Implementing the Affordable Care Act: State Action on Quality Improvement in State-Based Marketplaces

Dash, Sarah J.; Corlette, Sabrina; Thomas, Amy

doi:10.15868/socialsector.25006

Cited by 2 publications

(2 citation statements)

References 2 publications

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“…Whether these effects manifest depends not just on state regulatory actions, but on their capacity to effectively enforce their regulations, which has often been lacking. 40,41 Changes in the regulation of small group health insurance plans during the Trump administration also have the potential affect premiums and coverage rates in much the same way as STLDI. ERISA gives states the authority to regulate multi-employer welfare agreements (MEWAs) (29 U.S.C.…”

Section: Discussionmentioning

confidence: 99%

Effect of Eased Restrictions for ACA-Exempt Short-Term Health Plans on Marketplace Premiums and Uninsured Rate: A Difference in Differences Analysis

Костяев

Chakravarty

Cantor

2023

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The Affordable Care Act (ACA) established broad standards for private health insurance in the United States including requiring minimum essential benefits and prohibiting medical underwriting, but the law also permitted some exceptions. This paper examines one type of exempt plan option, Short-Term, Limited Duration Insurance (STLDI) that is not required to fully meet ACA benefit and underwriting standards. Federal rules governing STLDI plans have changed over time, with more permissive rules in the Trump administration allowing individuals to remain covered for longer durations of time relative to the original Obama regulations. Within applicable federal guidelines, states have also varied STLDI rules. Using publicly available data measuring state-level variations in STLDI regulations, ACA benchmark premiums, uninsured rates, and population characteristics for 2014 to 2021, we estimate difference-in-differences models to examine if more permissible STLDI policies are associated with higher premiums in the fully regulated non-group market and, also, lower uninsured rates. We find that longer duration, more permissible STLDI is associated with higher benchmark premiums in ACA exchanges and no difference in state-level uninsured rates. Trump administration regulations permitting longer duration STLDI plans to make available more affordable ACA-exempt health insurance were associated with higher premium costs in the ACA-regulated non-group market but we did not observe measurable impact on state uninsured rates. While longer-duration STLDI plans may result in lower costs for some, they have negative consequences for others requiring comprehensive coverage with no discernible benefit in overall coverage rates. Understanding these tradeoffs can help guide future policies regarding exceptions to ACA plan requirements.

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Section: Discussionmentioning

confidence: 99%

Effect of Eased Restrictions for ACA-Exempt Short-Term Health Plans on Marketplace Premiums and Uninsured Rate: A Difference in Differences Analysis

Костяев

Chakravarty

Cantor

2023

INQUIRY

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“…Early evaluations of the experiences within the ACA marketplaces have focused on coverage rates, awareness of exchanges, and price sensitivity (American Institutes for Research, 2015; Collins, Rasmussen, Doty, & Beutel, 2015; French, Homer, Gumus, & Hickling, 2016; Hamel et al, 2014). Other papers report on the range of plan choices (Corlette, Ahn, Lucia, & Ellison, 2016), access to providers for patients and network accuracy (Haeder, Weimer, & Mukamel, 2016), the range of functionalities of the marketplaces and assistor programs (Grob & Schlesinger, 2015; Wong et al, 2016), or the perceptions and impressions of marketplace staff on outreach and decision support strategies that are improving consumer enrollment (e.g., Giovannelli & Curran, 2016). In this article, we investigate how consumers in two state-based marketplaces shop for health insurance, which tools and strategies they use, and who is at risk for having difficulty understanding and using their health plans.…”

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confidence: 99%

Consumer Health Insurance Shopping Behavior and Challenges: Lessons From Two State-Based Marketplaces

2017

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Selecting a health plan in a health insurance exchange is a critical decision, yet consumers are known to face challenges with health plan choice. We surveyed new enrollees in two state-based exchanges in 2015 to investigate how a nonelderly, primarily low-income population chose their health plans and the implications of shopping behavior for early experiences in their plans. Financial considerations were most important to enrollees. Prior Medicaid enrollees and the uninsured were more likely to have multiple shopping challenges (e.g., difficulty identifying the best or most affordable plan, fair/poor experience, unmet need for help) than enrollees with prior employer coverage (42.9% vs. 32.5% vs. 16.4%, respectively, p < .01). Shopping challenges were associated with difficulty finding a doctor, understanding coverage, and getting questions answered. Assistance targeting enrollees who previously had Medicaid or lacked insurance could improve both shopping experiences and downstream outcomes in plans.

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Implementing the Affordable Care Act: State Action on Quality Improvement in State-Based Marketplaces

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Cited by 2 publications

References 2 publications

Effect of Eased Restrictions for ACA-Exempt Short-Term Health Plans on Marketplace Premiums and Uninsured Rate: A Difference in Differences Analysis

Effect of Eased Restrictions for ACA-Exempt Short-Term Health Plans on Marketplace Premiums and Uninsured Rate: A Difference in Differences Analysis

Consumer Health Insurance Shopping Behavior and Challenges: Lessons From Two State-Based Marketplaces

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