Health Insurance

Financial and structural characteristics of the public and private programs that cover medical costs. LDI analyzes how to expand and improve coverage through insurance exchanges, employer-sponsored insurance, and public programs.

The Experience of Young Adults on HealthCare.gov: Suggestions for Improvement

Oct. 15, 2015

Charlene Wong, David Asch, Cjloe Vinoya, Carol Ford, Tom Baker, Robert Town, Raina Merchant

In the Annals of Internal Medicine, Charlene Wong and colleagues, including David Asch, Tom Baker, Robert Town, and Raina Merchant, survey young adults on ways to improve the HealthCare.gov insurance selection process. Participants explained their thinking in real time as they used the website and made decisions about health insurance. Challenges that they expressed included poor understanding of health insurance terms that were inadequately explained on the website. Although participants expressed their preferred plan benefits, they had difficulty matching plans with their...

Insurance Plan Presentation and Decision Support on HealthCare.gov and State-Based Web Sites Created for the Affordable Care Act

Oct. 15, 2015

Charlene Wong, Gabbie Nirenburg, Daniel Polsky, Robert Town, Tom Baker

In the Annals of Internal Medicine, Charlene Wong and colleagues, including Daniel Polsky, Robert Town, and Tom Baker, assess the presentation of insurance plans as well as the availability of consumer decision aids on Healthcare.gov and state-based health insurance marketplaces. The authors examined HealthCare.gov and all state-based marketplaces during the first and second open enrollment periods. They collected information on what consumers would see while they were “window shopping” (before creating an account) and “real shopping” (after creating an account). The authors find...

Economists Step Up to Defend Cadillac Tax

Oct. 2, 2015

What are the chances of getting 101 prominent U.S. economists and health policy experts to agree on something? It seems the embattled Cadillac tax, a key provision of the Affordable Care Act (ACA) that taxes employers for high-cost insurance plans and takes effect in 2018, may have achieved the impossible.

The Price of Responsibility: The Impact of Health Reform on Non-Poor Uninsureds

Sep. 29, 2015

While the Affordable Care Act has achieved a second victory before the Supreme Court and produced significant coverage gains, it might also have produced a less positive outcome: in an NBER working paper, Penn LDI colleagues Mark Pauly, Adam Leive and Scott Harrington found that a large portion of non-poor (measured by income above 138% of the poverty level) who gained coverage now have a higher financial burden and lower welfare (well-being) than when they were uninsured.

State Medicaid Spending on Sovaldi

Sep. 25, 2015

With a price tag of $1,000 per pill and $84,000 for a 12-week course of Sovaldi (sofosbuvir), Gilead Sciences prompted widespread concern about whether its new treatment for hepatitis C (HCV) would bankrupt public and private payers. These concerns were particularly significant for state Medicaid programs, which face both limited state budgets and high HCV prevalence among beneficiaries.

Elimination of cost-sharing and receipt of screening for colorectal and breast cancer

Sep. 17, 2015

Stacey A. Fedewa, Michael Goodman, W. Dana Flanders, Xuesong Han, Robert A. Smith, Elizabeth M. Ward, Chyke A. Doubeni, Ann Goding Sauer, Ahmedin Jemal

In Cancer, Stacey Fedewa and colleagues, including Chyke Doubeni, investigate whether the cost-sharing provision of the Affordable Care Act (ACA), which aimed to reduce financial barriers for preventive services, affected the prevalence of screening for certain cancers. The research looks specifically at the rates of screening for colorectal cancer and breast cancer among the privately insured and Medicare-enrolled adults of varying socioeconomic status (SES). It uses data from the National Health Interview Survey from 2008 and 2013. The authors find that the rate of screening for...

State Variation in Narrow Networks on the ACA Marketplaces

Data Brief
Aug. 24, 2015

In June, we presented national data from one of the first attempts to measure the size of provider networks in plans sold on the health
insurance marketplaces. We used simple “T-shirt” sizes to categorize networks in a way that could help consumers quickly grasp the
choices they were making. In this Data Brief, we present network sizes summarized up to the level of the state and the rating area.
This analysis should help regulators and consumers assess and understand the trade-off between premiums and network size as we
enter the next open enrollment period.

How Wide Are Your Physician Networks?

Aug. 24, 2015

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”.

It's All in the Presentation

Aug. 17, 2015

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.

Mergers, Monopolies, and the Medical Loss Ratio

Aug. 1, 2015

cross-posted with US News

Health insurers are merging everywhere you turn in the newly reformed and more heavily regulated health insurance system. Anthem announced last week it will buy insurance giant Cigna for over $54 billion, acquiring more than 53 million new patients. And Aetna, earlier this month, announced its agreement to buy Humana, the nation’s fifth-largest health insurer.

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