reforms prohibited health underwriting, required minimum essential health benefits and first-dollar coverage of approved preventive services, ended benefit limits and exclusions based on pre-existing conditions, and capped enrollees’ annual out-of-pocket liability. In addition, insurers offering products in the small group market are now required to set rates using a single risk pool that includes all enrollees across their small group plans in the state. Finally, small employers can avoid having to meet minimum participation thresholds if they obtain coverage during a November-to-December open enrollment period.

To date, only firms with 50 or fewer workers have been affected by these provisions. Although the ACA allowed states to expand the small group market to include firms with 51 to 100 workers for 2014 and 2015, no state elected to do so. This expansion is set to be enacted nationwide in 2016, however, newly subjecting these mid-size firms to the ACA’s rating and benefit reforms at the same time they must also begin complying with the ACA’s employer mandate. Concerns about the potential for premium increases, adverse selection and market destabilization resulting from this expansion have prompted a rare bipartisan effort in Congress to repeal this provision of the ACA and leave the market definition decision to the states.

SHOP Exchanges and Tax Credits

The ACA also created the Small Business Health Options Program (SHOP) exchanges, or marketplaces, where small businesses can shop for health insurance. Responding to small business owners’ concerns about their inability to give employees a choice of plans, SHOPs are designed to provide an “employee choice” option whereby employers can set a contribution level and let each employee select his or her preferred option from a range of plans.

Each state has a SHOP, some run by the state but the majority operated by the federal government. With few exceptions, the SHOPs were slow to get off the ground and enrollment has been low so far. In 2014, only a minority of states offered online enrollment and fewer still prioritized the SHOP in their marketing and outreach campaigns.2 In addition, mandatory nationwide implementation of employee choice was delayed until 2016, resulting in uneven rollout of this option across states. As of 2015, 31 states are providing some form of employee choice (Figure 1).

The ACA also provides premium tax credits to help make insurance more affordable for very small employers with moderate-income workers. The credits are available only to businesses enrolling through the SHOP, and then only for two years. Few small businesses have made use of these credits, likely due to narrow and complex eligibility requirements and relatively low credit amounts.3,4

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Events

January 27, 2020
SDOH-webinar-graphic-012720

This webinar will explore public and private sector efforts to improve health outcomes by addressing social determinants of health.

December 19, 2019
shutterstock_560761723_1

Part of the Beyond the Beltway: Health Policy Webinars for Journalists series, this rapid response webinar explained the December 18th ruling from the Fifth Circuit on the Affordable Care Act.

Watch the Recording

In the News

January 2020
Population Health Spotlight
newsletter-loneliness-kas_10

Grants

Journalism GrantsJournalism Grant Program

We are no longer accepting letters of inquiry for the 2019-2020 round of grantmaking. NIHCM will notify grant winners in November 2019.

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Investigator-Initiated Research Grant Program

Nine new grantees for the 2019-2020 funding cycle have been announced! We will begin accepting Letters of Inquiry for the 2020-2021 funding cycle in late spring 2020.

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Awards

Now Accepting Entries for the 26th Annual Research and Journalism Awards

Winners Announcment 2018 1

Submit your research or reporting published in 2019 by February 3, 2020 for a chance to win up to $20,000. Winners and finalists will be recognized at a dinner in Washington, D.C., in May 2020.

Learn More and Apply