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.

A Tale of Two States: Do Consumers See Mental Health Insurance Parity When Shopping on State Exchanges?

Nov. 19, 2015

Kelsey Berry, Haiden Huskamp, Howard Goldman, Colleen Barry

In Psychiatric Services, Kelsey Berry and colleagues, including Colleen Barry, present an analysis of parity compliance in how behavioral health benefits are presented to consumers shopping on health insurance exchanges established by the Affordable Care Act.  All insurance plans sold on the exchanges are required to offer mental health and substance use disorder benefits in compliance with requirements of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The researchers reviewed summaries of benefits documents available to...

Cost Differences After Initial CT Colonography Versus Optical Colonoscopy in the Elderly

Nov. 19, 2015

Hanna Zafar, Jianing Yang, Katrina Armstrong, Peter Groeneveld

In Academic Radiology, Hanna Zafar and colleagues, including Peter Groeneveld, compare differences in total Medicare costs among asymptomatic elderly patients in the year after initial computed tomographic colonography (CTC) or initial optical colonoscopy (OC). In 2009, the Centers for Medicare and Medicaid Services stopped covering CTC screening among asymptomatic individuals based on the scarcity of data regarding differences in outcomes and costs between patients who received CTC and OC. Zafar and colleagues performed a retrospective cohort study of asymptomatic Medicare...

“Sticker Shock” in Individual Insurance under Health Reform?

Nov. 9, 2015

Mark Pauly, Scott Harrington, Adam Leive

In 2013, before the ACA’s health insurance marketplaces opened, more than 10 million people purchased insurance in the individual market. In the American Journal of Health Economics, Mark Pauly, Scott Harrington, and Adam Leive estimate how the ACA affected the prices these buyers faced in 2014.  Before taking any federal subsidies into account, they find that the impact of the ACA on total average price was relatively modest.

They looked at the effects of the ACA on premiums, expected out-of-pocket payments, and total expected price paid by these former buyers. They...

Seeing Health Insurance and HealthCare.gov Through the Eyes of Young Adults

Oct. 15, 2015

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

In the Journal of Adolescent Health, Charlene Wong and colleagues, including David Asch, Tom Baker, Robert Town, and Raina Merchant, describe young adults’ perspectives on health insurance and HealthCare.gov, including their attitudes toward health insurance, health insurance literacy, and benefit and plan preferences. Access to preventive or primary care and peace of mind were the most salient advantages of health insurance for young adults. The authors find that young adults perceive the financial strain of paying for health insurance as the most salient disadvantage. Deductible...

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...

Influence of provider mix and regulation on primary care services supplied to US patients

Oct. 15, 2015

Michael Richards, Daniel Polsky

In Health Economics, Policy and Law, Michael Richards and Daniel Polsky explore the link between provider mix and access for different patient types. The authors use data from a field study spanning 10 states where trained audit callers were randomly assigned an insurance status and then contacted primary care physician practices seeking new patient appointments. Clinics with more non-physician clinicians are associated with better access for Medicaid patients and lower prices for office visits. However, the authors only find this association in states granting full practice...

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.

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