Topics on this page: Goal 1. Objective A | Table of Related Performance Measures | Analysis of Results | Plans for the Future | Objective Progress Update Summary
Goal 1. Objective A: Make coverage more secure for those who have insurance, and extend affordable coverage to the uninsured
Before the Affordable Care Act, millions of Americans lacked access to affordable health insurance. Many who did have health insurance had gaps in coverage, such as exclusions for pre-existing conditions, or they were one step away from losing coverage because of a change in employment. Individuals with health insurance face increasingly high premiums and medical costs that drive some to bankruptcy or force choices between maintaining health insurance coverage and paying for other household essentials. HHS has been identified as the lead federal agency responsible for implementing the Affordable Care Act, which contains many new health insurance market reforms and programs to address these and other issues. The Affordable Care Act is making comprehensive health coverage available to millions of Americans who previously lacked access to or could not afford health insurance. As a result, about 10 million previously uninsured Americans gained health coverage in the first full year of Affordable Care Act implementation.
Starting in 2010 and continuing in 2014, HHS has implemented new regulations aimed at increasing consumer protections and at creating a more competitive insurance market to both lower cost and improve quality. These new protections and increased oversight of the insurance industry help ensure that consumers are receiving value for their premium dollars; this oversight will also make the healthcare system more responsive to the needs of its patients, providers, and other stakeholders.
Within HHS, divisions such as ACL, AHRQ, CDC, CMS, IHS, OASH and SAMHSA work to implement the reforms prescribed in the law to make affordable coverage more accessible. The Office of the Secretary led this Objective’s assessment as a part of the Strategic Review.
Objective 1.A Table of Related Performance Measures
Improve availability and accessibility of health insurance coverage by increasing enrollment of eligible children in CHIP and Medicaid (Lead Agency - CMS; Measure ID - CHIP 3.3)
| FY 2011 | FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | |
|---|---|---|---|---|---|---|
| Target | N/A | 43,212,512 children | 45,592,385 children | 46,617,385 children | 47,642,385 children | 48,667,385 children1 |
| Result | 43,542,385 children | 44,453,639 children | 45,292,410 children | Mar 31, 2015 | Mar 31, 2016 | Mar 31, 2017 |
| Status | Historical Actual | Target Exceeded | Target Not Met but Improved | Pending | Pending | Pending |
Maintain or exceed percent of beneficiaries in Medicare fee-for-service (MFFS) who report access to care (Lead Agency - CMS; Measure ID - MCR1.1a)
| FY 2011 | FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | |
|---|---|---|---|---|---|---|
| Target | 90 % | 90 % | 90 % | 90 % | 90 % | N/A2 |
| Result | 92 % | 90 % | 91 % | 91 % | Dec 31, 2015 | |
| Status | Target Exceeded | Target Met | Target Exceeded | Target Exceeded | Pending |
Maintain or exceed percent of beneficiaries in Medicare Advantage (MA) who report access to care (Lead Agency - CMS; Measure ID - MCR1.1b)
| FY 2011 | FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | |
|---|---|---|---|---|---|---|
| Target | 90 % | 90 % | 90 % | 90 % | 90 % | N/A3 |
| Result | 92 % | 91 % | 91 % | 90 % | Dec 31, 2015 | |
| Status | Target Exceeded | Target Exceeded | Target Exceeded | Target Met | Pending |
Reduce the average out-of-pocket share of prescription drug costs while in the Medicare Part D Prescription Drug Benefit coverage gap for non-Low Income Subsidy (LIS) Medicare beneficiaries who reach the gap and have no supplemental coverage in the gap (Lead Agency - CMS; Measure ID - MCR23)
| FY 2011 | FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | |
|---|---|---|---|---|---|---|
| Target | N/A | 58.0% | 55.0% | 53.0% | 50.0% | 48.0% |
| Result | 57.0% | 57.0% | Feb 28, 2015 | Feb 28, 2016 | Feb 28, 2017 | Feb 28, 2018 |
| Status | Historical Actual | Target Exceeded | Pending | Pending | Pending | Pending |
Maintain the number of months to produce the Insurance Component tables following data collection (MEPS-IC) (Lead Agency - AHRQ; Measure ID - 1.3.16)
| FY 2011 | FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | |
|---|---|---|---|---|---|---|
| Target | 6 months | 6 months | 6 months | 6 months | 6 months | 6 months |
| Result | 6 months | 6 months | 6 months | 6 months | Oct 30, 2015 | Sep 30, 2016 |
| Status | Target Met | Target Met | Target Met | Target Met | Pending | Pending |
Increase the number of individuals referred to mental health or related services (Lead Agency - SAMHSA; Measure ID - 3.2.37)
| FY 2011 | FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | |
|---|---|---|---|---|---|---|
| Target | N/A | N/A | Set Baseline | 5,911 | 5,911 | 8,850 |
| Result | 4,304 | 3,760 | 7,389 | 8,219 | Dec 31, 2015 | Dec 31, 2016 |
| Status | Historical Actual | Historical Actual | Baseline | Target Exceeded | Pending | Pending |
Increase the percentage of enrolled homeless persons in the Projects for Assistance in Transition from Homelessness (PATH) program who receive community mental health services (Lead Agency - SAMHSA; Measure ID - 3.4.15)
| FY 2011 | FY 2012 | FY 2013 | FY 2014 | FY 2015 | FY 2016 | |
|---|---|---|---|---|---|---|
| Target | 47 % | 47 % | 50 % | 47 % | 66 % | 66 % |
| Result | 40 % | 66 % | 66 % | Jul 31, 2015 | Jul 31, 2016 | Jul 31, 2017 |
| Status | Target Not Met | Target Exceeded | Target Exceeded | Pending | Pending | Pending |
Analysis of Results
CMS tracks combined Medicaid and Children's Health Insurance Program (CHIP) enrollment of children. The most recent results report more than 45 million children were enrolled in 2013, which missed the target but improved over the previous year’s result. The Affordable Care Act requires maintenance of eligibility standards for children in Medicaid and CHIP through 2019.
Passage of the Medicare Modernization Act (MMA) prompted modifications in the Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys to include measurement of experience and beneficiary satisfaction with the care and services provided through the Medicare Prescription Drug Plans as well as Medicare Fee for Service (MFFS) and Medicare Advantage (MA). Since FY 2008, we have either met or exceeded the goal of 90 percent of beneficiaries who reported access to care.
The Affordable Care Act also included changes to Medicare to enhance the affordability of prescription drugs. Through the Coverage Gap Discount Program, CMS seeks to reduce the costs Medicare Part D enrollees are required to pay for their prescriptions once they reach the coverage gap (commonly known as the “donut hole”). The program will accomplish these reductions through significant manufacturer discounts and increased Medicare coverage according to a predetermined scale for FY 2011 through 2020. In FY 2012, CMS exceeded its target for reductions. In April 2014, more than 5 million beneficiaries, reached the coverage gap and saved more than $4.7 billion on their medications. These savings averaged about $941 per person. Cumulatively since enactment of the Affordable Care Act, 9.4 million beneficiaries have saved a total of $15 billion on prescription drugs.
The MEPS-Insurance Component provides annual national and state estimates of aggregate spending on employer-sponsored health insurance for the National Health Expenditure Accounts (NHEA) that are maintained by CMS and for the gross domestic product produced by the Bureau of Economic Analysis. In support of the Affordable Care Act, MEPS-IC state-level premium estimates are the basis for determining the average limits for the federal tax credit available to small businesses that provide health insurance to their employees. In FY 2010, a baseline of 6 months was established to make data available for use after data collection. Since baseline determination, AHRQ has been successful in maintaining the 6 months target.
SAMHSA recognizes that some populations have different needs for behavioral health services and is concerned about the needs of those with serious mental illness (SMI) and/or co-occurring substance use disorder who experience homelessness or are at risk of homelessness. It is common for those experiencing homelessness also to have a mental health issue(s) and/or substance use disorder(s). SAMHSA has committed to increase the percentage of homeless people served through its programs who receive behavioral health services. These include substance abuse and alcohol counseling, group supports, and treatments to reduce anxiety. In FY 2013, 66 percent of homeless enrolled in the Projects to Assist in the Transition from Homelessness (PATH) received mental health services. SAMHSA also focuses on suicide prevention and early intervention strategies for those at high risk of suicide, including youth. SAMHSA’s State-Sponsored Youth Suicide Prevention and Early Intervention program is focused on individuals 10 to 24 years old who are at especially high risk of suicide. In FY 2014 SAMHSA planned to have at least 5,911 individuals receive direct treatment including outpatient, day treatment, intensive outpatient or residential programs in an effort to prevent suicide. For FY 2014, the program referred 8,219 youth for mental health services, well exceeding the target. Additional services are also available to participants including support service, wrap-around services, and outreach services.
Plans for the Future
The FY 2016 target is to increase CHIP and Medicaid enrollment to 48,667,385 children, (Medicaid: 39,758,322/CHIP: 8,909,063), over 30 percent more children than were covered in FY 2008. CMS will continue to aim outreach efforts to inform parents that they can enroll children in Medicaid and CHIP at any time of the year. In addition, CMS is working closely with states to implement Affordable Care Act provisions related to streamlining eligibility and enrollment processes in Medicaid and CHIP, as well as options to help children maintain coverage over time.
CMS will continue to monitor beneficiary satisfaction with access to care for Medicare Fee for Service (MFFS) and Medicare Advantage (MA) using the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Medicare will also analyze data at the plan, enrollee subgroup, and geographic levels to assist plans in developing interventions that are both actionable and targeted to maintain or improve performance on measures through FY 2015, at which time the goal will be reported as a contextual indicator.
Between 2011 and 2020, CMS will work to reduce out of pocket costs for Medicare coverage for prescription drugs. Prior to the passage of the Affordable Care Act, a beneficiary was responsible for paying 100 percent of the prescription costs between the initial coverage limit and the catastrophic limit. By 2016, CMS will aim to reduce the coverage gap to 48 percent, using a combination of rebate checks, manufacturers’ discounts, and enhanced Medicare benefits.
AHRQ plans to continue producing insurance component tables from the Medical Expenditure Panel Survey (MEPS) and be able to produce searchable tables within 6 months of the data collection. Schedules for data release will be maintained through FY 2016.
For the current reporting period, SAMHSA expects a slight decrease in the percentage of homeless assisted by the PATH program. This is due to a 10 percent reduction in funding in 2013. This small target decline is followed by a significantly increased target in FY 2015, which is maintained in FY 2016. Factors that influence performance include resources, changes in the collection methodology and the clarification of definitions for certain PATH data elements. The transient nature of the populations served by PATH increases the challenge for the program to meet its performance targets. SAMHSA expects to maintain the number of individuals referred to mental health or related services in FY 2015 and increase that number substantially in FY 2016.
Objective Progress Update Summary
HHS demonstrated progress toward this objective as shown by the representative performance measures described in the HHS Annual Performance Plan and Report. Further evidence of progress is described below.
- Over eight million people selected a health insurance plan through the Health Insurance Marketplace (including both state-based Marketplaces and the federally-facilitated Marketplace) through March 31, 2014 (including additional special enrollment period (SEP) activity reported through Saturday, April 19, 2014).4 As of October 15, 2014, 6.7 million individuals were enrolled and paying for health coverage (“effectuated” enrollees) through the Marketplace.5
- Beginning in FY 2013, CMS began to track combined Medicaid and Children’s Health Insurance Program (CHIP) enrollment. In 2013, 45,292,410 children were enrolled in Medicaid (37,198,483) and CHIP (8,093,927), falling short of our target of 45,592,385 children (Medicaid 37,246,233/CHIP 8,346,152). The results represent an increase in enrollment between 2012 and 2013.
- CMS met or exceeded FY 2014 targets reflecting beneficiary experience in fee-for-service and Medicare Advantage access to care in 2013.
- The Affordable Care Act Coverage Gap Discount Program reduces the amount Medicare Part D enrollees are required to pay for their prescriptions once they reach the coverage gap. CMS has succeeded in reducing the average out-of-pocket share of costs due to this gap and plans to build on this success with further reductions in the future.
- The Medical Expenditure Panel Survey, first funded in 1995, is the only national source for comprehensive annual data on how Americans use and pay for medical care. AHRQ has maintained a 6 month production cycle for the data table from this survey and plans to maintain that schedule in the future.
The Department is continuing to support and execute the programs contributing to this objective, monitoring progress, performance, and program integrity while adjusting to any budgetary constraints or changes to programmatic demands.
1 Subject to an extension of CHIP. Under current law, FY 2015 is the final year of appropriations for CHIP and states have two years to spend their FY 2015 allotments.
