Individual market health plan affordability after cost‐sharing reduction subsidy cuts. (20th June 2019)

• Record Type: Journal Article
• Authors: Drake, Coleman; Abraham, Jean M.
• Is Part Of: Health services research. Volume 54:Number 4(2019)
• Page Start: 730
• Page End: 738
• Publication Date: 2019-06-20
• Subjects: Affordable Care Act -- health insurance -- Health Insurance Marketplace; Medical care -- Periodicals; Medical care -- Evaluation -- Periodicals; Hospital care -- Periodicals; Health services administration -- Periodicals; 362
• DOI: 10.1111/1475-6773.13190
• Languages: English
• ISSNs: 0017-9124

Abstract

Abstract: Objective: To investigate how changes in insurer participation and composition as well as state policies affect health plan affordability for individual market enrollees. Data Sources: 2014‐2019 Qualified Health Plan Landscape Files augmented with supplementary insurer‐level information. Study Design: We measured plan affordability for subsidized enrollees using premium spreads, the difference between the benchmark plan and the lowest cost plan, and premium levels for unsubsidized enrollees. We estimated how premium spreads and levels varied with insurer participation, insurer composition, and state policies using log‐linear models for 15 222 county‐years. Principal Findings: Increased insurer participation reduces premium levels, which is beneficial for unsubsidized enrollees. However, it also reduces premium spreads, leading to lower plan affordability for subsidized enrollees. States responding to cost‐sharing reduction subsidy payment cuts by increasing only silver plans' premiums increase premium spreads, particularly when premium increases are restricted to on‐Marketplace silver plans. The latter approach also protects unsubsidized, off‐Marketplace enrollees from experiencing premium shocks. Conclusions: Insurer participation and insurer composition affect subsidized and unsubsidized enrollees' health plan affordability in different ways. Decisions by state regulators regarding health plan pricing can significantly affect health plan affordability for each enrollee segment.