Private Insurance/Exchanges

The main source of health insurance in the US, primarily through employers. The Affordable Care Act established health insurance exchanges (marketplaces) for the individual and small group market.

Understanding Geographic Variation in Systemic Overuse Among the Privately Insured

Mar. 1, 2020

Allison H. Oakes, Aditi Sen, Jodi B. Segal 

Abstract [from journal]

Background: Medical care overuse is a significant source of patient harm and wasteful spending. Understanding the drivers of overuse is essential to the design of effective interventions.

Objective: We tested the association between structural factors of the health care delivery system and regional differences systemic overuse.

Research Design: We conducted a retrospective analysis of deidentified claims for 18- to 64-year-old adults from the IBM MarketScan Commercial Claims and

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Did the Affordable Care Act Contain Costs?

Issue Brief
Feb. 20, 2020

The Affordable Care Act was designed to curb the growth of health care costs as it broadly expanded coverage. Through provider payment reductions, alternative payment models, and a commission to enforce growth targets, the ACA sought to rein in Medicare spending. Through a tax on high-cost employer plans and competition in individual marketplaces, it sought to influence spending in the private market as well. But a number of provisions were never implemented, limiting the ACA’s impact on costs. While statutory reductions in Medicare provider rates have slowed cost growth in Medicare, they are not likely to be sustainable in the long term. Changing the trajectory of cost growth remains a challenge for future reform efforts.

Revisiting CHIP Buy-In Programs for Children

Issue Brief
Feb. 14, 2020

States have a long history of providing families with the option to purchase Medicaid or Children’s Health Insurance Program (CHIP) coverage for their children, but these programs have dwindled in recent years. In a February 2020 Health Affairs blog post, we review states’ experiences with buy-in programs for children, present updated information on the four remaining CHIP buy-in programs, and compare them to child-only coverage on the individual market. This document provides an overview of our findings.

Disease-Specific Plan Switching Between Traditional Medicare and Medicare Advantage

Nov. 22, 2019

Sungchul Park, Paul Fishman, Lindsay White, Eric B Larson, Norma B Coe

Abstract [from journal]

Introduction: Previous research has reported switching from traditional Medicare (TM) to Medicare Advantage (MA) plans increased from 2006 to 2011 at the aggregate level, and switching from MA plans to TM also increased. However, little is known about switching behavior among individuals with specific chronic diseases.

Objective: To examine disease-specific switching patterns between TM and MA to understand the impact on MA

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Household Labor Search, Spousal Insurance, and Health Care Reform

Oct. 1, 2019

Hanming Fang, Andrew J. Shephard

Abstract [from journal]

Health insurance in the United States for the working age population has traditionally been provided in the form of employer-sponsored health insurance (ESHI). If employers offered ESHI to their employees, they also typically extended coverage to their spouse and dependents. Provisions in the Affordable Care Act (ACA) significantly alter the incentive for firms to offer insurance to the spouses of employees. We evaluate the long-run impact of ACA on firms’ insurance offerings and on household outcomes by developing and estimating an equilibrium job search...

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