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.

What Do We Know About Health Insurance Choice?

Issue Brief
Jun. 30, 2020

From choosing a doctor to selecting an insurance plan, choices pervade nearly all aspects of our health care system. However, there is little agreement among policymakers and the public about what constitutes “choice,” which choices are important, and how and whether patients should be asked to make various health care choices. Although Americans claim to value having health insurance choices, research shows that when presented with options, people do not actually like to choose. Other studies suggest that people frequently make health insurance decisions that leave them worse off, or not much better than before. At Penn LDI’s Medicare for All and Beyond conference, a panel of researchers and policy experts discussed the current evidence around health insurance choice and implications for future health care reform efforts. This brief summarizes the panel’s key takeaways.

Payment and Pricing Decisions in Health Care Reform

Issue Brief
Jun. 23, 2020

Any effort to reform health insurance in the United States must tackle the prices we pay for health care. There are many complex challenges to addressing prices. Some proposals build on the existing Medicare fee schedule, while others suggest promoting alternative payment mechanisms—or even starting from scratch. The stakes are substantial, as many reform proposals rely on reining in prices to achieve the savings necessary to expand health insurance to the uninsured. At Penn’s LDI Medicare for All and Beyond conference, a panel of researchers, hospital administrators, and policy experts considered issues related to health care payment and pricing that any health care reform proposal must address, including the implications of rate setting for providers and patients. At what level should these rates be set to assure access and quality of care, while incentivizing innovation and rewarding excellence?

Setting Standards for Affordable Health Care

Issue Brief
Jun. 16, 2020

In the run-up to the presidential election, the affordability of health care remains a top concern of the American voting public. But how do we know when health care is affordable? On a policy level, how do we set a standard for affordability that can be implemented in a reformed system? Sometimes policy debates about affordability focus only on whether insurance premiums are affordable, although consumers tend to be concerned about both premiums and out-of-pocket costs. At Penn LDI’s Medicare for All and Beyond conference, a panel of researchers, policy experts, and consumer advocates discussed and debated affordability in theory and practice. This issue brief summarizes the panel’s insights.

Health Care Cost Drivers and Options for Control

Issue Brief
Apr. 28, 2020

The growth of health care costs remains a serious concern in the United States. Slowing this growth involves understanding what drives health care costs and how to target those drivers effectively. In this brief, we review the relative importance of different health care cost drivers, including insurance benefits design, price inflation, provider incentives, technological growth, and inefficient system performance. We analyze the impact of these factors on the growth of health care spending in the last decade, which has been concentrated in hospitals and felt most acutely in the private 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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