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Author: Eric Lewis Publisher: ISBN: Category : Languages : en Pages :
Book Description
The goals of the Affordable Care Act (ACA) are to expand access to health care, improve the quality of care, and lower health care spending growth in the United States. However, there have been several challenges introduced during its implementation that raise concerns over the long-term sustainability of the health insurance market under the new law. A potential improvement that has been debated over the past decade is the establishment of a government-run public option in the health insurance exchanges to compete with private insurers and offer additional health plans in areas where few insurers exist. This paper evaluates the potential impact of establishing a public option in the health insurance exchanges. I conduct a case study on Germanys health care system to assess the advantages and disadvantages of balancing both a public and private sector in the health insurance market. Then, based on the analysis of Germanys health care system, I provide suggestions on how to improve the design of the public option to address the challenges presented by the ACA.
Author: Eric Lewis Publisher: ISBN: Category : Languages : en Pages :
Book Description
The goals of the Affordable Care Act (ACA) are to expand access to health care, improve the quality of care, and lower health care spending growth in the United States. However, there have been several challenges introduced during its implementation that raise concerns over the long-term sustainability of the health insurance market under the new law. A potential improvement that has been debated over the past decade is the establishment of a government-run public option in the health insurance exchanges to compete with private insurers and offer additional health plans in areas where few insurers exist. This paper evaluates the potential impact of establishing a public option in the health insurance exchanges. I conduct a case study on Germanys health care system to assess the advantages and disadvantages of balancing both a public and private sector in the health insurance market. Then, based on the analysis of Germanys health care system, I provide suggestions on how to improve the design of the public option to address the challenges presented by the ACA.
Author: Joel C. Cantor Publisher: Routledge ISBN: 0415651956 Category : Business & Economics Languages : en Pages : 193
Book Description
In this volume, leading American health economists provide a critical assessment of the current state of knowledge of insurance market reform that is accessible to both policy-makers and researchers.
Author: Laura Summer Publisher: ISBN: Category : Languages : en Pages : 6
Book Description
The passage of the Patient Protection and Affordable Care Act (ACA) presents both opportunities and significant challenges for the safety net, a system of health care providers that primarily serve patients who otherwise cannot afford or gain access to care. In 2014, the ACA will extend health insurance coverage to more than 30 million currently uninsured people. The law also promises some significant investments to build provider capacity and help deliver care in a more coordinated manner. However, safety net providers are concerned that changes in the ACA regarding health care financing may affect the availability of adequate and sustainable funding as they continue to care for the most vulnerable consumers, particularly the millions who will still lack insurance. Safety net providers note that the successes of health reform and of the safety net are bound together as the health of the nation will not improve unless providers are available to deliver care. All providers recognize the need to plan strategically in anticipation of major changes in the health care system, but safety net providers also face the immediate challenge of responding to a significant increase in the demand for services that accompanied the recent recession. At the same time, cuts in Medicaid, the largest single revenue source for safety net providers, have occurred in states that face large budget deficits. Safety net providers must focus on sustaining current services while planning for the major changes to come in 2014 The ACA gives federal agencies the discretion to define critical terms and concepts in the law. The manner in which they are interpreted can have a profound impact on the viability of the safety net.
Author: Petra Willis Rasmussen Publisher: ISBN: Category : Languages : en Pages : 183
Book Description
Following the implementation of the Affordable Care Act (ACA), millions of Americans have gained coverage, many for the first time in their lives. The law has created more options for affordable coverage and put millions into the driver seat when it comes to selecting their coverage and enrolling in a health plan. The individual health insurance market has undergone significant changes under the ACA, including the creation of state-based and federally facilitated marketplaces where individuals in all states can go to shop for and enroll in potentially subsidized individual market coverage. This dissertation seeks to improve our understanding of consumer decision-making in this new health insurance landscape. Through three sets of analyses of consumer behavior during the insurance decision-making process, this dissertation will provide needed updates to the literature on this topic. It also highlights key considerations for policymakers and agencies to weigh when evaluating how consumers might respond to policies that change their available coverage options. The first paper examines two key components of health plans that individuals weigh when making enrollment decisions - cost and quality. The ACA requires both federally facilitated and state-based marketplaces to provide easy to understand plan quality information to customers shopping for coverage. Through two hypothetical choice experiments, this paper examines how consumers weighed health plan costs and quality in different choice environments and explored the consumer characteristics associated with a preference for high quality plans as well as with the selection of inferior plans. In each experiment, participants responded to a series of choice scenarios that asked them to choose between five health plans that differed only in their costs and quality ratings, represented by stars. Overall, between scenarios individuals were willing to pay more for higher quality plans when the quality ratings of all available plans were lower, when the higher quality plan's rating was two stars higher rather than one star higher than other plans, and when the price differential was lower. More risk averse participants had higher predicted probabilities of consistently choosing the higher quality, more expensive plan. However, a significant portion of the study population made poor decisions: more than a third of participants chose a dominated plan at least once. The less numerate, those with higher risk-seeking tendencies, and those with low health insurance literacy had the highest predicted probabilities of choosing poorly. The second experiment also found that individuals are more likely to choose a dominated plan when the quality star ratings are similar across plans. The second and third papers use data from California's health insurance marketplace, Covered California, to examine consumer behavior following the implementation of silver loading in 2018. Silver loading is a policy California and other states put into place after the cancellation of federal funding for a set of subsidies included in the ACA that reduce the amount of cost-sharing required by low-income enrollees in silver tier marketplace plans, known as cost-sharing reductions (CSRs). Silver loading placed the cost of providing CSRs in the absence of federal funding onto the premiums of silver plans, subsequently raising premium subsidies which are tied to the cost of silver coverage. The second paper focuses on enrollment in silver plans that became dominated because of silver loading. This paper looks at enrollment in these plans over time (both before and after they became dominated) and by enrollees' prior year enrollment decisions to examine differences in enrollment by pre-existing biases regarding metal tier labeling and the potential role of status quo bias. Overall, more than 60,000 Californians enrolled in a dominated plan in 2018 and, on average, households enrolled in dominated plans in 2018 spent an additional $38.87 per month in premiums. Households that were enrolled in silver coverage in the year before the examined silver plans became dominated had the highest predicted probability of enrolling in a dominated plan in 2018. The third paper examines Covered California consumers' decisions to switch health plans during open enrollment over the first four open enrollment periods where individuals could renew their coverage (2015-2018). Under the ACA, switching rates in the individual market have been much higher than those previously seen in other markets. Looking at re-enrollees in Covered California, this paper provides data on consumer switching behavior over time and identifies the consumer, plan, and choice environment characteristics associated with consumers' decisions to change their coverage during open enrollment. The percentage of re-enrollees in Covered California who made changes to their coverage steadily increased between the 2014-15 and 2017-18 open enrollment periods. Following the implementation of silver loading the proportion of consumers who moved into gold plans during the 2017-18 open enrollment period drastically increased, compared to previous years. Among bronze or silver plan enrollees who switched metal tiers during open enrollment, those who could enroll in gold plans that were no more than $49 per month more expensive than their initial bronze or silver plan had a significantly higher probability of switching into gold coverage than those who faced larger premium differences. The results of this dissertation identify several consumer, health plan, and choice environment characteristics that can influence consumer health insurance decision-making. Policymakers and marketplace regulators can use this work to help inform the decisions they make around marketplace choice architecture, policies aimed at retaining enrollees and recruiting new consumers, and decisions about re-enrollment for consumers who do not actively renew their coverage during annual re-enrollment periods.
Author: Pietro Tebaldi Publisher: ISBN: Category : Languages : en Pages : 0
Book Description
The recent nation-wide health reform -- Patient Protection and Affordable Care Act, or simply ACA -- drastically altered the functioning of the health insurance industry in the US, opening many questions about how the system should be designed and regulated. While previous literature largely focused on health insurance provided through public programs or employer-sponsored insurance, in this dissertation I study the health coverage provision for outsiders: the twenty-one percent of the US population who as of 2013 were not offered insurance through their job, were not covered by the government, and yet did not purchase coverage in the so-called individual market.After the ACA, market institutions were largely redesigned with attention to this group, and policymakers are still dealing with great uncertainty about the efficacy of the new system and its costs for taxpayers in future years. In this context, my research advances our knowledge in two directions. On the one hand I provide empirical results of immediate policy relevance; on the other, I develop economic and statistical models to be used in this novel institutional environment. I consider three of the main channels through which, since 2014, the government affects the individual market for health insurance. First, state authorities determine how the geography of the state is divided in the local geographic markets in which insurers can participate and compete. Second, the ACA limits premium adjustments based on age or other observable characteristics of buyers. Third, the Federal government provides a large premium subsidy for all buyers whose income is between 133 and 400% of the Federal povery level. My dissertation contains three chapters, each of them analyzing the interaction of these three policies with the incentives of private health insurers.The first chapter -- The Impact of Market Size and Composition on Health Insurance Premium -- shows that the way in which states are divided into regions (with prices and plans fixed for all buyers within each region) is an important determinant of market outvi comes. While some states decided to bundle together small, rural areas with larger cities in the same region, others decided to separate urban and rural counties into different regions. Exploiting this variation, this work shows that the former choice tends to “help” the rural populations since under this bundling they benefit from lower prices and have more options to choose from. More precisely, the key finding is that when states combine small, rural counties with neighboring urban areas into a single region, the included rural markets see 0.6 to 0.8 more active insurers, on average, and savings in annual premiums of between $200 and $300.The second chapter -- Regulated Age-Based Pricing in Health Insurance Exchanges -- shows how limiting insurers' ability to charge different prices for buyers of different ages affects market prices, and the amount of public funds needed to provide coverage for lowincome groups. We measure that the policy implied a reduction in Federal spending of approximately $2.3 billion per-year (or approximately 5%). Additional insights gained from this work show how states failed to take into account the age-composition of their uninsured population when deciding how to regulate age-based pricing.
Author: R. Paul Shaw Publisher: World Bank Publications ISBN: 0821369504 Category : Business & Economics Languages : en Pages : 188
Book Description
Specialist groups have often advised health ministers and other decision makers in developing countries on the use of social health insurance (SHI) as a way of mobilizing revenue for health, reforming health sector performance, and providing universal coverage. This book reviews the specific design and implementation challenges facing SHI in low- and middle-income countries and presents case studies on Ghana, Kenya, Philippines, Colombia, and Thailand.
Author: Maria-Luisa Escobar Publisher: Brookings Institution Press ISBN: 0815705468 Category : Social Science Languages : en Pages : 239
Book Description
Over the past twenty years, many low- and middle-income countries have experimented with health insurance options. While their plans have varied widely in scale and ambition, their goals are the same: to make health services more affordable through the use of public subsidies while also moving care providers partially or fully into competitive markets. Until now, however, we have known little about the actual effects of these dramatic policy changes. Understanding the impact of health insurance-based care is key to the public policy debate of whether to extend insurance to low-income populationsand if so, how to do itor to serve them through other means.
Author: Steven Brill Publisher: Random House ISBN: 0812996968 Category : History Languages : en Pages : 528
Book Description
NEW YORK TIMES BESTSELLER • A NEW YORK TIMES NOTABLE BOOK • “A tour de force . . . a comprehensive and suitably furious guide to the political landscape of American healthcare . . . persuasive, shocking.”—The New York Times America’s Bitter Pill is Steven Brill’s acclaimed book on how the Affordable Care Act, or Obamacare, was written, how it is being implemented, and, most important, how it is changing—and failing to change—the rampant abuses in the healthcare industry. It’s a fly-on-the-wall account of the titanic fight to pass a 961-page law aimed at fixing America’s largest, most dysfunctional industry. It’s a penetrating chronicle of how the profiteering that Brill first identified in his trailblazing Time magazine cover story continues, despite Obamacare. And it is the first complete, inside account of how President Obama persevered to push through the law, but then failed to deal with the staff incompetence and turf wars that crippled its implementation. But by chance America’s Bitter Pill ends up being much more—because as Brill was completing this book, he had to undergo urgent open-heart surgery. Thus, this also becomes the story of how one patient who thinks he knows everything about healthcare “policy” rethinks it from a hospital gurney—and combines that insight with his brilliant reporting. The result: a surprising new vision of how we can fix American healthcare so that it stops draining the bank accounts of our families and our businesses, and the federal treasury. Praise for America’s Bitter Pill “An energetic, picaresque, narrative explanation of much of what has happened in the last seven years of health policy . . . [Brill] has pulled off something extraordinary.”—The New York Times Book Review “A thunderous indictment of what Brill refers to as the ‘toxicity of our profiteer-dominated healthcare system.’ ”—Los Angeles Times “A sweeping and spirited new book [that] chronicles the surprisingly juicy tale of reform.”—The Daily Beast “One of the most important books of our time.”—Walter Isaacson “Superb . . . Brill has achieved the seemingly impossible—written an exciting book about the American health system.”—The New York Review of Books
Author: National Academies of Sciences, Engineering, and Medicine Publisher: National Academies Press ISBN: 0309452961 Category : Medical Languages : en Pages : 583
Book Description
In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.
Author: Eric Lewis
Author: Eric Lewis
Author: Joel C. Cantor
Author: Laura Summer
Author: Petra Willis Rasmussen
Author: Douglas Holtz-Eakin
Author: Pietro Tebaldi
Author: R. Paul Shaw
Author: Maria-Luisa Escobar
Author: Steven Brill
Author: National Academies of Sciences, Engineering, and Medicine