The 2017 AHA Environmental Scan: Insurance & Coverage

  • In fiscal year 2016, the Medicaid enrollment growth rate is expected to slow across all states, and the variation in enrollment growth between expansion and nonexpansion states is expected to narrow. Slower overall growth in Medicaid enrollment in fiscal year 2016 is anticipated because of three main factors. First, enrollment growth among those newly eligible under the Affordable Care Act Medicaid expansion is moderating after the initial surge in 2014 and 2015. Second, an improving economy has contributed to less demand for Medicaid. Third, in some states, slowing enrollment is tied to the timing of annual renewals.1
  • The looming “Cadillac tax” accelerates cost-shifting — and the ACA’s insurance excise tax set to begin in 2020 is already influencing employers’ benefit design. To avoid paying the 40 percent tax on health plan premiums over $10,200 for individual coverage and $27,500 for self and spouse or family coverage, employers are upping the amount that employees must pay, thereby reducing their costs.2
  • More than 80 percent of ACA individual enrollees receive some type of subsidy or tax credit, which mitigates large rate increases.3
  • Among people with health insurance, one in five (20 percent) working-age Americans report having had problems paying medical bills in the past year that often cause serious financial challenges and changes in employment and lifestyle. Among the insured with medical bill problems, 63 percent report using up most or all of their savings, and 42 percent took on an extra job or worked more hours.  People with health insurance who have had problems with medical bills also reported skipping or putting off other health care in the past year because of the cost. They have postponed dental care (62 percent), skipped doctor-recommended tests or treatments (43 percent) or not filled a prescription (41 percent).4
  • Perhaps an even bigger driver of change is the private health exchanges. The number of workers participating in private exchanges is expected to grow from the current 6 million to 40 million by 2018.5

2017 AHA Environmental Scan

Download the complete 2017 AHA Environmental Scan PDF sponsored by B. E. Smith.


  1. “Medicaid Enrollment & Spending Growth: FY 2015 & 2016,” Robin Rudowitz, Laura Snyder and Vernon K. Smith, Kaiser Commission on Medicaid and the Uninsured, October 2015
  2. “Medical Cost Trend: Behind the Numbers 2016,” Health Research Institute, PricewaterhouseCoopers, June 2015
  3. “Two Years In, the ACA’s Impact on Health Insurer Ratings Remains Limited,” Standard & Poor's Financial Services, Dec. 14, 2015
  4. “New Kaiser/New York Times Survey Finds One in Five Working-Age Americans with Health Insurance Report Problems Paying Medical Bills,” Kaiser Family Foundation, Jan. 5, 2016
  5. “FutureScan 2016-2021, Healthcare Trends and Implications,” the American Hospital Association's Society for Healthcare Strategy & Market Development and American College of Healthcare Executives, with support from Evariant