Monitoring the Impacts of the Affordable Care Act in California: Stakeholder Input and Priorities

By: Masters Policy Consulting

Because the Affordable Care Act (ACA) will have far-reaching effects on Californians, CHCF funded the State Health Access Data Assistance Center (SHADAC) to develop a framework and identify measures for tracking health insurance coverage, affordability and comprehensiveness of coverage, and access to care before and after ACA implementation. The SHADAC framework identified 51 indicators of progress, potential data sources, and gaps in available data.

To gather feedback about the framework, CHCF hosted a stakeholder engagement process led by Masters Policy Consulting in February 2012. In general, although participants felt the SHADAC metrics covered the main issues, they offered some concerns and suggestions, including:


  • Extend the tracking of “churn” — the percentage of people leaving coverage and then re-enrolling within three months — beyond public coverage
  • Track underinsurance by measuring how well insurance covers people’s medical needs and their total out-of-pocket costs
  • Break out coverage data between large and small employers to track trends

Affordability and Comprehensiveness of Coverage

  • Include a measure on cost-sharing in the affordability data overall and by income group
  • Include benefits information as well as costs to get a better picture of affordability
  • Include medical debt in the financial burden category


  • Include a measure for behavioral health
  • Include measures for uncompensated and indigent care

In the feedback about access, there was significant discussion around the metrics and availability of data to assess provider capacity.

As a next step, CHCF will develop a plan for reporting existing data and filling data gaps, seeking to partner where appropriate with existing and emerging efforts. The foundation aims to develop baseline data in 2013 and conduct reporting in 2014 and beyond as the state moves forward with health reform implementation.

A fact sheet about the stakeholder engagement process is available as a Document Download. The full report on the SHADAC framework is available through the External Links below.