Paul D. Jacobs

Comparing The Assets Of Uninsured Households To Cost Sharing Under High-Deductible Health Plans

Financial assets are relevant when one is assessing whether high-deductible plans, which require greater up-front cost sharing, are worthwhile for the uninsured. We show that uninsured households have less financial assets compared to the insured; at lower income levels, their net financial assets may even be negative. Although lower premiums may increase the ability of the uninsured to buy some coverage, high out-of-pocket liability may leave families exposed to costs that they cannot meet. Paying premiums for a policy that exposes the uninsured to unaffordable medical bills may be viewed as an uneconomical use of their limited assets.

Insurer Competition In Federally Run Marketplaces Is Associated With Lower Premiums

Federal subsidies for health insurance premiums sold through the Marketplaces are tied to the cost of the benchmark plan, the second-lowest-cost silver plan. According to economic theory, the presence of more competitors should lead to lower premiums, implying smaller federal outlays for premium subsidies. The long-term impact of the Affordable Care Act on government spending will depend on the cost of these premium subsidies over time, with insurer participation and the level of competition likely to influence those costs. We studied insurer participation and premiums during the first two years of the Marketplaces. We found that the addition of a single insurer in a county was associated with a 1.2 percent lower premium for the average silver plan and a 3.5 percent lower premium for the benchmark plan in the federally run Marketplaces. We found that the effect of insurer entry was muted after two or three additional entrants. These findings suggest that increased insurer participation in the federally run Marketplaces reduces federal payments for premium subsidies.

Changes In Health Status And Care Use After ACA Expansions Among The Insured And Uninsured

Following the Affordable Care Acts insurance expansion provisions in 2014, the average health status and use of health care within coverage groups has likely changed. Medicaid enrollees and the uninsured were both healthier in 2014 than those respective groups were in 2013. By contrast, those with individual private insurance coverage appeared less healthy as a group.

Getting What We Pay For: How Do Risk-Based Payments to Medicare Advantage Plans Compare with Alternative Measures of Beneficiary Health Risk?

OBJECTIVE To estimate the relative health risk of Medicare Advantage (MA) beneficiaries compared to those in Traditional Medicare (TM). DATA SOURCES/STUDY SETTING Medicare claims and enrollment records for the sample of beneficiaries enrolled in Part D between 2008 and 2015. STUDY DESIGN We assigned therapeutic classes to Medicare beneficiaries based on their prescription drug utilization. We then regressed nondrug health spending for TM beneficiaries in 2015 on demographic and therapeutic class identifiers for 2014 and used coefficients from this regression to predict relative risk of both MA and TM beneficiaries. PRINCIPAL FINDINGS Based on prescription drug utilization data, beneficiaries enrolled in MA in 2015 had 6.9 percent lower health risk than beneficiaries in TM, but differences based on coded diagnoses suggested MA beneficiaries were 6.2 percent higher risk. The relative health risk based on drug usage of MA beneficiaries compared to those in TM increased by 3.4 p.p. from 2008 to 2015, while the relative risk using diagnoses increased 9.8 p.p. CONCLUSIONS Our results add to a growing body of evidence suggesting MA receives favorable, or, at worst, neutral selection. If MA beneficiaries are no healthier and no sicker than similar beneficiaries in TM, then payments to MA plans exceed what is warranted based on their health status.

Despite Coverage Gains, One-Third Of People In Small-Firm Low-Income Families Were Uninsured In 2014–15

Obtaining health insurance coverage has historically been challenging for workers at small firms and the self-employed. Using data from the Medical Expenditure Panel Survey, we found that the overall uninsurance rate for these workers and their families declined by 5 percentage points over the past decade, but one-third of those with lower incomes remained uninsured in 2014-15.

Adults Are More Likely To Become Eligible For Medicaid During Future Recessions If Their State Expanded Medicaid

Eligibility for and enrollment in Medicaid can vary with economic recessions, recoveries, and changes in personal income. Understanding how Medicaid responds to such forces is important to budget analysts and policy makers tasked with forecasting Medicaid enrollment. We simulated eligibility for Medicaid for the period 2005-14 in two scenarios: assuming that each states eligibility rules in 2009, the year before passage of the Affordable Care Act (ACA), were in place during the entire study period; and assuming that the ACAs expanded eligibility rules were in place during the entire period for all states. Then we correlated the results with unemployment rates as a measure of the economy. Each percentage-point increase in the unemployment rate was associated with an increase in the share of people eligible for Medicaid of 0.32 percentage point under the 2009 eligibility rules and 0.77 percentage point under the ACA rules. Our simulations showed that the ACA expansion increased Medicaids responsiveness to changes in unemployment. For states that have not expanded Medicaid eligibility, our analysis demonstrates that increased responsiveness to periods of high unemployment is one benefit of expansion.