Data Needs for Policy Research on State-Level Health Insurance Markets

Abstract

Private and public health insurance provision in the United States operates against a backdrop of 50 different regulatory environments in addition to federal rules. Through creative use of available data, a large body of research has contributed to our understanding of public policy in state health insurance markets. This research plays an important role as recent trends suggest states are taking the lead in health care reform. However, several important questions have not been answered due to lack of data. This paper identifies some of these areas, and discusses how the Agency for Healthcare Research and Quality could push the research agenda in state health insurance policy further by augmenting the market-level data available to researchers. As states consider new forms of regulation and assistance for their insurance markets, there is increased need for better warehousing and maintenance of policy databases.Americans face a patchwork of different markets providing health insurance. These markets, be they private or public, are governed by several sets of regulations enacted at the state as well as federal level. The variation that exists in policies, particularly at the state level, has spawned a large literature assessing the policies' impacts on health insurance and related outcomes. Yet several new questions could be answered if additional market-level data were collected. The Agency for Healthcare Research and Quality (AHRQ) has an opportunity to further the research by facilitating the creation of such resources. In this paper, I briefly review the available market-level data, 1 research questions that have been explored with these measures, and identify additional questions that could be answered with new data. This paper begins with a review of the different segments of markets for health insurance. Regulating Private vs. Public Health InsuranceThe private insurance market consists of two separate domains-group and nongroup markets-which are further split in the manner shown in Figure 1. To convey a sense of the relative sizes of some of these components, in 2004 about 161.5 million individuals (or 63.3% of all nonelderly Americans) held employer health insurance, while 11.2% of the nonelderly held coverage through Medicaid/State Children's Health Insurance Program (SCHIP), 2.3% held Medicare/Tricare coverage, 5.4% had directly

State Health Insurance Regulation and Self-Employment Rates After the Great Recession: The Role of Guaranteed Issue Mandates

“…The GI − 1 results align with Blumberg et al's (2013) contested prediction-see Heim and Yang (2014) and Miller (2016)-that nationwide GI − 1 will boost selfemployment. The GI − 1 finding answers "yes" to Simon's (2008) question of whether self-employment rates are sensitive to regulations that let the SENE shop in the small-group market. And, the GI − 1 finding aligns with a proposal that the National Association of Insurance Commissioners made in its 1996 Small Employer Health Insurance Availability Model Act to define "small employer to include a business group of one" (Allen & Park, 1999, p. 3).…”

“…Heim and Lurie (2013) treated insurance regulation as a key moderator in models aimed at delineating self-employment's links to tax policies, and in their analysis, individual market GI differentiates states as having "heavy" versus "moderate" or "light" regulation (p. 96). Simon (2008) asserted that research on the SENE's ability to shop in the small-group market is needed to assess "whether there is more entry into self-employment when access to health insurance is eased" (p. 94). Blumberg et al (2013) cited GI for groups of one in the small-group market as central to the post-ACA selfemployment uptick that they projected.…”

NHSR 176: Geographic Variation in Health Insurance Coverage: United States, 2021

“…7 Living within a large fringe MSA with a population of 1 million or more (similar to suburbs). 8 Living within a medium or small MSA with a population of less than 1 million. 9 Not living in an MSA.…”

“…Previous research based on national surveys has found geographic variation in insurance coverage in the United States by urbanization level, state Medicaid expansion status, region, and state (4)(5)(6). Population estimates of health insurance coverage at the state level are necessary for the development and assessment of federal and state health care coverage programs and policies (7)(8)(9). A recent study found that about 3.7 more people would gain coverage in 2023 if the remaining non-Medicaid expansion states fully implemented a Medicaid expansion under the provisions of the Affordable Care Act (10,11).…”

Geographic Variation in Health Insurance Coverage: United States, 2022

“…Previous research based on national surveys has found geographic variation in insurance coverage in the United States by urbanization level, state Medicaid expansion status, region, and state (4)(5)(6). Population estimates of health insurance coverage at the state level are necessary to develop and assess federal and state healthcare coverage programs and policies (7)(8)(9). For example, a 2020 study found that more than 4 million people would gain coverage if the remaining non-Medicaid expansion states would fully implement a Medicaid expansion under the provisions of the Affordable Care Act (ACA) (10,11).…”