Insurance Reform: Research

State Efforts to Close the Health Coverage Gap

Feb. 6, 2018

This review examines prominent state efforts to expand health coverage to the remaining uninsured. It analyzes and compares efforts in Massachusetts, Vermont, Colorado, California, and Nevada and highlights insights and themes that emerge. It explores the context and climate for reform within the state, stakeholder involvement, political coalitions, financing, and possible opposition. As such, it serves as a case study in how different states build, or fail to build, the popular and political will towards health care coverage for all residents. This is the first in a series of reports that will monitor and analyze developments at the state level to expand coverage and improve access to care.

Association of Patient Out-of-Pocket Costs With Prescription Abandonment and Delay in Fills of Novel Oral Anticancer Agents

Research Brief
Jan. 19, 2018

High out-of-pocket (OOP) costs may limit access to novel oral cancer medications. In a retrospective study, nearly one third of patients whose OOP costs were $100 to $500 and nearly half of patients whose OOP costs were more than $2,000 failed to pick up their new prescription for an oral cancer medication, compared to 10% of patients who were required to pay less than $10 at the time of purchase. Delays in picking up prescriptions were also more frequent among patients facing higher OOP costs. 

Exploring the Decline of Narrow Networks on the ACA Marketplaces in 2017

Issue Brief
Nov. 6, 2017

The prevalence of narrow provider networks on the ACA Marketplace is trending down. In 2017, 21% of plans had narrow networks, down from 25% in 2016. The largest single factor was that 70% of plans from National carriers exited the market and these plans had narrower networks than returning plans. Exits account for more than half of the decline in the prevalence of narrow networks, with the rest attributed to broadening networks among stable plans, particularly among Blues carriers. The narrow network strategy is expanding among traditional Medicaid carriers and remains steady among provider-based carriers and regional/local carriers.

Effects Of State Insurance Mandates On Health Care Use And Spending For Autism Spectrum Disorder

Oct. 30, 2017

Colleen L. Barry, Andrew J. Epstein, Steven C. Marcus, Alene Kennedy-Hendricks, Molly K. Candon, Ming Xie and David S. Mandell

In Health Affairs, Colleen Barry and colleagues, including Andrew Epstein, Steven Marcus and David Mandell, examine whether state mandates requiring commercial insurers to cover treatment for children with autism spectrum disorder (ASD) altered service use or spending among commercially insured children with ASD. To date, 46 states and the District of Columbia have enacted such mandates.

The authors compared children age 21 or younger who were eligible for mandates to children not subject to mandates using 2008–12 claims data from three national insurers. They found that...

Early Medicaid Expansion Associated With Reduced Payday Borrowing in California

Oct. 25, 2017

Heidi Allen, Ashley Swanson, Jialan Wang, Tal Gross

In Health Affairs, Heidi Allen and colleagues, including Ashley Swanson, analyzed the impact of California’s early Medicaid expansion under the Affordable Care Act (ACA) on the use of payday loans, a form of high-interest borrowing often used by low- and middle-income households. No studies to date have focused on how health insurance coverage affects the use of alternative financial products. This research is especially important given the documented relationship between poverty, medical debt, and bad credit outcomes.

Using a difference-in-differences research design, the...

Narrow Networks on the Individual Marketplace in 2017

Issue Brief
Sep. 14, 2017

This Issue Brief describes the breadth of physician networks on the ACA marketplaces in 2017. We find that the overall rate of narrow networks is 21%, which is a decline since 2014 (31%) and 2016 (25%). Narrow networks are concentrated in plans sold on state-based marketplaces, at 42%, compared to 10% of plans on federally-facilitated marketplaces. Issuers that have traditionally offered Medicaid coverage have the highest prevalence of narrow network plans at 36%, with regional/local plans and provider-based plans close behind at 27% and 30%. We also find large differences in narrow networks by state and by plan type. 

Stabilizing Individual Health Insurance Markets With Subsidized Reinsurance

Issue Brief
Sep. 11, 2017

Subsidized reinsurance represents a potentially important tool to help stabilize individual health insurance markets. This brief describes alternative forms of subsidized reinsurance and the mechanisms by which they spread risk and reduce premiums. It summarizes specific state initiatives and Congressional proposals that include subsidized reinsurance. It compares approaches to each other and to more direct subsidies of individual market enrollment. For a given amount of funding, a particular program’s efficacy will depend on how it affects insurers’ risk and the risk margins built into premiums, incentives for selecting or avoiding risks, incentives for coordinating and managing care, and the costs and complexity of administration. These effects warrant careful consideration by policymakers as they consider measures to achieve stability in the individual market in the long term.

Networks in ACA Marketplaces are Narrower for Mental Health Care Than for Primary Care

Research Brief
Sep. 5, 2017

In 2016, ACA marketplace plans offered provider networks that were far narrower for mental health care than for primary care. On average, plan networks included 24 percent of all primary care providers and 11 percent of all mental health care providers in a given market. Just 43 percent of psychiatrists and 19 percent of nonphysician mental health providers participate in any network. These findings raise important questions about network sufficiency, consumer choice, and access to mental health care in marketplace plans.

Public Awareness of and Contact With Physicians Who Receive Industry Payments: A National Survey

Jul. 27, 2017

Genevieve Kanter, Michelle M. Mello, Lisa Soleymani Lehmann, Eric G. Campbell, and Daniel Carpenter 

In the Journal of General Internal Medicine, Genevieve Kanter and colleagues investigate public awareness and physicians’ perceptions of industry payments to doctors. As part of the Affordable Care Act, pharmaceutical and medical device manufacturers are now required to report payments that they make to health care providers to a database called Open Payments. This provision was partially motivated by concerns that industry payments could sway physicians’ decisions on patient care, and that patients may not know about these payments when selecting a provider. The authors conducted...

The Exaggerated Life of Death Panels? The Limited but Real Influence of Elite Rhetoric in the 2009-2010 Health Care Debate

Jul. 25, 2017

Daniel Hopkins

In Political Behavior, Daniel Hopkins analyzes the ability of American elites to frame political issues to sway public opinion, as well as the real-world constraints on that ability. Previous experiments demonstrate that elites can influence public opinion through framing, yet those experiments may not account for limitations on that ability. The author uses the 2009-2010 health care debate, along with automated content analyses of elite- and general population language, to study real-world effects of framing. He finds that the language Americans use to explain their opinions is...

Association Between Hospital Participation in a Medicare Bundled Payment Initiative and Payments and Quality Outcomes for Lower Extremity Joint Replacement Episodes

Jun. 29, 2017

Laura A. Dummit, Daver Kahvecioglu, Grecia Marrufo, Rahul Rajkumar, Jaclyn Marshall, Eleonora Tan, Matthew J. Press, Shannon Flood, L. Daniel Muldoon, Qian Gu, Andrea Hassol, David M. Bott, Amy Bassano, Patrick H. Conway

In JAMA, Laura Dummit and colleagues, including Matthew Press, evaluate whether a Centers for Medicare and Medicaid Services (CMS) bundled payment pilot program is associated with a reduction in Medicare payments. Specifically, the authors assess if Bundled Payments for Care Improvement (BPCI) reduced Medicare payments and maintained quality in lower extremity joint replacement. This CMS program was launched in 2013 to test whether linking payments for services provided during an episode of care can reduce Medicare payments and maintain quality. The authors used a difference-in-...

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