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...
October 16, 2017 [cross-posted from the Health Cents blog on philly.com]
September 22, 2017 [cross-posted from the Health Cents blog on philly.com]
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.
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.
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.
It’s called “adverse tiering” and it’s a benefit strategy designed to dissuade patients with expensive chronic conditions from enrolling in marketplace plans. The ACA prohibited plans from refusing to cover patients with pre-existing conditions and from charging them higher premiums. To avoid high-cost patients, some plans have structured their formularies to require substantial cost sharing for drugs in a certain class, particularly for expensive conditions such as HIV/AIDS.
The Exaggerated Life of Death Panels? The Limited but Real Influence of Elite Rhetoric in the 2009-2010 Health Care Debate
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...
The package of Essential Health Benefits (EHBs) ushered in by the Affordable Care Act (ACA) has been under attack in the GOP-led Congress. The latest incarnation of the Senate health reform plan includes the Cruz amendment, which would allow insurers to offer plans that do not cover all ten categories of EHBs.