Acquisition of physician practices by private equity firms has accelerated, 1,2 with unknown implications for care delivery and patient outcomes. However, available data are limited to single specialties or come from industry reports or opinion articles. A dearth of evidence and the use of nondisclosure agreements at early stages of negotiation have constrained the ability to evaluate this phenomenon empirically. 3 In this study, we describe physician group practices acquired in 2013-2016 across specialties. Methods | We identified US physician group practice acquisitions by private equity firms using the Irving Levin Associates Health Care M&A data set, 4 which includes manually collected and verified transactional information on a broad set of health care mergers and acquisitions. We excluded practices bought by entities not classified as private equity firms at the time of acquisition. We verified practice names, locations, specialties, and group practice status via Google searches. We linked acquisitions to the SK&A data set, a commercial data set of verified physician-and practice-level characteristics (eg, specialty, credentials, practice ownership, size, and locations) for US office-based practices. Transactions Key limitations include that the data are based on publicly announced transactions and therefore underestimate total acquisitions, particularly of smaller practices, and that available data lag behind the rapid pace of private equity acquisitions.

The Affordable Care Act (ACA) expanded Medicaid eligibility to adults with incomes under 138% of the federal poverty level, leading to substantial reductions in uninsured rates among low-income adults. Despite large gains in coverage, studies suggest that Latinos may be less likely than other racial/ethnic groups to apply and enroll in health insurance, and they remain the group with the highest uninsured rate in the United States. We explore two potential factors related to racial/ethnic differences in ACA enrollment—awareness of the law and receipt of application assistance such as navigator services. Using a survey of nearly 3000 low-income U.S. citizens (aged 19-64) in 3 states in late 2014, we find that Latinos had significantly lower levels of awareness of the ACA relative to other groups, even after adjusting for demographic covariates. Higher education was the strongest positive predictor of ACA awareness. In contrast, Latinos were much more likely to receive assistance from navigators or social workers when applying, relative to other racial/ethnic groups. Taken together, these results highlight the importance of ACA outreach efforts to increase awareness among low-income and less educated populations, two groups that are overrepresented in the Latino population, to close existing disparities in coverage.

The Affordable Care Act (ACA) has increased the number of Americans with health insurance. Yet many policy makers and consumers have questioned the value of Marketplace plan coverage because of the generally high levels of cost sharing. We simulated out-of-pocket spending for bronze, silver, or gold Marketplace plans (those having actuarial values of 60 percent, 70 percent, and 80 percent, respectively). We found that for the vast majority of consumers, the proportion of covered spending paid by the plans is likely to be far less than their actuarial values, the metric commonly used to convey plan generosity. Indeed, only when annual health care spending exceeds $16,500 for bronze plans, $19,500 for silver plans, and $21,500 for gold plans do plans in these metal tiers cover the proportion of costs matching their actuarial values. While Marketplace plans substantially reduce consumers' exposure to financial risk relative to being uninsured, the use of actuarial values to communicate plan generosity is likely to be misleading to consumers.

Risk-adjustment policies, which transfer money from insurers with healthy consumers to those with sick consumers, are an important tool to contend with adverse selection in health insurance markets. While the steady-state properties of risk-adjustment have been studied extensively, there is less evidence on the transition phase of policy implementation. We study the introduction and removal of risk-adjustment at California Public Employees' Retirement System and show that these changes meaningfully impact premiums via plan differences in enrollee health status. Despite these premium differences, there is limited consumer resorting due to consumer inertia, though new active enrollees respond more fluidly. We show that, with inertial consumers, risk-adjustment changes have substantial distributional consequences, leading to worse outcomes for sicker consumers when removed and vice-versa when implemented. We estimate a model of plan choice with premium sensitivity, brand preferences, and inertia and use these estimates to study the interaction between riskadjustment policies and the strength of inertia.

Background: Recent work has documented that low-income adults have higher life expectancy in more affluent areas of the US. Less is known about the relationship between area affluence and morbidity in the low-income population.Objective: To evaluate the association between the prevalence of chronic conditions among lowincome older adults and the economic affluence of a local area Design: -Cross-sectional association study. Setting: Medicare in 2015.Participants: 6,363,097 Medicare beneficiaries aged 66 to 100 with a history of low income support under Medicare Part D.Measurements: Adjusted prevalence of 48 chronic conditions was computed for 736 commuting zones (CZ). Factor analysis was used to assess spatial covariation of condition prevalence and to construct a composite condition prevalence index for each CZ. The association between morbidity and area affluence was measured by comparing the mean of condition prevalence index across deciles of median CZ house values.