Health Insurance Cost Sharing

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How Insurance Marketplace Regulators Can Help Consumers Enroll in Better Coverage

The Affordable Care Act simplified shopping for health care by creating the individual health insurance marketplaces where plans are categorized into labeled tiers. Consumers rely on these labels when comparing plans. But the labels don't tell consumers everything they need to know.

Petra Rasmussen, David M. Anderson

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Addressing Surprise Medical Bills Without Raising the Cost of Health Care

Patients who try to stay within their insurers' networks can be hit with surprise bills when they unknowingly receive care from out-of-network physicians. How much should a physician be paid for providing a service that is critical but rendered without the patient's ready ability to choose an in-network provider?

Erin Lindsey Duffy, Mark W. Friedberg, et al.

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Medicare for All: Sounds Good, but What Does It Mean?

Traditional Medicare is popular and therefore can lend a good brand name to coverage expansion proposals, but its limits can be significant for some patients. Those proposing and evaluating “Medicare for All” proposals should consider whether and how these limits are addressed.

David Anderson, Jodi L. Liu @jodilliu, et al.

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Misconceptions About 'Medicare for All'

Medicare for All is a talking point for both major U.S. political parties. Would it be free? Would people have to switch doctors? Would waits be long? Misconceptions abound about single-payer proposals and their likely effects. Here are the facts.

Jodi L. Liu @jodilliu, Christine Eibner @Chrissyeibner

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Savings from a Single-Payer Health System Would Not Be Automatic

Polls have shown increasing public support for a single-payer system in the United States. Yet there is no agreement on how to set up and pay for a single-payer system or even how much it would cost.

Jodi L. Liu @jodilliu

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Four Steps That Could Stabilize the Health Insurance Market

Congress will soon discuss options to stabilize the individual market and ensure that all Americans have access to affordable coverage. Policymakers could encourage enrollment, make targeted investments to lower premiums, fund cost-sharing reductions, and enforce the individual mandate.

Christine Eibner @Chrissyeibner

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Insuring Younger Adults Through the ACA's Marketplaces: Options to Expand Enrollment

Whether or not the Affordable Care Act is repealed, having young adults participate in the individual health insurance market remains critical to achieving affordable premiums for everyone.

Evan Saltzman, Christine Eibner @Chrissyeibner

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Easing the Pain When Critical Medications Are No Longer Covered

Allowing insurance companies to limit the drugs they cover is necessary to give them leverage that can result in lower medication costs for all patients. Still, there are ways to make the process more transparent and manageable.

Erin Audrey Taylor

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Estimating the Impacts of the Trump and Clinton Health Plans

Donald Trump wants to repeal and replace the Affordable Care Act. Hillary Clinton wants to maintain and modify it. How could each proposal impact coverage, out-of-pocket costs, and the deficit?

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At 40, a Pioneering Health Care Experiment Remains Relevant

The impact of RAND's Health Insurance Experiment has been wide-reaching. The study's conclusions encouraged the restructuring of private insurance and helped increase the stature of managed care in the United States.

Michael D. Rich @michaeldrich

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Modifying the ACA's Family Subsidy Rules to Help Ensure Affordability

The ACA encourages workers to retain employer coverage by restricting their eligibility for marketplace subsidies. Modifying the policy could help 700,000 people gain coverage and lower spending for 1.6 million who are insured but face high health care costs under current ACA policy.

Amado Cordova, Sarah A. Nowak, et al.

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Bringing Sky-High Prescription Drug Prices Down to Earth

Increased competition among drug companies and improved bargaining power of insurers and consumers could help keep high prescription prices in check.

Erin Audrey Taylor

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What Happens If the ACA's Tax Credits Are Replaced with Premium Support?

As policymakers consider alternatives to reduce the federal government's financial burden from providing subsidies under the ACA, they should consider the consequences for enrollees. Existing premium-support models yield considerable savings for the federal government but could create age and income disparities in coverage.

Evan Saltzman, Christine Eibner @Chrissyeibner

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Policy Barriers to Best Practices: The Impact of Restrictive State Regulations on Access to Long-Acting Reversible Contraceptives

Long-acting reversible contraceptive (LARC) methods of birth control, which include the intrauterine device and subdermal implant, are highly effective, very safe, preferable to women, and cost effective. But some states' contraceptive policies create direct and indirect barriers to LARC use.

Priya Batra, Chloe E. Bird @ChloeBirdPhD

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Employer-Provided Health Insurance: Why Does It Persist, and Will It Continue after 2014?

As the ACA is implemented, policy makers should be attuned to potential inefficiencies and inequities created by a system with different regulatory and tax rules for small employers, large employers, and individual health plans. Attempts to equalize the playing field may be difficult.

Christine Eibner @Chrissyeibner

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Quick Takes: The Math of Medicaid Expansion

Expanding Medicaid under the Affordable Care Act (ACA) is both contentious and complicated. RAND mathematician Carter Price has been using the COMPARE model to help those making decisions understand what their choices mean for their budgets and population health.

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Health Care Spending: What's in Store?

Resolving the question of whether or not the U.S. has finally gotten a handle on health care spending is vitally important, because the choices we make going forward will have profound implications for our economy, the financial wellbeing of millions of American families, and ultimately America's standing in the world.

Arthur L. Kellermann

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Are You a 'Wise' Health Care Consumer?

To be wise purchasers of health care services, consumers need access to accurate and understandable information about health plans and providers. They wrongly assume that more expensive providers are better than less expensive ones, despite inconsistent evidence that there is any link between health care cost and quality.

Ramya Chari, Arthur L. Kellermann

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Health Care Cost Growth Is Hurting Middle-Class Families

Unfortunately, nearly every actor in our health care delivery system—hospitals, physicians, other health care providers, insurance companies and the manufacturers of drugs and devices—is currently focused on maximizing revenue growth, write Arthur Kellermann and David Auerbach.

Arthur L. Kellermann, David I. Auerbach

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Health Care Costs Are Killing Us

At a time when our country is teetering on the edge of a “fiscal cliff,” no challenge in health care is more important than reducing health care spending, writes Arthur L. Kellermann.

Arthur L. Kellermann

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When Patients Don't Take Their Medicine: What Role Do Doctors Play in Promoting Prescription Adherence?

A new paradigm that clarifies joint provider–patient responsibility may be needed to better guide communication about medication adherence, write Douglas S. Bell and David M. Adamson.

Douglas S. Bell, David M. Adamson

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Will More Employers Drop Coverage Under the ACA? Don't Bet on It

A problem with using surveys to predict behavior is that they measure employer sentiment toward the ACA today, rather than the economic decisions employers typically make when the time comes, writes Art Kellermann.

Arthur L. Kellermann

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Expanding Consumer-Directed Health Plans Could Help Cut Overall Health Care Spending

If consumer-directed health plans grow to account for half of all employer-sponsored insurance in the United States, health costs could drop by $57 billion annually—about 4 percent of all health care spending among the nonelderly.

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Can the Patient-Centered Outcomes Research Institute Become Relevant to Controlling Medical Costs and Improving Value?

A scientific and political case could be made to amend health care legislation to require that cost be included in the studies that the PCORI funds, writes Robert H. Brook.

Robert H. Brook

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The Public Option: Sorting Rhetoric from Reality

President Obama and several Congressional leaders have recently expressed support for the idea of allowing citizens to buy into a public insurance program as part of any health reform legislation. The intensity of the ensuing debate has been fascinating given the lack of specifics that have been offered by either side, writes Elizabeth A. McGlynn.

Elizabeth A. McGlynn

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A Better Way to Pay for Prescriptions

The pricing plans most people choose for their cell phones are simple: Pay one price and talk as much as you want. What if paying for your prescription drugs were as easy and appealing?, writes Dana P. Goldman.

Dana P. Goldman