As the Supreme Court mulls yet another challenge to the constitutionality of the Affordable Care Act (ACA), we have new evidence of the law’s positive impact on young adults, who were allowed to stay on their parents’ insurance until age 26 under the Dependent Coverage Provision (DCP). The ACA helped young adults with cancer maintain continuous coverage, which is key to maintaining access to cancer treatment.
In arecent retrospective cohort study, my colleagues and I found that cancer patients who turned 19 in 2010-2012 (who were eligible to stay on their parents’ insurance) were 15% less likely to lose coverage than those who turned 19 in 2007-2009, before the ACA. We used commercial claims data to identify about 2,800 young adults with a cancer diagnosis between 2000 and 2015, and compared them to their peers prior to the ACA’s implementation. We matched the two groups on cancer type, diagnosis date, and clinical characteristics, and compared time to loss of insurance over 5 years.
In June, we described the first attempt to measure, in a consumer-friendly way, the breadth of physician networks offered by all silver plans on the 2014 health insurance marketplaces. We estimated network size based on the fraction of office-based physicians participating in the network within relevant rating areas in the state. We categorized networks using "T-shirt" sizes: x-small (less than 10%), small (10%-25%), medium (25%-40%), large (40%-60%), and x-large (more than 60%). We found that nationally, 41% of all networks were either “small” or “x-small”. For simplicity, we combined these two t-shirt sizes as our definition of a narrow network. In our new Data Brief, we take a closer look at the state variation in network size.
In the beginning (Web Site 1.0), we measured the success of health insurance marketplace sites by whether they worked. Last year (Web Site 2.0), technical glitches were resolved, and we can start to measure success by whether the sites help people make the best decisions in choosing a health plan. A new study by LDI Fellow Charlene Wong and colleagues takes stock of some features of each web site, and should help state and federal policymakers improve their sites even further in Web Site 3.0 (opening Nov. 1, 2015 on a screen near you).
Although health reform has reduced many financial barriers to care, geographic barriers remain. In two separate studies, LDI Fellows David Shalowitz, and LDI Senior Fellows Michael Mullen, Charles Branas, and Brendan Carr looked at the geographic distribution of specialty care in the United States, specifically gynecologic cancer care and comprehensive stroke treatment. In both cases, greater distance to specialized care can put patients at risk for poor outcomes. The studies, one involving actual mapping and the other a virtual trial, found large regions of low access, and recommended data-driven planning to improve the population's geographic access to these services.
The news coming out of the 8th International AIDS Society Conference last month was a stunning affirmation of progress being made on the way to eliminating AIDS. The Vancouver Consensus Statement that emerged, signed by more than 500 of the world's leading clinicians, researchers, and others, calls for immediate access to antiretrovirals for all patients upon HIV diagnosis, and for pre-exposure prophylaxis to all people at high risk. Having mustered the scientific resources to develop treatments for this disease, we must now muster the political will as a global community to eliminate it. In this post, I look back on the beginnings of the epidemic, and describe two new papers by LDI Fellow Matthew Kavanagh on the Vancouver statement and the human rights imperative we face today.
Twitter has been abuzz with commentary about ProPublica’s Surgeon Scorecard, which reports on how individual surgeons perform on in-hospital mortality and readmission (complication) rates for eight common elective procedures. Amidst the pointed criticisms of the Scorecard, there exists moderate agreement that it provides some value in helping consumers select a surgeon. And while choosing the right surgeon is certainly important; the Scorecard tells us little about how well surgeons operate as part of a health care team.
Not every health system can be Kaiser Permanente, but many try. Kaiser’s model of integrated health delivery is highly regarded for high-quality and efficient health care. But while many have tried to replicate this structural integration (perhaps without evidence of effectiveness?), could it be that the ‘secret sauce’ of Kaiser’s success is something else entirely? A new study by LDI Senior Fellows Matthew McHugh and Linda Aiken, of Penn Nursing, and Lawton Burns, of Wharton, sheds light on whether the organization and work environment of nurses might account for some of that success.
Health insurers are merging everywhere you turn in the newly reformed and more heavily regulated health insurance system. Ordinarily, as consumers, we ought to worry about having fewer sellers because that will lead to higher market power and higher prices.
In recent weeks, two sets of already huge health insurers—Aetna and Humana, Cigna and Anthem—have announced plans to combine. And more mergers may be in the works. Should the rest of us fear being trampled when these behemoths connect? The answer to that question, as with almost all questions in health economics, is “it all depends.”
Yesterday, I looked at the aggregate effects of some of the ACA’s premium stabilization programs (reinsurance, risk adjustment, and risk corridors, the 3Rs). Today, I illustrate the potential effects of the 3Rs on insurers’ reported revenues, costs, and underwriting profits (losses). Because of considerable concern about the financial condition of the ACA’s Consumer Oriented and Operated Plans (CO-OPs), and in the wake of the announcement that the second of 23 CO-OP plans will cease business, I chose to highlight the largest CO-OP (Health Republic Insurance Company of New York), and the one that just announced it will cease operations at the end of the year (Louisiana Health Cooperative).
We now have better information on how the “3Rs”—the ACA’s mechanisms designed to help stabilize premiums and protect insurers against large losses in the first years of health care reform—affected insurers’ bottom lines in 2014. In this first of two posts, I review the information reported by CMS for two of the 3Rs: reinsurance and risk adjustment. In the second post tomorrow, I take as examples the largest CO-OP plan and the Louisiana CO-OP that just announced it will cease operations at the end of 2015 to illustrate the combined effects of the three Rs on the insurers’ bottom lines. Here’s what we currently know about each “R” for the 2014 benefit year.
It is no accident of history that LDI, the first institute of health economics in the United States, was founded at Penn in 1967, in the wake of the passage of Medicare and Medicaid. As these landmark programs celebrate their 50th birthday, we went back to see what our founders had to say about Medicaid and Medicare. Those conversations shaped our institute and still inspire our dedication to research that leads to affordable, high-quality health care that is accessible to all.