Health Insurance

Financial and structural characteristics of the public and private programs that cover medical costs. LDI analyzes how to expand and improve coverage through insurance exchanges, employer-sponsored insurance, and public programs.

State Efforts to Close the Health Coverage Gap

Feb. 6, 2018

This review examines prominent state efforts to expand health coverage to the remaining uninsured. It analyzes and compares efforts in Massachusetts, Vermont, Colorado, California, and Nevada and highlights insights and themes that emerge. It explores the context and climate for reform within the state, stakeholder involvement, political coalitions, financing, and possible opposition. As such, it serves as a case study in how different states build, or fail to build, the popular and political will towards health care coverage for all residents. This is the first in a series of reports that will monitor and analyze developments at the state level to expand coverage and improve access to care.

Association of Patient Out-of-Pocket Costs With Prescription Abandonment and Delay in Fills of Novel Oral Anticancer Agents

Research Brief
Jan. 19, 2018

High out-of-pocket (OOP) costs may limit access to novel oral cancer medications. In a retrospective study, nearly one third of patients whose OOP costs were $100 to $500 and nearly half of patients whose OOP costs were more than $2,000 failed to pick up their new prescription for an oral cancer medication, compared to 10% of patients who were required to pay less than $10 at the time of purchase. Delays in picking up prescriptions were also more frequent among patients facing higher OOP costs. 

Making Shoppable Care More Probable

Dec. 7, 2017

The late, great economist Uwe Reinhardt once likened the ability of U.S. consumers to shop for health care to sending blindfolded shoppers into a department store. In a new report to the Pennsylvania Insurance Commissioner, the “Shoppable Care Work Group” provides advice on how to take the blindfold off.

Can Affordability of Health Care Be Measured?

Nov. 21, 2017

Affordability may be the most ubiquitous buzzword in health reform. In repeated surveys, Americans cite the affordability of health care as their top financial concern. Despite their handwringing, politicians often avoid defining what constitutes “affordable” health care, and both non-experts and seasoned policymakers seem to lack robust measures of affordability. How can the most important crisis in health care lack reliable metrics?

Exploring the Decline of Narrow Networks on the ACA Marketplaces in 2017

Issue Brief
Nov. 6, 2017

The prevalence of narrow provider networks on the ACA Marketplace is trending down. In 2017, 21% of plans had narrow networks, down from 25% in 2016. The largest single factor was that 70% of plans from National carriers exited the market and these plans had narrower networks than returning plans. Exits account for more than half of the decline in the prevalence of narrow networks, with the rest attributed to broadening networks among stable plans, particularly among Blues carriers. The narrow network strategy is expanding among traditional Medicaid carriers and remains steady among provider-based carriers and regional/local carriers.

Reimagining the Future of Medicare Across the Care Continuum

Oct. 30, 2017

Reforming Medicare to protect the health of an aging and vulnerable population is a pressing policy concern. To share some perspective, Dr. Mary Naylor led a panel entitled “Shaping the Future of Medicare” at Penn LDI’s 50th Anniversary Symposium.

The panelists addressed several core themes, including cost-effective personal care in the home, end-of-life care, Medicare payment reforms, and reimagining care for families of an aging population.

Effects Of State Insurance Mandates On Health Care Use And Spending For Autism Spectrum Disorder

Oct. 30, 2017

Colleen L. Barry, Andrew J. Epstein, Steven C. Marcus, Alene Kennedy-Hendricks, Molly K. Candon, Ming Xie and David S. Mandell

In Health Affairs, Colleen Barry and colleagues, including Andrew Epstein, Steven Marcus and David Mandell, examine whether state mandates requiring commercial insurers to cover treatment for children with autism spectrum disorder (ASD) altered service use or spending among commercially insured children with ASD. To date, 46 states and the District of Columbia have enacted such mandates.

The authors compared children age 21 or younger who were eligible for mandates to children not subject to mandates using 2008–12 claims data from three national insurers. They found that...

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