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 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.
Forty economists and health policy experts, including Dan Polsky and Zeke Emanuel, have signed a strongly worded letter opposing the Better Care Reconciliation Act (BCRA), the Senate proposal to repeal the Affordable Care Act.
[Reposted: Clifford Marks, Janet Weiner, and Daniel Polsky. Confronting the Trade-offs in Health Reform: What We Learned From the ACA, Health Affairs Blog, June 7, 2017. http://healthaffairs.org/blog/2017/06/07/confronting-the-trade-offs-in-health-reform-what-we-learned-from-the-aca/: Copyright ©2017 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc.]
Exit, Voice or Loyalty? An Investigation into Mandated Portability of Front-Loaded Private Health Plans
In a National Bureau of Economic Research Working Paper, Juan Pablo Atal and colleagues, including Hanming Fang, study how a mandate designed to increase competition in the German private health care market influences rates of consumers switching insurers or switching plans within an insurer. In the German system, those who opt into private insurance are required to front-load premium costs, so that younger, healthier consumers pay disproportionately into old-age provisions to offset increased costs for older enrollees. Before a 2009 mandate, consumers who switched insurers could...
After the House passed the American Health Care Act (AHCA), I asked a few of our Senior Fellows to comment on the economic problems the AHCA is designed to fix, and the economic problems it might cause, all politics aside. Dan Polsky immediately pushed back on the premise of 'politics aside':
The Affordable Care Act (ACA) has an “empty shelf” problem: consumers can use their premium subsidies only on the public health insurance exchanges, but insurers are not required to offer any plans on these exchanges.
[cross-posted from the Health Cents blog on philly.com]
Our colleagues at the Wharton Public Policy Initiative have released a new Issue Brief, The Economic Realities of Replacing the Affordable Care Act, by LDI Senior Fellow Hanming Fang, PhD. In it, Dr. Fang uses a new model of labor and health insurance market dynamics to simulate the long-run effects of the ACA's mechanisms, thus shedding some much-needed light on the repeal-and-replace debate.
In Medical Care Research and Review, Ambar La Forgia and colleagues compare the premiums of the lowest priced 'silver' plans of...