This report estimates the potential impacts of a California Workers' Compensation formulary in terms of changes in prescription drug use and spending and discusses the potential broader impacts of these changes on the California economy.
Despite their differences, the Affordable Care Act and the current proposals to replace it take a similar approach to providing health insurance. What might some alternatives look like? And how could they provide coverage to more Americans?
The American Health Care Act would guarantee that individuals with pre-existing conditions could enroll in insurance even if they had a coverage lapse. But there is no guarantee that this coverage would be affordable, and coverage of some essential health benefits could be excluded.
The American Health Care Act would have reduced insurance enrollment by an estimated 14.2 million people in 2020 and by 19.7 million people by 2026. The uninsured would have been older, sicker, and poorer than those currently uninsured. Also, the AHCA would have increased the deficit by $38 billion in 2020 while reducing it by $5 billion in 2026.
The Trump health care proposal would decrease the number of insured and increase consumer health spending among those with marketplace insurance relative to current law. The policies would also increase the federal deficit by varying amounts.
The Clinton health care proposal would increase the number of insured individuals and decrease consumers' health spending relative to current law. However, the policies with the largest coverage gains also increase the federal deficit the most.
This report supports the California Division of Workers' Compensation's efforts to establish a drug formulary by comparing existing workers' compensation formularies and analyzing options for designing and implementing the formulary.
A study of nearly 7 million prescription drug users' experiences provides strong evidence that the Affordable Care Act has increased treatment rates while reducing out-of-pocket spending, particularly for those with certain chronic health conditions.
Strategic behavior by health insurers could unravel the market for cures for chronic diseases. The cost of these cures is front-loaded, but the benefits build up over time. Thus, insurers might try to delay treatment or avoid patients who need it, in the hope that they change insurers.
The ACA provides tax subsidies to qualified individuals for purchasing insurance while retaining tax exemptions for contributions to employer-sponsored insurance premiums. There are several options for leveling the financial playing field between the two markets.
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.
Prescription data on more than one million Marketplace patients shows that those who enrolled earlier were older and used more medication than later enrollees. However, Marketplace enrollees as a whole had lower average drug spending than the employer-sponsored comparison group.
Subsidies in the ACA's health insurance exchanges help stabilize the insurance market by encouraging younger, healthier people to stay enrolled in the face of premium hikes. Critics of the current subsidies have proposed alternatives. What effects would these have?
Our primary objective was to examine the variability in drug coverage in the exchanges across plan types (health maintenance organization or preferred provider organization) and metal tiers (bronze, silver, gold, and platinum).