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.
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.
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
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.
[cross-posted from the Health Cents blog on philly.com]
It seems that every time Obamacare gets a cold, experts call it pneumonia.
Primary Care Appointment Availability for Medicaid Patients: Comparing Traditional and Premium Assistance Plans
In 2014, Arkansas and Iowa expanded their Medicaid programs and enrolled many of their adult beneficiaries in commercial Marketplace plans. This study suggests that this “private option” may make it easier for new Medicaid patients to get primary care appointments.
In the Journal of Adolescent Health, Alexander Bain and colleagues, including Charlene Wong, Daniel Polsky, Raina Merchant, and David Rubinm, identify the most prevalent and costly inpatient hospitalizations in a national cohort of privately insured young adults since the implementation of the Affordable Care Act. The researchers analyzed 158,777 hospitalizations among 4.7 million young adults from January 2012 to June 2013. They find that the top diagnoses for young adult female hospitalizations were pregnancy related (71.9%) and mental illness (8.9%). The top diagnoses for young...
The cost of private health insurance, the main mechanism by which people access and pay for health care, is high and rising. In fact, the average family spends more than $17,000 annually on health insurance premiums (KFF). That is, even when a family consumes no health care, they are buying the equivalent of a base-model Toyota Corolla in health insurance every year.
Martin Gaynor, PhD recently visited Penn and presented his new paper, “The Price Ain’t Right? Hospital Prices and Health Spending on the Privately Insured” (co-authored by Zack Cooper, Stuart Craig, and John Van Reenen). The national study was the first to analyze health care spending and hospital transaction prices among the privately insured—an analysis made possible by the availability of data from three of the largest private insurers in the U.S.
In Health Affairs, Charlene Wong and colleagues go shopping on the most recent iteration of ACA marketplaces. They find added features to help consumers browse and pick a health plan, including total cost estimators and provider look-up tools. Marketplaces differ in how they estimate out-of-pocket costs and how they display plan choices, although most continue to present plans in premium order.