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Health Insurance Benefit Design

Commentary

ACA Subsidies for Higher-Income Families Are Key to Enrolling More Americans

The House Ways and Means Committee has proposed several insurance reforms in its emergency COVID-19 relief package, including increasing subsidizes and extending subsidies to people with higher incomes. The proposed combined approach is a far more efficient means of covering uninsured Americans than enhancing subsidies only for those who are currently eligible.

Mar 1, 2021
Journal Article

Evaluation Report of the First Three Years (2017-2019) of the Medicare Advantage Value-Based Insurance Design Model Test

CMMI contracted with the RAND Corporation to evaluate the first three years of the MA VBID model test. This report serves as our second and final evaluation of the first three years of the model test.

Oct 21, 2020
Journal Article

First Annual Evaluation Report of the Medicare Advantage Value-Based Insurance Design Model Test: 2017, Year 1 of the Intervention

RAND researchers are evaluating a five-year model test to assess whether value-based insurance design can increase use of high-value services, reduce use of avoidable services, improve quality of care, and improve health outcomes and reduce spending.

Oct 21, 2020
Journal Article

Disentangling Moral Hazard and Adverse Selection in Private Health Insurance

This study disentangled the effects of moral hazard from health plan selection. Our estimates imply that 53% of the additional medical spending observed in the most generous plan in our data relative to the least generous is due to adverse selection.

Sep 24, 2020
Report

Types and Costs of Services for Dual Beneficiaries by Medicare Advantage Health Plans: An Environmental Scan

This report identifies the types of services that Medicare Advantage plans implement to meet the needs of dually enrolled and other high-cost, high-need beneficiaries and presents a typology of the services that plans implement.

Apr 12, 2019
Journal Article

Expanding Enrollment Without the Individual Mandate: Options to Bring More People Into the Individual Market

The options analyzed would increase individual market enrollment by 400,000 to 3.2 million in 2020. Net increases in total enrollment (300,000 to 2.4 million) are smaller because of offsetting decreases in employer-sponsored insurance.

Dec 27, 2018
Journal Article

What Is the Impact on Enrollment and Premiums If the Duration of Short-Term Health Insurance Plans Is Increased?

Extending the duration of short-term individual health plans will have little effect on premiums or enrollment in the individual market.

Jun 14, 2018
Journal Article

The Moral Hazard Effects of Consumer Responses to Targeted Cost-sharing

A targeted cost-sharing program implemented by the California Public Employees Retirement System led to an increase in the use of low-price colonoscopy providers.

Dec 7, 2017
Journal Article

Association of Reference Pricing with Drug Selection and Spending

Over an 18 month period, reference pricing for drugs was associated with a reduction in employer spending of $1.34 million but an out-of-pocket spending increase of $0.12 million for employees.

Sep 28, 2017
Report

Modeling the Economic Impact of a California Workers' Compensation Formulary

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.

Jul 17, 2017
Report

The Benefits and Drawbacks of Alternative Tax Subsidization Approaches for Health Insurance

This report reviews the features of tax-based approaches to subsidizing health insurance, including tax credits and tax deductions, and summarizes their associated benefits and drawbacks.

Jul 13, 2017
Commentary

Ingredients for Health Care Reform

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?

Jul 10, 2017
Q&A

How Would the House Health Care Plan Affect People with Pre-Existing Conditions?

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.

May 28, 2017
Report

The Effects of the American Health Care Act

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.

May 3, 2017
Journal Article

Hillary Clinton's Health Care Reform Proposals: Anticipated Effects on Insurance Coverage, Out-of-Pocket Costs, and the Federal Deficit

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.

Nov 4, 2016
Journal Article

Donald Trump's Health Care Reform Proposals: Anticipated Effects on Insurance Coverage, Out-of-Pocket Costs, and the Federal Deficit

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.

Nov 4, 2016
Report

Implementing a Drug Formulary for California's Workers' Compensation Program

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.

Aug 25, 2016
Journal Article

Prescription Drug Use Rises, Out-of-Pocket Spending Drops Among Those Newly Insured Under the ACA

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.

Aug 19, 2016
Report

Policy Options for Covering High-Cost Cures

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.

May 3, 2016
Journal Article

Medicare Prescription Plan Enrollees' Experiences Compared to Their Medicare Advantage Counterparts

Medicare enrollees with standalone prescription coverage reported less positive experience with their plans than their counterparts in Medicare Advantage plans.

Mar 14, 2016

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RAND Health Care