Insurance Exchanges

This brief discusses the issues that states will face in making decisions about how to structure health insurance exchanges and health insurance markets.
 

At the outset of the third open-enrollment period for the Affordable Care Act’s (ACA) health insurance marketplaces, the U.S. Department of Health and Human Services (HHS) reported that the number of insurance companies participating in the federally run marketplaces would remain relatively consistent from 2015 to 2016. This analysis of the 17 state-based marketplaces also found stable participation. Despite the struggles of many Consumer Operated and Oriented Plans (CO-OPs) and persistent market challenges, most state-based marketplaces have an equal or greater number of insurers competing for business this year.

SHADAC is aggregating State-Based Marketplace (SBM) enrollment reports released during the third ACA Open Enrollment Period (November 1, 2015, to January 31, 2015) and posting them to its marketplace enrollment reports library. The library will also incorporate federal enrollment reports for both Federally Facilitated Marketplaces (FFMs) and SBMs, as well as for Medicaid and the Children’s Health Insurance Program (CHIP). State and federal reports covering the first and second ACA Open and Special Enrollment Periods are also available.

Private insurance plans typically require some form of cost sharing (also called out-of-pocket costs) when enrollees receive a health care service covered by their plan. These expenses, which are in addition to the amount an enrollee spends on his or her monthly premium, come in a variety of forms: copayments, coinsurance, and deductibles. This brief shows the cost sharing in plans sold to individuals through Healthcare.gov for 2016, with a focus on the variation in the ways plans may set cost sharing for services, such as physician visits, prescription drugs, and hospital stays.

As Marketplace enrollees begin to shop for coverage starting in 2016, the number of insurance choices available to them is changing in some parts of the country. Over the past year, some insurers have announced their exit or been required to withdraw from the Marketplaces, most notably a number of nonprofit Consumer Operated and Oriented Plans and some larger insurers like Blue Cross Blue Shield of New Mexico.  Despite these withdrawals, the Department of Health and Human Services recently announced that the average number of issuers per state is increasing slightly in 2016 and that about 9 out of 10 returning Healthcare.gov customers will have 3 or more insurers from which to choose in 2016. This Data Note highlights areas where insurer participation is changing in 2016, and where this may have an appreciable effect on market competition. It also examines insurer participation in rural areas, which have historically had low rates of insurer competition.

A central aim of the Affordable Care Act is to increase the number of Americans with health insurance coverage. Over the past two years, significant progress has been made towards this goal as measured by the decline in the proportion of Americans who lack health insurance coverage, with an estimated 17.6 million uninsured people having gained health insurance coverage since several of the ACA coverage provisions took effect. This brief examines the composition of people that remained uninsured though the first quarter of 2015 and may be eligible to purchase insurance coverage from a Qualified Health Plan through the Marketplaces. It also presents data on the attitudes and experiences of the uninsured, drawn from a number of private surveys.

Two models have dominated the policy literature on health insurance exchanges, with many hybrids borrowing elements of each. At one end of the policy spectrum, the insurance exchange can serve as a “marketplace” or “clearinghouse” where buyers and sellers transact with minimal regulation of the product features and prices. At the other end of the policy spectrum, the exchange serves as an “active purchaser” of health insurance on behalf of its clients, the individual consumers. This blogpost discusses what it means to be an active purchaser, and offers a case study comparing Covered California, which uses an active purchaser model, to two other exchange models and some early indications of the benefits of active purchasing.
 

This analysis presents changes in premiums for the lowest- and second-lowest cost silver marketplace plans in major cities in 13 states and the District of Columbia, for which complete data on rates for all insurers are publically available. This page will be updated as complete rate information becomes available for more states
 

States are developing accountable care organizations (ACOs) for their Medicaid populations to target health care costs and improve health care quality by better coordinating care for high-need, high-cost patients and reducing inappropriate inpatient and emergency department visits. Many high-need, high-cost Medicaid patients have mental health and substance use issues and are often not well-served in the current fragmented health care system. In response, states are increasingly looking to integrate behavioral health into their Medicaid ACO programs to help move the needle on cost and quality. This technical assistance tool examines four broad strategies states can use to integrate behavioral health services into ACOs.

Most employers who provide health insurance to employees subsidize their premiums and provide a comprehensive benefit package. Before the ACA, people who lacked health insurance through a job and purchased it on their own paid the full cost of their plans, which often came with more limited benefits and higher deductibles. Findings from The Commonwealth Fund Affordable Care Act Tracking Survey, March–May 2015, indicate that the law’s tax credits have made premium costs in health plans sold through the marketplaces roughly comparable to employer plans, at least for people with low and moderate incomes.