On September 13 and 14, the University of Pennsylvania Law School, Penn LDI, and Princeton University's Center for Health and Wellbeing will host the Sixth Annual Health Insurance Exchange Conference. This nonpartisan, off-the-record workshop brings together senior state policymakers and researchers studying health care markets to discuss the latest research on the exchanges and current challenges.
On November 1st, the sixth year of open enrollment on the ACA Marketplace will start. While the basic rules that govern the Marketplace and the sliding-scale subsidies remain intact, gains in enrollment are unlikely given the end of penalties for the individual mandate, the emergence of association health plans, and new rules related to “short-term limited duration.”
In the not-too-distant future, individuals may be able to learn their risk of developing Alzheimer’s disease through biomarkers – measures of disease activity – detected up to 20 years before symptoms present. This information would allow individuals (and their loved ones) to prepare for future cognitive and functional decline, but it also has implications for the purchase of private long-term care insurance.
The adequacy of “narrow network” plans offered on the Affordable Care Act (ACA) Marketplaces continues to be a concern in the wake of exclusions of some high-cost providers and the incidence of “surprise medical bills” even in facilities that are in-network.
Shopping on the Public and Private Health Insurance Marketplaces: Consumer Decision Aids and Plan Presentation
Abstract [from journal]
Background: The design of the Affordable Care Act’s (ACA) health insurance marketplaces influences complex health plan choices.
Objective: To compare the choice environments of the public health insurance exchanges in the fourth (OEP4) versus third (OEP3) open enrollment period and to examine online marketplace run by private companies, including a total cost estimate comparison.
Design: In November–December 2016, we examined the...
For the nearly 30 million people in the United States who have no health insurance, gaining access to care and paying for that care can be a challenge. A new “secret shopper” study explores whether the uninsured can get a new primary care appointment, and at what price.
Prior Authorization Requirements for Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors Across US Private and Public Payers
A comprehensive review of prior authorization (PA) requirements for a new class of expensive cholesterol-lowering drugs known as proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors has found unusually complex and burdensome demands across public and private insurance plans in the United States. These findings raise concerns that current policies may create undue barriers to care even in medically appropriate patients, particularly since requirements were just as stringent for patients with a genetic condition that creates more clear-cut eligibility for PCSK9 inhibitor treatment.
In response to regulatory changes at the federal level, states that run their own marketplaces have taken steps to stabilize their individual markets. In this comparison of state-based and federally-facilitated marketplaces from 2016-2018, we find that SBMs had slower premium increases (43% vs. 75%), and fewer carrier exits, than FFMs. The total population participating in FFMs declined by 10%, while the enrolled population in SBMs remained largely stable, increasing by 2%. We find that the performance of the ACA marketplaces varies by state and appears to cluster around marketplace types.
Association of Patient Out-of-Pocket Costs With Prescription Abandonment and Delay in Fills of Novel Oral Anticancer Agents
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.
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.
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...