State Regulation of Coverage Options Outside of the Affordable Care Act: Limiting the Risk to the Individual Market

2018 ◽  
Author(s):  
JoAnn Volk Volk ◽  
Sabrina Corlette Corlette ◽  
Kevin W. Lucia Lucia ◽  
Justin Giovannelli Giovannelli ◽  
Dania Palanker Palanker ◽  
...  
Keyword(s):  
Affordable Care Act ◽  
State Regulation ◽  
Individual Market ◽  
The Affordable Care Act ◽  
The Individual

scholarly journals Sources of Success in California's Individual Marketplace under the Affordable Care Act

2019 ◽  
Vol 44 (4) ◽  
pp. 679-706
Author(s):  
Petra W. Rasmussen ◽  
Gerald F. Kominski
Keyword(s):  
Affordable Care Act ◽  
The United States ◽  
Community Partners ◽  
Early Adoption ◽  
Individual Market ◽  
The Affordable Care Act ◽  
The Law ◽  
The Stability ◽  
The Individual ◽  
Trump Administration

Abstract When passed in 2010, the Affordable Care Act (ACA) became the greatest piece of health care reform in the United States since the creation of Medicare and Medicaid. In the 9 years since its passage, the law has ushered in a drastic decrease in the number of uninsured Americans and has encouraged delivery system innovation. However, the ACA has not been uniformly embraced, and states differ in their implementation of the law and in their individual health insurance marketplace's successfulness. Furthermore, under the Trump administration the law's future and the stability of the individual market have been uncertain. Throughout, however, California has been a leader. Today, the state's marketplace, known as Covered California, offers comprehensive, standardized health plans to over 1.3 million consumers. California's success with the ACA is largely attributable to its historical receptiveness to health reform; its early adoption of the law; its decision to have Covered California operate as an active purchaser, help shape the plans sold through the marketplace, and design a consumer-friendly enrollment experience; its engagement with stakeholders and community partners to encourage enrollment; and Covered California's commitment to continually innovate, improve, and anticipate the needs of the individual market as the law moves forward.

Implementing the Affordable Care Act: State Regulation of Marketplace Plan Provider Networks

2015 ◽  
Author(s):  
Sabrina Corlette Corlette ◽  
Kevin W. Lucia Lucia ◽  
Justin Giovannelli Giovannelli
Keyword(s):  
Affordable Care Act ◽  
State Regulation ◽  
Provider Networks ◽  
The Affordable Care Act

scholarly journals Regulating Markups in US Health Insurance

2019 ◽  
Vol 11 (4) ◽  
pp. 71-104 ◽  
Author(s):  
Steve Cicala ◽  
Ethan M. J. Lieber ◽  
Victoria Marone
Keyword(s):  
Health Insurance ◽  
Affordable Care Act ◽  
Natural Experiment ◽  
Loss Ratio ◽  
Profit Margins ◽  
Medical Claims ◽  
Commercial Markets ◽  
Individual Market ◽  
The Individual ◽  
Medical Loss Ratio

A health insurer's Medical Loss Ratio (MLR) is the share of premiums spent on medical claims, or the inverse markup over average claims cost. The Affordable Care Act introduced minimum MLR provisions for all health insurance sold in fully insured commercial markets, thereby capping insurer profit margins, but not levels. While intended to reduce premiums, we show this rule creates incentives to increase costs. Using variation created by the rule's introduction as a natural experiment, we find medical claims rose nearly one-for-one with distance below the regulatory threshold: 7 percent in the individual market and 2 percent in the group market. Premiums were unaffected. (JEL G22, H51, I13, I18)

Financial Performance of Health Insurers: State-Run Versus Federal-Run Exchanges

2017 ◽  
Vol 75 (3) ◽  
pp. 384-393 ◽  
Author(s):  
Mark A. Hall ◽  
Michael J. McCue ◽  
Jennifer R. Palazzolo
Keyword(s):  
Financial Performance ◽  
Affordable Care Act ◽  
First Year ◽  
Policy Makers ◽  
Administrative Costs ◽  
Individual Market ◽  
The Difference ◽  
The Individual ◽  
Financial Losses ◽  
Health Insurers

Many insurers incurred financial losses in individual markets for health insurance during 2014, the first year of Affordable Care Act mandated changes. This analysis looks at key financial ratios of insurers to compare profitability in 2014 and 2013, identify factors driving financial performance, and contrast the financial performance of health insurers operating in state-run exchanges versus the federal exchange. Overall, the median loss of sampled insurers was −3.9%, no greater than their loss in 2013. Reduced administrative costs offset increases in medical losses. Insurers performed better in states with state-run exchanges than insurers in states using the federal exchange in 2014. Medical loss ratios are the underlying driver more than administrative costs in the difference in performance between states with federal versus state-run exchanges. Policy makers looking to improve the financial performance of the individual market should focus on features that differentiate the markets associated with state-run versus federal exchanges.

Affordable Care Act Turmoil: Large Losses in the Individual Market Portend an Uncertain Future

2018 ◽  
Author(s):  
Brian Blase ◽  
Doug Badger ◽  
Douglas Badger ◽  
Seth J. Chandler ◽  
Edmund Haislmaier
Keyword(s):  
Affordable Care Act ◽  
Individual Market ◽  
Uncertain Future ◽  
The Individual
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