Insurance Market Reform

Concern about even modest disruption of existing health insurance coverage by the ACA regenerates the belief that "there's got to be a better way" to make coverage available, adequate and affordable. But this brief shows that disruption is inevitable in any health reform and that the ACA's disruption is remarkably limited—far less than single payer proposals on the left or market-based proposals on the right. Further, unlike even many narrowly targeted reform alternatives, the ACA improves the pooling of risk that is essential to effective insurance.

This document contains proposed regulations relating to the ACA requirement to maintain minimum essential coverage. It stipulates that while certain types of Medicaid coverage and military health programs do not qualify as minimum essential coverage, individuals enrolled in these programs will not be subject to the shared responsibility payment for 2014. This proposed rule also provides more detail on hardship exemptions and enrollment in employer-sponsored health insurance plans.

The new health insurance marketplaces aim to improve consumers’ purchasing experiences by setting uniform coverage levels for health plans and giving them tools to explore their options. Marketplace administrators may choose to limit the number and type of plans offered to further simplify consumer decision-making. This issue brief examines the policies set by some state-based marketplaces to simplify plan choices: adopting a meaningful difference standard, limiting the number of plans or benefit designs insurers may offer, or requiring standardized benefit designs.

Part of states' roles in administering the new health insurance marketplaces is to certify the health plans available for purchase. This analysis focuses on how state-based and state partnership marketplaces are using their flexibility in setting certification standards to shape plan design in the individual market. It focuses on three aspects of certification: provider networks; inclusion of essential community providers; and benefit substitution, which allows plans to offer benefits that differ from a state’s benchmark plan.

The Affordable Care Act requires health insurers to justify rate increases of 10 percent or more for non-grandfathered plans in the individual and small-group markets. Analyzing these filings for rates taking effect from mid-2012 through mid-2013, insurers attributed the great bulk—three-quarters or more—of these larger rate increases to routine factors such as trends in medical costs. Insurers attributed only a very small portion of these medical cost trends to factors related to the Affordable Care Act.