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.

Effects of the ACA on Health Care Cost Containment

Issue Brief
Mar. 2, 2017

This brief reviews the evidence on how key ACA provisions have affected the growth of health care costs. Coverage expansions produced a predictable jump in health care spending, amidst a slowdown that began a decade ago. Although we have not returned to the double-digit increases of the past, the authors find little evidence that ACA cost containment provisions produced changes necessary to “bend the cost curve.” Cost control will likely play a prominent role in the next round of health reform and will be critical to sustaining coverage gains in the long term.

Price Transparency in Primary Care: Can Patients Learn About Costs When Scheduling an Appointment?

Feb. 16, 2017

Brendan Saloner, Lisa Clemens Cope, Katherine Hempstead, Karin Rhodes, Daniel Polsky, Genevieve Kenney

In the Journal of General Internal Medicine, Brendan Saloner, Daniel Polsky, Karin Rhodes, and colleagues investigate whether new patients can obtain price information for a primary care visit and identify variation across insurance types, offices and geographic areas. Cost-sharing in insurance plans incentivizes patients to shop for lower prices, but can patients obtain price information when scheduling office visits? The authors used a simulated patient methodology in which trained interviewers posed as patients (with different types of insurance) seeking new primary care...

How to Save the Individual Insurance Market Post-ACA

Feb. 10, 2017

[cross-posted from the Health Cents blog on philly.com]

Just 6% of people under age 65 buy health insurance on the individual market (rather than getting it through their jobs), but the political debate about how to arrange insurance for them is causing great turmoil and has revived discussion of the individual mandate.

Exchanges Can Survive End of Individual Mandate

Jan. 23, 2017

One of the many scary trial balloons being floated by the Administration as part of its first 100 days is to abolish enforcement of the individual mandate. That mandate imposes a penalty of $695 per person, or 2.5% of income per family, for people who fail to obtain qualified health insurance. It isn’t much of a penalty because about half of the uninsured can get exemptions and the penalties are small relative to premiums.

Insurance Coverage and Access to Care Under the Affordable Care Act

Issue Brief
Dec. 8, 2016

This brief details changes in insurance coverage and access to care under the Affordable Care Act. About 20 million individuals gained coverage under the law and access to care improved.  Despite these gains, more than 27 million individuals are still uninsured, and many others face barriers in accessing care.  As a result of the 2016 elections, the future of the ACA is uncertain.  As the next Administration and policymakers debate further health system reforms, they should consider the scope of the ACA’s effects on their constituents. 

Trends In Physician Networks in the Marketplace in 2016

Data Brief
Dec. 6, 2016

In this brief, we describe the breadth of physician provider networks offered on the health insurance marketplaces in 2016, and present differences by plan type, physician specialty, and state. We also compare networks in 2016 to those in 2014. We find little change in overall prevalence of narrow networks, but we find important geographic shifts and a trend towards x-small networks among plans with narrow networks. We discuss the policy implications of our findings for consumers, regulators, and health plans.

Turmoil in the Health Insurance Marketplaces

Issue Brief
Oct. 27, 2016

This issue brief is first in a four-part series that will summarize the latest evidence on how the Affordable Care Act has affected key areas of our health and economic systems. It explores the current volatility in the ACA’s Marketplaces and discusses key factors in their evolution over the past three years. The brief concludes with options for policymakers to address the turmoil in the Health Insurance Marketplaces. 

Marketplace Plans With Narrow Physician Networks Feature Lower Monthly Premiums Than Plans With Larger Networks

Research Brief
Oct. 4, 2016

Insurers offering plans on the Affordable Care Act’s health insurance marketplaces have used a strategy of restricted, or narrow, provider networks to limit costs. Narrow network plans are thought to be less expensive for consumers, but how much are they actually saving in premiums by choosing such plans? This study uses data from all ‘silver’ plans offered on the marketplaces in 2014 in all 50 states and the District of Columbia to categorize networks into “t-shirt sizes” and to estimate the association between the breadth of a provider network and plan premiums.

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