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How Would a Public Option on Health Insurance Affect Costs and Coverage?

May 28, 2020

Interest in a government-sponsored health insurance plan with publicly determined provider rates is growing. An analysis of four such public option plans finds that lower provider payment rates would lower premiums. But the effect on enrollees also depends on tax credits. And changes to the number of uninsured would be small.
Report

Medicare for 50-to-64-Year-Olds

Nov 18, 2019

Allowing Americans aged 50 to 64 to buy into Medicare would lower health care premiums for the group. But it would also drive up costs for younger people who buy health insurance on Affordable Care Act exchanges.

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Report

Setting U.S. Hospital Prices Could Cut Overall Health Spending by Billions

Price regulations face political obstacles and have been strongly opposed by medical providers. But setting prices for all commercial health care payers could reduce hospital spending by $61.9 billion to $236.6 billion a year if the rates were set at 100 to 150 percent of the amounts paid by Medicare.

Feb 18, 2021
News Release

Setting Hospital Prices Can Achieve Greater Savings Than Increasing Competition or Price Transparency

Among strategies to curb hospital prices among the commercially insured population in the United States, direct price regulations such as setting rates are likely to achieve greater savings than other approaches like increasing competition or improving price transparency.

Feb 18, 2021
Journal Article

Low Rates of Pediatric Dental Coverage for Families Purchasing Marketplace Insurance Plans

Pediatric dental care is an essential health benefit that the Affordable Care Act requires most private health plans to cover. It is unknown how these different pediatric dental coverage offerings may affect uptake of coverage.

Feb 12, 2021
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
Commentary

Options for Designing a Public Option

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.

May 28, 2020
Report

Public Options for Individual Health Insurance: Assessing the Effects of Four Public Option Alternatives

There is growing interest in a "public option" for individual market insurance to improve affordability and enrollment. The authors estimate how adding a federal public option could affect enrollment, premiums, and government spending.

May 28, 2020
News Release

Public Option Could Lower Health Insurance Premiums, but Would Not Substantially Raise Number of Insured

Offering a government-sponsored health plan with publicly determined payment rates to people who buy their own insurance could lower the cost of premiums, but on its own it is unlikely to substantially increase the overall number of people with coverage.

May 28, 2020
Report

The Effects of Limiting Payments to Hospitals for Out-of-Network Care

There is growing interest among U.S. policymakers to use out-of-network payment limits to curb surprise medical bills and as a tool to control rising health care costs. How might such limits affect negotiated in-network prices and total payments for hospital care?

Mar 12, 2020
News Release

Limiting Out-of-Network Payments to Hospitals Could Produce Cost Savings Similar to Single-Payer Options

Placing limits on what hospitals can collect for out-of-network care could yield savings similar to more-sweeping proposals such as Medicare for All or setting global health spending caps. Because such an approach has the possibility to sharply cut hospital revenues, any cap would need to be set carefully as to not overly disrupt hospital operations.

Mar 12, 2020
News Release

Opening Medicare to Americans Aged 50 to 64 Would Cut Their Insurance Costs, but Drive Up Insurance Prices for Younger ...

Opening Medicare to Americans aged 50 to 64 would lower health care premiums for the group, but also drive up costs for younger people who buy health insurance on exchanges created under the federal Affordable Care Act.

Nov 18, 2019
Blog

RAND's Summer Reading List for Congress

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.

Aug 5, 2019
Commentary

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?

Apr 1, 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
Report

Impacts of Eliminating the Individual Mandate Penalty in New York

In 2019, the ACA's individual mandate penalty will be eliminated. How will this affect New York's nongroup insurance market? It could result in an estimated 23 to 25 percent increase in premiums and a 37 percent reduction in enrollment.

Sep 20, 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

Early Impact of the Affordable Care Act Coverage Expansion on Safety-Net Hospital Inpatient Payer Mix and Market Shares

Following Medicaid expansion, non safety-net hospitals experienced a greater percentage increase in Medicaid stays than did safety-net hospitals, which may reflect patient choice or a crowd-out of private insurance.

Feb 14, 2018
Report

The Effects of Iowa's Proposed Stopgap Measure on Health Insurance Costs and Coverage

This report uses RAND's COMPARE microsimulation model to estimate the effects of a 1332 waiver application from the state of Iowa. The waiver is designed to stabilize Iowa's Affordable Care Act individual market through a series of modifications.

Oct 17, 2017
Journal Article

Americans Support Price Shopping For Health Care, But Few Actually Seek Out Price Information

A survey of U.S. nonelderly adults found that only 13 percent who had spent money out of pocket in their last health care encounter sought information about expected spending before receiving care, and just 3 percent had compared costs across providers before receiving care.

Sep 6, 2017

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