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.
State and federal policymakers are considering adding state-backed public options to the individual market in an effort to expand health coverage and improve affordability. We analyzed what would happen if public options became available in U.S. health insurance exchanges.
For busy staff, August's respite from back-to-back meetings, hearing preparation, and late votes is hard-earned. The summer recess also provides an opportunity to get ahead of issues that will resurface in the fall. To that end, we have compiled recent RAND research on topics likely to top the congressional agenda come September.
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?
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.
As Congress considers repealing and replacing the Affordable Care Act, it will need to consider how federal budget scoring can affect the fate of legislation. Depending on the ultimate cost of a replacement, finding enough savings to offset costs while maintaining budget neutrality could make it hard to pass a replacement.
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.
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.
Since September 2013, the number of people with health insurance coverage has increased by 16.6 million. But since the second ACA open enrollment period in February 2015, the number of people with coverage has remained relatively flat. The third open enrollment period began on November 1. Whether the number of uninsured will continue to decline remains an open question.
Under the Affordable Care Act, older adults cannot be charged more than three times as much as 21- to 24-year-olds for the same plan. Changing this rule to 5-to-1 may not be a cost-effective way to encourage enrollment among the young and healthy.
As part of its goal of near-universal coverage, the Affordable Care Act requires most Americans to obtain insurance or pay a penalty. Repealing that requirement would significantly reduce health insurance enrollment and cause individual market premiums to rise.