Health insurance, patient protection and Affordable Care Act, and young adults.

PubMed

Dodich, Colleen; Patel, Dilip

2013-12-01

In summary, the ACA aims to correct some of the shortcomings of our current health insurance systems. It aims to make health insurance more affordable and more accessible and the health insurance systems easier to navigate. For the young adult population, it aims to protect more individuals by allowing them to stay on their parent's insurance longer and by making it easier to choose an insurance plan that is right for them. Those with preexisting medical conditions do not have to worry about being excluded from a health plan because of their medical history. The law is also making health insurance mandatory, which may help prevent young adults who fall ill from incurring large medical bills. Initial outcomes from the implementation of the ACA have shown both positive and negative responses. All in all, it is giving young adults more options when it comes to obtaining health insurance. As part of discussion with adolescents and young adults, physicians may take into consideration key points summarized in Table 4.

Health insurers' financial performance and quality improvement expenditures in the Affordable Care Act's second year.

PubMed

McCue, Michael J; Hall, Mark

2015-02-01

The Affordable Care Act requires health insurers to rebate any amounts less than 80%-85% of their premiums that they fail to spend on medical claims or quality improvement. This study uses the new comprehensive reporting under this law to examine changes in insurers' financial performance and differences in their quality improvement expenditures. In the ACA's second year (2012), insurers' median medical loss ratios continued to increase and their median administrative cost ratios dropped, producing moderate operating margins in the group markets but a small operating loss in the individual market, at the median. For-profit insurers showed larger changes, in general, than did nonprofits. For quality improvement, insurers reported spending a significantly greater amount per member in their government plans than they did on their self-insured members, with spending on commercial insurance being in between these two extremes. The magnitude and source of these differences varied by corporate ownership. © The Author(s) 2014.

Private Health Insurance Exchanges

PubMed Central

Buttorff, Christine; Nowak, Sarah; Syme, James; Eibner, Christine

2017-01-01

Abstract Private health insurance exchanges offer employer health insurance, combining online shopping, increased plan choice, benefit administration, and cost-containment strategies. This article examines how private exchanges function, how they may affect employers and employees, and the possible implications for the Affordable Care Act's (ACA's) Small Business Health Options Program (SHOP) Marketplaces. The authors found that private exchanges could encourage employees to select less-generous plans. This could expose employees to higher out-of-pocket costs, but premium contributions would drop substantially, so net spending would decrease. On the other hand, employee spending may increase if, in moving to private exchanges, employers decrease their health insurance contributions. Most employers can avoid the ACA's “Cadillac tax” by reducing the generosity of the plans they offer, regardless of whether they move to a private exchange. There is not yet enough evidence to determine whether the private exchanges will become prominent in the insurance market and how they will affect employers and their employees. PMID:28845340

Insurance Type and Access to Health Care Providers and Appointments Under the Affordable Care Act.

PubMed

Alcalá, Héctor E; Roby, Dylan H; Grande, David T; McKenna, Ryan M; Ortega, Alexander N

2018-02-01

Millions of adults have gained insurance through the Affordable Care Act (ACA). However, disparities in access to care persist. This study examined differences in access to primary and specialty care among patients insured by private individual market insurance plans (both on-exchange and off-exchange) and Medicaid compared with those with employer-sponsored insurance. Using data from the 2014 and 2015 California Health Interview Survey, logistic regression analyses were used to calculate the odds of being unable to access primary care providers, access specialty care providers and receive a needed doctor's appointment in a timely manner, with insurance type serving as the independent variable. Interaction terms examined if the expiration of the ACA's optional Medicaid primary care fee increase in 2014 modified any of these associations. Findings showed poorer access to providers among those insured through Medicaid and the individual market (whether purchased through the state's health insurance exchange or off-exchange) relative to employer-based insurance. Poor access to primary care providers was seen among private coverage purchased via exchanges, relative to private coverage purchased on the individual market. In addition, findings showed that reduction of Medicaid fees coincided with reduced ability to see primary care providers. However, a similar trend was seen among those with employer-based coverage, which suggests that this change may not be attributable to reductions in Medicaid fees. Despite ACA-related gains in insurance coverage, those with on-exchange and off-exchange individual private insurance plans and Medicaid encounter more barriers to care than those with employer-based insurance.

Medicaid and Children's Health Insurance Programs; Mental Health Parity and Addiction Equity Act of 2008; the Application of Mental Health Parity Requirements to Coverage Offered by Medicaid Managed Care Organizations, the Children's Health Insurance Program (CHIP), and Alternative Benefit Plans. Final rule.

PubMed

2016-03-30

This final rule will address the application of certain requirements set forth in the Public Health Service Act, as amended by the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, to coverage offered by Medicaid managed care organizations, Medicaid Alternative Benefit Plans, and Children’s Health Insurance Programs.

The cost conundrum: financing the business of health care insurance.

PubMed

Kelly, Annemarie

2013-01-01

Health care spending in both the governmental and private sectors skyrocketed over the last century. This article examines the rapid growth of health care expenditures by analyzing the extent of this financial boom as well some of the reasons why health care financing has become so expensive. It also explores how the market concentration of insurance companies has led to growing insurer profits, fewer insurance providers, and less market competition. Based on economic data primarily from the Government Accountability Office, the Kaiser Family Foundation, and the American Medical Associa tion, it has become clear that this country needs more competitive rates for the business of health insurance. Because of the unique dynamics of health insurance payments and financing, America needs to promote affordability and innovation in the health insurance market and lower the market's high concentration levels. In the face of booming insurance profits, soaring premiums, many believe that in our consolidated health insurance market, the "business of insurance" should not be exempt from antitrust laws. All in all, it is in our nation's best interest that Congress restore the application of antitrust laws to health sector insurers by passing the Health Insurance Industry Antitrust Enforcement Act as an amendment to the McCarran-Ferguson Act's "business of insurance" provision.

77 FR 30377 - Health Insurance Premium Tax Credit

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-23

... Health Insurance Premium Tax Credit AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Final regulations. SUMMARY: This document contains final regulations relating to the health insurance premium tax credit enacted by the Patient Protection and Affordable Care Act and the Health Care and Education...

The National Insurance Acts 1911-1947, the approved societies and the Prudential Assurance Company.

PubMed

Heller, Michael

2008-01-01

The role of the British major life assurance companies in administering the National Insurance Acts in the guise of approved societies has long been controversial. The companies have been accused of profiteering rather than civic duty or social altruism. This article, using the Prudential Assurance Company as a case study, questions this argument. Life assurance companies such as the Prudential were fundamental to the operational running of national health insurance in the first half of the twentieth century due to their scale, scope and expertise. In addition, they were keen to extend the scope of national health insurance and campaigned to make the acts more comprehensive. Finally, while the companies certainly did see benefits in administering the acts, these were related more to corporate identity, branding and public relations than to direct pecuniary gain. An analysis of the inclusion of the life insurance companies in the administration of the National Health Insurance Acts is thus as important for an understanding of twentieth-century Britain as it is for the development of modern social welfare.

Group health plans and health insurance issuers relating to coverage of preventive services under the Patient Protection and Affordable Care Act. Final rules.

PubMed

2012-02-15

These regulations finalize, without change, interim final regulations authorizing the exemption of group health plans and group health insurance coverage sponsored by certain religious employers from having to cover certain preventive health services under provisions of the Patient Protection and Affordable Care Act.

Changes in Health Insurance Coverage and Barriers to Health Care Access Among Individuals with Serious Psychological Distress Following the Affordable Care Act.

PubMed

Novak, Priscilla; Anderson, Andrew C; Chen, Jie

2018-05-12

The Affordable Care Act (ACA) aims to expand health insurance coverage and minimize financial barriers to receiving health care services for individuals. However, little is known about how the ACA has impacted individuals with mental health conditions. This study finds that the implementation of the ACA is associated with an increase in rate of health insurance coverage among nonelderly adults with serious psychological distress (SPD) and a reduction in delaying and forgoing necessary care. The ACA also reduced the odds of an individual with SPD not being able to afford mental health care. Mental health care access among racial and ethnic minority populations and people with low income has improved during 2014-2016, but gaps remain.

Health insurance issuers implementing medical loss ratio (MLR) requirements under the Patient Protection and Affordable Care Act. Interim final rule with request for comments.

PubMed

2010-12-01

This document contains the interim final regulation implementing medical loss ratio (MLR) requirements for health insurance issuers under the Public Health Service Act, as added by the Patient Protection and Affordable Care Act (Affordable Care Act).

75 FR 63480 - Medicaid Program: Implementation of Section 614 of the Children's Health Insurance Program...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-15

... Children's Health Insurance Program Reauthorization Act of 2009 for Adjustments to the Federal Medical... section 614 of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA), Public Law... Medicaid program and required by Section 614 of the Children's Health Insurance Program Reauthorization Act...

Gaps in health insurance: why so many Americans experience breaks in coverage and how the Affordable Care Act will help: findings from the Commonwealth Fund Health Insurance Tracking Survey of U.S. Adults, 2011.

PubMed

Collins, Sara R; Robertson, Ruth; Garber, Tracy; Doty, Michelle M

2012-04-01

The Commonwealth Fund Health Insurance Tracking Survey of U.S. Adults finds that one-quarter of adults ages 19 to 64 experienced a gap in their health insurance in 2011, with a majority remaining uninsured for one year or more. Losing or changing jobs was the primary reason people experienced a gap. Compared with adults who had continuous coverage, those who experienced gaps were less likely to have a regular doctor and less likely to be up to date with recommended preventive care tests, with rates declining as the length of the coverage gap increases. Early provisions of the Affordable Care Act are already helping bridge gaps in coverage among young adults and people with preexisting conditions. Beginning in 2014, new affordable health insurance options through Medicaid and state insurance exchanges will enable adults and their families to remain insured even in the face of job changes and other life disruptions.

Insuring against health shocks: Health insurance and household choices.

PubMed

Liu, Kai

2016-03-01

This paper provides empirical evidence on the role of public health insurance in mitigating adverse outcomes associated with health shocks. Exploiting the rollout of a universal health insurance program in rural China, I find that total household income and consumption are fully insured against health shocks even without access to health insurance. Household labor supply is an important insurance mechanism against health shocks. Access to health insurance helps households to maintain investment in children's human capital during negative health shocks, which suggests that one benefit of health insurance could arise from reducing the use of costly smoothing mechanisms. Copyright © 2016 Elsevier B.V. All rights reserved.

75 FR 6673 - Expert Meeting on Measurement Criteria for Children's Health Insurance Program; Reauthorization...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-10

... on Measurement Criteria for Children's Health Insurance Program; Reauthorization Act Pediatric... enacted in the Children's Health Insurance Program Reauthorization Act (CHIPRA). DATES: The meeting will...) reauthorized the Child Health Insurance Program (CHIP) originally established in 1997, and in Title IV of the...

Reducing Employee Health Insurance Benefits: The Effect of McGann and the Americans with Disabilities Act.

ERIC Educational Resources Information Center

Julian, Frank H.

1994-01-01

The impact of a court decision (McGann vs. H&H Music) concerning reduction of employee health insurance benefits in a case of Acquired Immune Deficiency Syndrome (AIDS) and the federal Americans with Disabilities Act on college decisions regarding reduction of benefits is examined. Recommendations for college are offered. (MSE)

75 FR 62684 - Health Insurance Reform; Announcement of Maintenance Changes to Electronic Data Transaction...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-13

... 0938-AM50 Health Insurance Reform; Announcement of Maintenance Changes to Electronic Data Transaction Standards Adopted Under the Health Insurance Portability and Accountability Act of 1996 AGENCY: Office of... of the Health Insurance Portability and Accountability Act of 1996 standards made by the Designated...

Paying for individual health insurance through tax-sheltered cafeteria plans.

PubMed

Hall, Mark A; Monahan, Amy B

2010-01-01

When employees without group health insurance buy individual coverage, they do so using after-tax income--costing them from 20% to 50% more than others pay for equivalent coverage. Prior to the passage of the Patient Protection and Affordable Care Act (PPACA), several states promoted a potential solution that would allow employees to buy individual insurance through tax-sheltered payroll deduction. This technical but creative approach would allow insurers to combine what is known as "list-billing" with a Section 125 "cafeteria plan." However, these state-level reform attempts have failed to gain significant traction because state small-group reform laws and federal restrictions on medical underwriting cloud the legality of tax-sheltered list-billing. Several authorities have taken the position that insurance paid for through a cafeteria plan must meet the nondiscrimination requirements of the Health Insurance Portability and Accountability Act with respect to eligibility, premiums, and benefits. The recently enacted Patient Protection and Affordable Care Act addresses some of the legal uncertainty in this area, but much remains. For health reform to have its greatest effect, federal regulators must clarify whether individual health insurance can be purchased on a pre-tax basis through a cafeteria plan.

Effects of the Affordable Care Act's young adult insurance expansion on prescription drug insurance coverage, utilization, and expenditures.

PubMed

Look, Kevin A; Arora, Prachi

2016-01-01

The US Affordable Care Act (ACA) extended the age of eligibility for young adults to remain on their parents' health insurance plans in order to address the disproportionate number of uninsured young adults in the United States. Effective September 23, 2010, the ACA has required all private health insurance plans to cover dependents until the age of 26. However, it is unknown whether the ACA dependent coverage expansion had an impact on prescription drug insurance or the use of prescription drugs. To evaluate short-term changes in prescription health insurance coverage, prescription drug insurance coverage, prescription drug use, and prescription drug expenditures following implementation of the ACA young adult insurance expansion using national data from 2009 and 2011. Full-year health insurance coverage increased 4.9 percentage points during the study period, which was mainly due to increases in private health insurance among middle- and high-income young adults. In contrast, full-year prescription drug insurance coverage increased 5.5 percentage points and was primarily concentrated among high-income young adults. Although no significant short-term changes in overall prescription drug use were observed, a 30% decrease in out-of-pocket expenditures was seen among young adults. While the main goal of the ACA's young adult insurance expansion was to increase health insurance coverage among young adults, it also had the unintended positive effect of increasing coverage for prescription drug insurance. Additionally, young adults experienced substantial decreases in out-of-pocket spending for prescription drugs. It is important for evaluations of health care policies to assess both intended and unintended outcomes to better understand the implications for the broader health system. Copyright © 2015 Elsevier Inc. All rights reserved.

Knowledge as a Predictor of Insurance Coverage Under the Affordable Care Act.

PubMed

Hoerl, Maximiliane; Wuppermann, Amelie; Barcellos, Silvia H; Bauhoff, Sebastian; Winter, Joachim K; Carman, Katherine G

2017-04-01

The Affordable Care Act established policy mechanisms to increase health insurance coverage in the United States. While insurance coverage has increased, 10%-15% of the US population remains uninsured. To assess whether health insurance literacy and financial literacy predict being uninsured, covered by Medicaid, or covered by Marketplace insurance, holding demographic characteristics, attitudes toward risk, and political affiliation constant. Analysis of longitudinal data from fall 2013 and spring 2015 including financial and health insurance literacy and key covariates collected in 2013. A total of 2742 US residents ages 18-64, 525 uninsured in fall 2013, participating in the RAND American Life Panel, a nationally representative internet panel. Self-reported health insurance status and type as of spring 2015. Among the uninsured in 2013, higher financial and health insurance literacy were associated with greater probability of being insured in 2015. For a typical uninsured individual in 2013, the probability of being insured in 2015 was 8.3 percentage points higher with high compared with low financial literacy, and 9.2 percentage points higher with high compared with low health insurance literacy. For the general population, those with high financial and health insurance literacy were more likely to obtain insurance through Medicaid or the Marketplaces compared with being uninsured. The magnitude of coefficients for these predictors was similar to that of commonly used demographic covariates. A lack of understanding about health insurance concepts and financial illiteracy predict who remains uninsured. Outreach and consumer-education programs should consider these characteristics.

Effects of the Affordable Care Act's Dependent Coverage Mandate on Private Health Insurance Coverage in Urban and Rural Areas.

PubMed

Look, Kevin A; Kim, Nam Hyo; Arora, Prachi

2017-01-01

To evaluate the impact of the Affordable Care Act's (ACA) dependent coverage mandate on insurance coverage among young adults in metropolitan and nonmetropolitan areas. A cross-sectional analysis was conducted using data from 2006-2009 and 2011 waves of the Medical Expenditure Panel Survey. A difference-in-difference analysis was used to compare changes in full-year private health insurance coverage among young adults aged 19-25 years with an older cohort aged 27-34 years. Separate regressions were estimated for individuals in metropolitan and nonmetropolitan areas and were tested for a differential impact by area of residence. Full-year private health insurance coverage significantly increased by 9.2 percentage points for young adults compared to the older cohort after the ACA mandate (P = .00). When stratifying the regression model by residence area, insurance coverage among young adults significantly increased by 9.0 percentage points in metropolitan areas (P = .00) and 10.1 percentage points in nonmetropolitan areas (P = .03). These changes were not significantly different from each other (P = .82), which suggests the ACA mandate's effects were not statistically different by area of residence. Although young adults in metropolitan and nonmetropolitan areas experienced increased access to private health insurance following the ACA's dependent coverage mandate, it did not appear to directly impact rural-urban disparities in health insurance coverage. Despite residents in both areas gaining insurance coverage, over one-third of young adults still lacked access to full-year health insurance coverage. © 2016 National Rural Health Association.

Growth and variability in health plan premiums in the individual insurance market before the Affordable Care Act.

PubMed

Gruber, Jonathan

2014-06-01

Before we can evaluate the impact of the Affordable Care Act on health insurance premiums in the individual market, it is critical to understand the pricing trends of these premiums before the implementation of the law. Using rates of increase in the individual insurance market collected from state regulators, this issue brief documents trends in premium growth in the pre-ACA period. From 2008 to 2010, premiums grew by 10 percent or more per year. This growth was also highly variable across states, and even more variable across insurance plans within states. The study suggests that evaluating trends in premiums requires looking across a broad array of states and plans, and that policymakers must examine how present and future changes in premium rates compare with the more than 10 percent per year premium increases in the years preceding health reform.

Health insurance tax credits, the earned income tax credit, and health insurance coverage of single mothers.

PubMed

Cebi, Merve; Woodbury, Stephen A

2014-05-01

The Omnibus Budget Reconciliation Act of 1990 enacted a refundable tax credit for low-income working families who purchased health insurance coverage for their children. This health insurance tax credit (HITC) existed during tax years 1991, 1992, and 1993, and was then rescinded. A difference-in-differences estimator applied to Current Population Survey data suggests that adoption of the HITC, along with accompanying increases in the Earned Income Tax Credit (EITC), was associated with a relative increase of about 4.7 percentage points in the private health insurance coverage of working single mothers with high school or less education. Also, a difference-in-difference-in-differences estimator, which attempts to net out the possible influence of the EITC increases but which requires strong assumptions, suggests that the HITC was responsible for about three-quarters (3.6 percentage points) of the total increase. The latter estimate implies a price elasticity of health insurance take-up of -0.42. Copyright © 2013 John Wiley & Sons, Ltd.

Early Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non-Expansion States.

PubMed

Courtemanche, Charles; Marton, James; Ukert, Benjamin; Yelowitz, Aaron; Zapata, Daniela

2017-01-01

The Affordable Care Act (ACA) aimed to achieve nearly universal health insurance coverage in the United States through a combination of insurance market reforms, mandates, subsidies, health insurance exchanges, and Medicaid expansions, most of which took effect in 2014. This paper estimates the causal effects of the ACA on health insurance coverage in 2014 using data from the American Community Survey. We utilize difference-in-difference-in-differences models that exploit cross-sectional variation in the intensity of treatment arising from state participation in the Medicaid expansion and local area pre-ACA uninsured rates. This strategy allows us to identify the effects of the ACA in both Medicaid expansion and non-expansion states. Our preferred specification suggests that, at the average pre-treatment uninsured rate, the full ACA increased the proportion of residents with insurance by 5.9 percentage points compared to 2.8 percentage points in states that did not expand Medicaid. Private insurance expansions from the ACA were due to increases in both employer-provided and non-group coverage. The coverage gains from the full ACA were largest for those without a college degree, non-whites, young adults, unmarried individuals, and those without children in the home. We find no evidence that the Medicaid expansion crowded out private coverage.

Public and private health insurance premiums: how do they affect the health insurance status of low-income childless adults?

PubMed

Guy, Gery P; Adams, E Kathleen; Atherly, Adam

2012-01-01

The Patient Protection and Affordable Care Act (ACA) will substantially increase public health insurance eligibility and alter the costs of insurance coverage. Using Current Population Survey (CPS) data from the period 2000-2008, we examine the effects of public and private health insurance premiums on the insurance status of low-income childless adults, a population substantially affected by the ACA. Results show higher public premiums to be associated with a decrease in the probability of having public insurance and an increase in the probability of being uninsured, while increased private premiums decrease the probability of having private insurance. Eligibility for premium assistance programs and increased subsidy levels are associated with lower rates of uninsurance. The magnitudes of the effects are quite modest and provide important implications for insurance expansions for childless adults under the ACA.

Health insurance exchanges under the Patient Protection and Affordable Care Act: regulatory and design challenges.

PubMed

Hoffmann, Stephanie M

2012-12-01

Under the Patient Protection and Affordable Care Act, all states are required to establish health insurance exchanges, marketplaces where individuals and small businesses can purchase health care coverage. In establishing these exchanges, states must address a range of regulatory and design issues to ensure that their exchanges are sustainable and meet the needs of their populations. The issues include the degree of federal involvement in the management of the exchanges, the overall structure and governance of the exchanges, the requirements for insurance plans to be offered on the exchanges, and the design of the exchanges themselves. Each of these issues will play a crucial role in determining the quality of coverage offered to consumers and how effectively they can access that coverage. Copyright © 2012 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Knowledge as a predictor of insurance coverage under the Affordable Care Act

PubMed Central

Hoerl, Maximiliane; Wuppermann, Amelie; Barcellos, Silvia H.; Bauhoff, Sebastian; Winter, Joachim K.

2016-01-01

Background The Affordable Care Act established policy mechanisms to increase health insurance coverage in the United States. While insurance coverage has increased, 10 to 15% of the U.S. population remains uninsured. Objectives To assess whether health insurance literacy and financial literacy predict being uninsured, covered by Medicaid, or covered by Marketplace insurance, holding demographic characteristics, attitudes toward risk, and political affiliation constant. Research Design Analysis of longitudinal data from fall 2013 and spring 2015 including financial and health insurance literacy and key covariates collected in 2013. Subjects 2,742 U.S. residents ages 18-64, 525 uninsured in fall 2013, participating in the RAND American Life Panel, a nationally representative internet panel. Measures Self-reported health insurance status and type as of spring 2015. Results Among the uninsured in 2013, higher financial and health insurance literacy were associated with greater probability of being insured in 2015. For a typical uninsured individual in 2013, the probability of being insured in 2015 was 8.3 percentage points higher with high compared to low financial literacy, and 9.2 percentage points higher with high compared to low health insurance literacy. For the general population, those with high financial and health insurance literacy were more likely to obtain insurance via Medicaid or the Marketplaces compared to being uninsured. The magnitude of coefficients for these predictors was similar to that of commonly used demographic covariates. Conclusions A lack of understanding about health insurance concepts and financial illiteracy predict who remains uninsured. Outreach and consumer-education programs should consider these characteristics. PMID:27820594

77 FR 41048 - Health Insurance Premium Tax Credit; Correction

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-12

... the health insurance premium tax credit enacted by the Patient Protection and Affordable Care Act and... DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Part 1 [TD 9590] RIN 1545-BJ82 Health Insurance Premium Tax Credit; Correction AGENCY: Internal Revenue Service (IRS), Treasury. ACTION...

Small firm self-insurance under the Affordable Care Act.

PubMed

Buettgens, Matthew; Blumberg, Linda J

2012-11-01

The Affordable Care Act changes the small-group insurance market substan­tially beginning in 2014, but most changes do not apply to self-insured plans. This exemp­tion provides an opening for small employers with healthier workers to avoid broader sharing of health care risk, isolating higher-cost groups in the fully insured market. Private stop-loss or reinsurance plans can mediate the risk of self-insurance for small employ­ers, facilitating the decision to self-insure. We simulate small-employer coverage decisions under the law and find that low-risk stop-loss policies lead to higher premiums in the fully insured small-group market. Average single premiums would be up to 25 percent higher, if stop-loss insurance with no additional risk to employers than fully insuring is allowed--an option available in most states absent further government action. Regulation of stop-loss at the federal or state level can, however, prevent such adverse selection and increase stabil­ity in small-group insurance coverage.

Republican States Bolstered Their Health Insurance Rate Review Programs Using Incentives From the Affordable Care Act

PubMed Central

Fulton, Brent D.; Hollingshead, Ann; Karaca-Mandic, Pinar; Scheffler, Richard M.

2015-01-01

The Affordable Care Act (ACA) included financial and regulatory incentives and goals for states to bolster their health insurance rate review programs, increase their anticipated loss ratio requirements, expand Medicaid, and establish state-based exchanges. We grouped states by political party control and compared their reactions across these policy goals. To identify changes in states’ rate review programs and anticipated loss ratio requirements in the individual and small group markets since the ACA’s enactment, we conducted legal research and contacted each state’s insurance regulator. We linked rate review program changes to the Centers for Medicare and Medicaid Services’ (CMS) criteria for an effective rate review program. We found, of states that did not meet CMS’s criteria when the ACA was enacted, most made changes to meet those criteria, including Republican-controlled states, which generally oppose the ACA. This finding is likely the result of the relatively low administrative burden associated with reviewing health insurance rates and the fact that doing so prevents federal intervention in rate review. However, Republican-controlled states were less likely than non-Republican-controlled states to increase their anticipated loss ratio requirements to align with the federal retrospective medical loss ratio requirement, expand Medicaid, and establish state-based exchanges, because of their general opposition to the ACA. We conclude that federal incentives for states to strengthen their health insurance rate review programs were more effective than the incentives for states to adopt other insurance-related policy goals of the ACA. PMID:26396089

Health Insurance Basics

MedlinePlus

... Staying Safe Videos for Educators Search English Español Health Insurance Basics KidsHealth / For Teens / Health Insurance Basics What's ... thought advanced calculus was confusing. What Exactly Is Health Insurance? Health insurance is a plan that people buy ...

Self-insurance and the potential effects of health reform on the small-group market.

PubMed

Linehan, Kathryn

2010-12-21

The Patient Protection and Affordable Care Act (PPACA) as amended by the Health Care Education Reconciliation Act of 2010 makes landmark changes to health insurance markets. Individual and small-group insurance plans and markets will see the biggest changes, but PPACA also affects large employer and self-insured plans by imposing rules for benefit design and health plan practices. Over half of workers--most often those in very large firms--are covered by self-insured health plans in which employers (or employee groups) bear all or some of the risk of providing insurance coverage to a defined population of workers and their dependents. As PPACA provisions become effective, some have argued that smaller firms that offer insurance may opt to self-insure their health benefits because of new small-group market rules. Such a shift could affect risk pooling in the small-group market. This paper examines the definition and prevalence of self-insured health plans, the application of PPACA provisions to these plans, and the possible effects on the broader health insurance market, should many more employers decide to self-insure.

Are insurance companies liable under the Americans with Disabilities Act?

PubMed

Manning, J S

2000-03-01

Federal courts have split on the question of the applicability of the Americans with Disabilities Act to insurance coverage decisions that insurance companies make on the basis of disability; they have similarly split on other issues pertaining to the scope of that Act's application. In deciding whether to read the Act as prohibiting discrimination in insurance decisions that are often crucial in the lives of people with disabilities, courts have faced two problems. First, where it prohibits discrimination in the equal enjoyment of the goods and services of places of public accommodation, the Act's area of concern may be limited to the ability of people with disabilities to gain physical access to facilities; or that area may extend to all forms of disability-based discrimination in the provision of goods and services. This Comment argues that the language and legislative history of the Act are consistent only with the latter view. Second, the provision limiting the Act's applicability to insurance may create an exemption for all insurance decisions; or it may protect only the ability of an insurance company to make an insurance decision to the disadvantage of an insured with a disability where actuarial data support the decision. This comment argues that the ambiguous language of the limiting provision should be resolved in favor of the latter view. Legislative history and the broader background of the history of insurance discrimination law support this resolution. Consequently, the Act should be interpreted as prohibiting disability-based discrimination by insurance companies in selling insurance policies and as defining discrimination as making disability-based insurance decisions without the support of actuarial data. By accepting this interpretation, courts can help stop the pattern of judicial narrowing of the Act's application through inappropriately restrictive statutory construction.

Work, Health, And Insurance: A Shifting Landscape For Employers And Workers Alike.

PubMed

Buchmueller, Thomas C; Valletta, Robert G

2017-02-01

We examined the complex relationship among work, health, and health insurance, which has been affected by changing demographics and employment conditions in the United States. Stagnation or deterioration in employment conditions and wages for much of the workforce has been accompanied by the erosion of health outcomes and employer-sponsored insurance coverage. In this article we present data and discuss the research that has established these links, and we assess the potential impact of policy responses to the evolving landscape of work and health. The expansion of insurance availability under the Affordable Care Act may have helped reduce the burden on employers to provide health insurance. However, the act's encouragement of wellness programs has uncertain potential to help contain the rising costs of employer-sponsored health benefits. Project HOPE—The People-to-People Health Foundation, Inc.

20 CFR 726.203 - Federal Coal Mine Health and Safety Act endorsement.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Federal Coal Mine Health and Safety Act... LABOR FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969, AS AMENDED BLACK LUNG BENEFITS; REQUIREMENTS FOR COAL MINE OPERATOR'S INSURANCE Insurance Contracts § 726.203 Federal Coal Mine Health and Safety Act...

Insights in Public Health: All About the Insurance: The US health-Care System Through a Foreigner's Eyes.

PubMed

Pitt, Ruth

2016-09-01

Hawai'i had high insurance coverage rates even before the Affordable Health Care Act and continues to have a high percentage of the population with health insurance today. However, high insurance rates can disguise wide variation in what is covered and what it costs. In this essay, an Australian Masters in Public Health student from the University of Hawai'i considers the strengths and weaknesses of insurance coverage in the US health-care system when her friend "Peter" becomes seriously ill.

Failure to pay for social health insurance premiums: Acts of protest or desperation?

PubMed

von Wyl, Viktor; Beck, Konstantin

2015-01-01

In Switzerland, basic health insurance is mandatory for all inhabitants, but a rising number of insured have arrears in premium payments, potentially leading to coverage suspension. We aimed at characterizing insured with debt enforcement proceedings with respect to socio-demographic and health utilization aspects. Cross-sectional analysis of 508.000 insured with basic health insurance contracts in 2013, of whom 14,000 (2.8%) with debt enforcement proceedings, from 11 Swiss cantons. Groups were characterized using logistic regression and latent class analysis. Insured with debt enforcement proceedings were more likely to be young, male and without dependents (partner, kids). Having no supplementary insurance and receiving partial premium subsidies was associated with an increased debt enforcement proceedings risk. Within the debt enforcement proceedings group, three subgroups were identified: 60% were young and seemingly healthy, with a below-average fraction of premium subsidy recipients (18%) and low out-of-pocket payments in prior year (median Swiss Francs 0). Two groups consisted of relatively ill elderly persons (22%, 99% of whom with chronic illnesses) or families (18%), many of whom (29% and 51%) were recipients of premium subsidies. Median out-of-pocket payments in the prior year were high (Swiss Francs 625 and 688, respectively). Sixty percent of premium arrears derive from young insured without apparent financial problems; 40% are owed by elderly and families, which are potentially hurt by coverage loss.

Determinants of facilitated health insurance enrollment for patients with HIV disease, and impact of insurance enrollment on targeted health outcomes.

PubMed

Furl, Renae; Watanabe-Galloway, Shinobu; Lyden, Elizabeth; Swindells, Susan

2018-03-16

The introduction of the Affordable Care Act (ACA) has provided unprecedented opportunities for uninsured people with HIV infection to access health insurance, and to examine the impact of this change in access. AIDS Drug Assistance Programs (ADAPs) have been directed to pursue uninsured individuals to enroll in the ACA as both a cost-saving strategy and to increase patient access to care. We evaluated the impact of ADAP-facilitated health insurance enrollment on health outcomes, and demographic and clinical factors that influenced whether or not eligible patients enrolled. During the inaugural open enrollment period for the ACA, 284 Nebraska ADAP recipients were offered insurance enrollment; 139 enrolled and 145 did not. Comparisons were conducted and multivariate models were developed considering factors associated with enrollment and differences between the insured and uninsured groups. Insurance enrollment was associated with improved health outcomes after controlling for other variables, and included a significant association with undetectable viremia, a key indicator of treatment success (p < .0001). We found that minority populations and unstably housed individuals were at increased risk to not enroll in insurance. The National HIV/AIDS Strategy calls for new interventions to improve HIV health outcomes for disproportionately impacted populations. This study provides evidence to prioritize future ADAP-facilitated insurance enrollment strategies to reach minority populations and unstably housed individuals.

The Affordable Care Act, Insurance Coverage, and Health Care Utilization of Previously Incarcerated Young Men: 2008-2015.

PubMed

Winkelman, Tyler N A; Choi, HwaJung; Davis, Matthew M

2017-05-01

To estimate health insurance and health care utilization patterns among previously incarcerated men following implementation of the Affordable Care Act's (ACA's) Medicaid expansion and Marketplace plans in 2014. We performed serial cross-sectional analyses using data from the National Survey of Family Growth between 2008 and 2015. Our sample included men aged 18 to 44 years with (n = 3476) and without (n = 8702) a history of incarceration. Uninsurance declined significantly among previously incarcerated men after ACA implementation (-5.9 percentage points; 95% confidence interval [CI] = -11.5, -0.4), primarily because of an increase in private insurance (6.8 percentage points; 95% CI = 0.1, 13.3). Previously incarcerated men accounted for a large proportion of the remaining uninsured (38.6%) in 2014 to 2015. Following ACA implementation, previously incarcerated men continued to be significantly less likely to report a regular source of primary care and more likely to report emergency department use than were never-incarcerated peers. Health insurance coverage improved among previously incarcerated men following ACA implementation. However, these men account for a substantial proportion of the remaining uninsured. Previously incarcerated men continue to lack primary care and frequently utilize acute care services.

Keeping up with the Cadillacs: What Health Insurance Disparities, Moral Hazard, and the Cadillac Tax Mean to The Patient Protection and Affordable Care Act.

PubMed

Fletcher, Rebecca Adkins

2016-03-01

A major goal of The Patient Protection and Affordable Care Act is to broaden health care access through the extension of insurance coverage. However, little attention has been given to growing disparities in access to health care among the insured, as trends to reduce benefits and increase cost sharing (deductibles, co-pays) reduce affordability and access. Through a political economic perspective that critiques moral hazard, this article draws from ethnographic research with the United Steelworkers (USW) at a steel mill and the Retail, Wholesale and Department Store Union (RWDSU) at a food-processing plant in urban Central Appalachia. In so doing, this article describes difficulties of health care affordability on the eve of reform for differentially insured working families with employer-sponsored health insurance. Additionally, this article argues that the proposed Cadillac tax on high-cost health plans will increase problems with appropriate health care access and medical financial burden for many families. © 2014 by the American Anthropological Association.

Failure to pay for social health insurance premiums: Acts of protest or desperation?

PubMed Central

von Wyl, Viktor; Beck, Konstantin

2015-01-01

Background In Switzerland, basic health insurance is mandatory for all inhabitants, but a rising number of insured have arrears in premium payments, potentially leading to coverage suspension. We aimed at characterizing insured with debt enforcement proceedings with respect to socio-demographic and health utilization aspects. Methods Cross-sectional analysis of 508.000 insured with basic health insurance contracts in 2013, of whom 14,000 (2.8%) with debt enforcement proceedings, from 11 Swiss cantons. Groups were characterized using logistic regression and latent class analysis. Results Insured with debt enforcement proceedings were more likely to be young, male and without dependents (partner, kids). Having no supplementary insurance and receiving partial premium subsidies was associated with an increased debt enforcement proceedings risk. Within the debt enforcement proceedings group, three subgroups were identified: 60% were young and seemingly healthy, with a below-average fraction of premium subsidy recipients (18%) and low out-of-pocket payments in prior year (median Swiss Francs 0). Two groups consisted of relatively ill elderly persons (22%, 99% of whom with chronic illnesses) or families (18%), many of whom (29% and 51%) were recipients of premium subsidies. Median out-of-pocket payments in the prior year were high (Swiss Francs 625 and 688, respectively). Conclusions Sixty percent of premium arrears derive from young insured without apparent financial problems; 40% are owed by elderly and families, which are potentially hurt by coverage loss. PMID:26844060

Implementing the Affordable Care Act: state approaches to premium rate reforms in the individual health insurance market.

PubMed

Giovannelli, Justin; Lucia, Kevin W; Corlette, Sabrina

2014-12-01

The Affordable Care Act protects people from being charged more for insurance based on factors like medical history or gender and establishes new limits on how insurers can adjust premiums for age, tobacco use, and geography. This brief examines how states have implemented these federal reforms in their individual health insurance markets. We identify state rating standards for the first year of full implementation of reform and explore critical considerations weighed by policymakers as they determined how to adopt the law's requirements. Most states took the opportunity to customize at least some aspect of their rating standards. Interviews with state regulators reveal that many states pursued implementation strategies intended primarily to minimize market disruption and premium shock and therefore established standards as consistent as possible with existing rules or market practice. Meanwhile, some states used the transition period to strengthen consumer protections, particularly with respect to tobacco rating.

Patient Protection and Affordable Care Act Medicaid expansion and gains in health insurance coverage and access among cancer survivors.

PubMed

Nikpay, Sayeh S; Tebbs, Margaret G; Castellanos, Emily H

2018-04-17

The Patient Protection and Affordable Care Act extends Medicaid coverage to millions of low-income adults, including many survivors of cancer who were unable to purchase affordable health insurance coverage in the individual health insurance market. Using data from the 2011 to 2015 Behavioral Risk Factor Surveillance System, the authors compared changes in coverage and health care access measures for low-income cancer survivors in states that did and did not expand Medicaid. The study population of 17,381 individuals included adults aged 18 to 64 years, and was predominantly female, white, and unmarried. The authors found a relative reduction in the uninsured rate of 11.7 percentage points and a relative increase in the probability of having a personal physician of 5.8 percentage points. Stratifying by whether states expanded Medicaid by 2015, the authors found that relative gains in coverage and access were larger among those individuals residing in states with expanded Medicaid compared with those residing in nonexpansion states. The results of the current study suggest that the Patient Protection and Affordable Care Act Medicaid expansion has improved coverage and access for cancer survivors. Cancer 2018. © 2018 American Cancer Society. © 2018 American Cancer Society.

Employer-Sponsored Health Insurance Coverage Limitations: Results from the Childhood Cancer Survivor Study

PubMed Central

Kirchhoff, Anne C.; Kuhlthau, Karen; Pajolek, Hannah; Leisenring, Wendy; Armstrong, Greg T.; Robison, Leslie L.; Park, Elyse R.

2013-01-01

Purpose The Affordable Care Act (ACA) will expand health insurance options for cancer survivors in the United States. It is unclear how this legislation will affect their access to employer-sponsored health insurance (ESI). We describe the health insurance experiences for survivors of childhood cancer with and without ESI. Methods We conducted a series of qualitative interviews with 32 adult survivors from the Childhood Cancer Survivor Study to assess their employment-related concerns and decisions regarding health insurance coverage. Interviews were performed from August to December 2009 and were recorded, transcribed, and content analyzed using NVivo 8. Results Uninsured survivors described ongoing employment limitations, such as being employed at part-time capacity, which affected their access to ESI coverage. These survivors acknowledged they could not afford insurance without employer support. Survivors on ESI had previously been denied health insurance due to their pre-existing health conditions until they obtained coverage through an employer. Survivors feared losing their ESI coverage, which created a disincentive to making career transitions. Others reported worries about insurance rescission if their cancer history was discovered. Survivors on ESI reported financial barriers in their ability to pay for health care. Conclusions Childhood cancer survivors face barriers to obtaining employer-sponsored health insurance. While Affordable Care Act provisions may mitigate insurance barriers for cancer survivors, many will still face cost barriers to affording health care without employer support. PMID:22717916

78 FR 7264 - Health Insurance Premium Tax Credit

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-01

... DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Part 1 [TD 9611] RIN 1545-BL49 Health.... SUMMARY: This document contains final regulations relating to the health insurance premium tax credit enacted by the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation...

Employer-provided health insurance and hospital mergers.

PubMed

Garmon, Christopher

2013-07-01

This paper explores the impact of employer-provided health insurance on hospital competition and hospital mergers. Under employer-provided health insurance, employer executives act as agents for their employees in selecting health insurance options for their firm. The paper investigates whether a merger of hospitals favored by executives will result in a larger price increase than a merger of competing hospitals elsewhere. This is found to be the case even when the executive has the same opportunity cost of travel as her employees and even when the executive is the sole owner of the firm, retaining all profits. This is consistent with the Federal Trade Commission's findings in its challenge of Evanston Northwestern Healthcare's acquisition of Highland Park Hospital. Implications of the model are further tested with executive location data and hospital data from Florida and Texas.

State health insurance exchange laws: the first generation.

PubMed

Rosenbaum, Sara; Lopez, Nancy; Burke, Taylor; Dorley, Mark

2012-07-01

Health insurance exchanges are the centerpiece of the private health insurance reforms included in the Patient Protection and Affordable Care Act. As of May 2012, 13 states, together with the District of Columbia, had taken legal action to establish exchanges, through legislation or executive order. State implementing laws are essential to the translation of broad federal policies into specific state and market practices. Overall, the laws in the 14 jurisdictions vary, but they tend to show a common approach of according exchanges much flexibility in how they will operate and what standards they will apply to the insurance products sold. In all states, these "threshold policies" will be followed by policy decisions, expressed through regulations, guidelines, and health plan contracting and performance standards.

Health Insurance Portability and Accountability Act (HIPAA) legislation and its implication on speech privacy design in health care facilities

NASA Astrophysics Data System (ADS)

Tocci, Gregory C.; Storch, Christopher A.

2005-09-01

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 (104th Congress, H.R. 3103, January 3, 1986), among many things, individual patient records and information be protected from unnecessary issue. This responsibility is assigned to the U.S. Department of Health and Human Services (HHS) which has issued a Privacy Rule most recently dated August 2002 with a revision being proposed in 2005 to strengthen penalties for inappropriate breaches of patient privacy. Despite this, speech privacy, in many instances in health care facilities need not be guaranteed by the facility. Nevertheless, the regulation implies that due regard be given to speech privacy in both facility design and operation. This presentation will explore the practical aspects of implementing speech privacy in health care facilities and make recommendations for certain specific speech privacy situations.

48 CFR 752.228-3 - Worker's compensation insurance (Defense Base Act).

Code of Federal Regulations, 2010 CFR

2010-10-01

... insurance (Defense Base Act). 752.228-3 Section 752.228-3 Federal Acquisition Regulations System AGENCY FOR... Clauses 752.228-3 Worker's compensation insurance (Defense Base Act). As prescribed in 728.309, the... contracting officer. (a) The Contractor agrees to procure Defense Base Act (DBA) insurance pursuant to the...

48 CFR 752.228-3 - Worker's compensation insurance (Defense Base Act).

Code of Federal Regulations, 2011 CFR

2011-10-01

... insurance (Defense Base Act). 752.228-3 Section 752.228-3 Federal Acquisition Regulations System AGENCY FOR... Clauses 752.228-3 Worker's compensation insurance (Defense Base Act). As prescribed in 728.309, the... contracting officer. (a) The Contractor agrees to procure Defense Base Act (DBA) insurance pursuant to the...

48 CFR 52.228-3 - Workers' Compensation Insurance (Defense Base Act).

Code of Federal Regulations, 2014 CFR

2014-10-01

... Insurance (Defense Base Act). 52.228-3 Section 52.228-3 Federal Acquisition Regulations System FEDERAL... Provisions and Clauses 52.228-3 Workers' Compensation Insurance (Defense Base Act). As prescribed in 28.309(a), insert the following clause: Workers' Compensation Insurance (Defense Base Act) (JUL 2014) (a) The...

48 CFR 752.228-3 - Worker's compensation insurance (Defense Base Act).

Code of Federal Regulations, 2014 CFR

2014-10-01

... insurance (Defense Base Act). 752.228-3 Section 752.228-3 Federal Acquisition Regulations System AGENCY FOR... Clauses 752.228-3 Worker's compensation insurance (Defense Base Act). As prescribed in 728.309, the... contracting officer. (a) The Contractor agrees to procure Defense Base Act (DBA) insurance pursuant to the...

48 CFR 752.228-3 - Worker's compensation insurance (Defense Base Act).

Code of Federal Regulations, 2012 CFR

2012-10-01

... insurance (Defense Base Act). 752.228-3 Section 752.228-3 Federal Acquisition Regulations System AGENCY FOR... Clauses 752.228-3 Worker's compensation insurance (Defense Base Act). As prescribed in 728.309, the... contracting officer. (a) The Contractor agrees to procure Defense Base Act (DBA) insurance pursuant to the...

48 CFR 752.228-3 - Worker's compensation insurance (Defense Base Act).

Code of Federal Regulations, 2013 CFR

2013-10-01

... insurance (Defense Base Act). 752.228-3 Section 752.228-3 Federal Acquisition Regulations System AGENCY FOR... Clauses 752.228-3 Worker's compensation insurance (Defense Base Act). As prescribed in 728.309, the... contracting officer. (a) The Contractor agrees to procure Defense Base Act (DBA) insurance pursuant to the...

48 CFR 52.228-3 - Workers' Compensation Insurance (Defense Base Act).

Code of Federal Regulations, 2011 CFR

2011-10-01

... Insurance (Defense Base Act). 52.228-3 Section 52.228-3 Federal Acquisition Regulations System FEDERAL... Provisions and Clauses 52.228-3 Workers' Compensation Insurance (Defense Base Act). As prescribed in 28.309(a), insert the following clause: Workers' Compensation Insurance (Defense Base Act) (APR 1984) The Contractor...

48 CFR 52.228-3 - Workers' Compensation Insurance (Defense Base Act).

Code of Federal Regulations, 2013 CFR

2013-10-01

... Insurance (Defense Base Act). 52.228-3 Section 52.228-3 Federal Acquisition Regulations System FEDERAL... Provisions and Clauses 52.228-3 Workers' Compensation Insurance (Defense Base Act). As prescribed in 28.309(a), insert the following clause: Workers' Compensation Insurance (Defense Base Act) (APR 1984) The Contractor...

48 CFR 52.228-3 - Workers' Compensation Insurance (Defense Base Act).

Code of Federal Regulations, 2012 CFR

2012-10-01

... Insurance (Defense Base Act). 52.228-3 Section 52.228-3 Federal Acquisition Regulations System FEDERAL... Provisions and Clauses 52.228-3 Workers' Compensation Insurance (Defense Base Act). As prescribed in 28.309(a), insert the following clause: Workers' Compensation Insurance (Defense Base Act) (APR 1984) The Contractor...

48 CFR 52.228-3 - Workers' Compensation Insurance (Defense Base Act).

Code of Federal Regulations, 2010 CFR

2010-10-01

... Insurance (Defense Base Act). 52.228-3 Section 52.228-3 Federal Acquisition Regulations System FEDERAL... Provisions and Clauses 52.228-3 Workers' Compensation Insurance (Defense Base Act). As prescribed in 28.309(a), insert the following clause: Workers' Compensation Insurance (Defense Base Act) (APR 1984) The Contractor...

Health Insurance

MedlinePlus

Health insurance helps protect you from high medical care costs. It is a contract between you and ... Many people in the United States get a health insurance policy through their employers. In most cases, ...

75 FR 32182 - Medicaid Program: Proposed Implementation of Section 614 of the Children's Health Insurance...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-07

... of the Children's Health Insurance Program Reauthorization Act of 2009 for Adjustments to the Federal... subject to adjustment pursuant to section 614 of the Children's Health Insurance Program Reauthorization... assistance expenditures under the Children's Health Insurance Program under title XXI of the Social Security...

Competition between health maintenance organizations and nonintegrated health insurance companies in health insurance markets.

PubMed

Baranes, Edmond; Bardey, David

2015-12-01

This article examines a model of competition between two types of health insurer: Health Maintenance Organizations (HMOs) and nonintegrated insurers. HMOs vertically integrate health care providers and pay them at a competitive price, while nonintegrated health insurers work as indemnity plans and pay the health care providers freely chosen by policyholders at a wholesale price. Such difference is referred to as an input price effect which, at first glance, favors HMOs. Moreover, we assume that policyholders place a positive value on the provider diversity supplied by their health insurance plan and that this value increases with the probability of disease. Due to the restricted choice of health care providers in HMOs a risk segmentation occurs: policyholders who choose nonintegrated health insurers are characterized by higher risk, which also tends to favor HMOs. Our equilibrium analysis reveals that the equilibrium allocation only depends on the number of HMOs in the case of exclusivity contracts between HMOs and providers. Surprisingly, our model shows that the interplay between risk segmentation and input price effects may generate ambiguous results. More precisely, we reveal that vertical integration in health insurance markets may decrease health insurers' premiums.

48 CFR 652.228-74 - Defense Base Act insurance rates-Limitation.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 4 2011-10-01 2011-10-01 false Defense Base Act insurance....228-74 Defense Base Act insurance rates—Limitation. As prescribed in 628.309-70(c), insert the following provision: Defense Base Act Insurance Rates—Limitation (JUN 2006) (a) The Department of State has...

Veterans' Health Insurance Coverage Under the Affordable Care Act and Implications of Repeal for the Department of Veterans Affairs

PubMed Central

Dworsky, Michael; Farmer, Carrie M.; Shen, Mimi

2018-01-01

Abstract This article describes the Affordable Care Act's (ACA's) effects on nonelderly veterans' insurance coverage and demand for Department of Veterans Affairs (VA) health care and assesses the coverage and VA utilization changes that could result from repealing the ACA. Although prior research has shown that the number of uninsured veterans fell after the ACA took effect, the implications of ACA repeal for veterans and, especially, for VA have received less attention. Besides providing a new coverage option to veterans who are not enrolled in VA, the ACA also had the potential to affect health care use among VA patients. Findings include the following: In 2013, prior to the major coverage expansions under the ACA, nearly one in ten nonelderly veterans were uninsured, lacking access to both VA coverage and non-VA health insurance. Uninsurance among nonelderly veterans fell by an adjusted 36 percent (3.3 percentage points) after implementation of the ACA, from 9.1 percent in 2013 to 5.8 percent in 2015. By increasing non-VA health insurance coverage for VA patients, the ACA likely reduced demand for VA care; the authors estimate that, if the gains in insurance coverage that occurred between 2013 and 2015 had not occurred, nonelderly veterans would have used about 1 percent more VA health care in 2015: 125,000 more office visits, 1,500 more inpatient surgeries, and 375,000 more prescriptions. Recent congressional proposals to repeal and replace the ACA would increase the number of uninsured nonelderly veterans and further increase demand for VA health care. PMID:29607249

Amendment to the interim final rules for group health plans and health insurance coverage relating to status as a grandfathered health plan under the Patient Protection and Affordable Care Act. Amendment to interim final rules with request for comments.

PubMed

2010-11-17

This document contains an amendment to interim final regulations implementing the rules for group health plans and health insurance coverage in the group and individual markets under provisions of the Patient Protection and Affordable Care Act regarding status as a grandfathered health plan; the amendment permits certain changes in policies, certificates, or contracts of insurance without loss of grandfathered status.

20 CFR 726.203 - Federal Coal Mine Health and Safety Act endorsement.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false Federal Coal Mine Health and Safety Act... OF LABOR FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969, AS AMENDED BLACK LUNG BENEFITS; REQUIREMENTS FOR COAL MINE OPERATOR'S INSURANCE Insurance Contracts § 726.203 Federal Coal Mine Health and...

20 CFR 726.203 - Federal Coal Mine Health and Safety Act endorsement.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 4 2013-04-01 2013-04-01 false Federal Coal Mine Health and Safety Act... OF LABOR FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969, AS AMENDED BLACK LUNG BENEFITS; REQUIREMENTS FOR COAL MINE OPERATOR'S INSURANCE Insurance Contracts § 726.203 Federal Coal Mine Health and...

77 FR 28788 - Health Insurance Issuers Implementing Medical Loss Ratio (MLR) Under the Patient Protection and...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-16

... DEPARTMENT OF HEALTH AND HUMAN SERVICES 45 CFR Part 158 [CMS-9998-IFC3] Health Insurance Issuers..., entitled ``Health Insurance Issuers Implementing Medical Loss Ratio (MLR) Requirements Under the Patient...) requirements for health insurance issuers under section 2718 of the Public Health Service Act, as added by the...

Employer-provided health insurance and the incidence of job lock: a literature review and empirical test.

PubMed

Rashad, Inas; Sarpong, Eric

2008-12-01

The incidence of 'job lock' in the health insurance context has long been viewed as a potential problem with employer-provided health insurance, a concept that was instrumental in the passage of the United States Consolidated Omnibus Budget Reconciliation Act of 1986, and later, the Health Insurance Portability and Accountability Act in 1996. Several recent developments in healthcare in the USA include declining healthcare coverage and a noticeable shift in the burden of medical care costs to employees. If these developments cause employees with employer-provided health insurance to feel locked into their jobs, optimal job matches in the labor force may not take place. A summary of the seminal papers in the current literature on the topic of job lock is given, followed by an empirical exercise using single individuals from the National Health Interview Survey (1997-2003) and the 1979 cohort of the National Longitudinal Survey of Youth (1989-2000). Econometric methods used include difference in differences, ordinary least squares and individual fixed effects models, in gauging the potential effect that employer-provided health insurance may have on job tenure and voluntary job departure. Our findings are consistent with recent assertions that there is some evidence of job lock. Individuals with employer-provided health insurance stay on the job 16% longer and are 60% less likely to voluntarily leave their jobs than those with insurance that is not provided by their employers. Productivity may not be optimal if incentives are altered owing to the existence of fringe benefits, such as health insurance. Further research in this area should determine whether legislation beyond the Consolidated Omnibus Budget Reconciliation Act and Health Insurance Portability and Accountability Act laws is needed.

Rules regarding the health insurance premium tax credit. Final and temporary regulations.

PubMed

2014-07-28

This document contains final and temporary regulations relating to the health insurance premium tax credit enacted by the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, as amended by the Medicare and Medicaid Extenders Act of 2010, the Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act of 2011, and the Department of Defense and Full-Year Continuing Appropriations Act of 2011 and the 3% Withholding Repeal and Job Creation Act. These regulations affect individuals who enroll in qualified health plans through Affordable Insurance Exchanges (Exchanges) and claim the premium tax credit, and Exchanges that make qualified health plans available to individuals. The text of the temporary regulations in this document also serves as the text of proposed regulations set forth in a notice of proposed rulemaking (REG-104579-13) on this subject in the Proposed Rules section in this issue of the Federal Register.

Exploring health insurance services in Sudan from the perspectives of insurers.

PubMed

Salim, Anas Mustafa Ahmed; Hamed, Fatima Hashim Mahmoud

2018-01-01

It has been 20 years since the introduction of health insurance in Sudan. This study was the first one that explored health insurance services in Sudan from the perspectives of the insurers. This was a qualitative, exploratory, interview study. The sampling frame was the list of Social Health Insurance and Private Health Insurance institutions in Sudan. Participants were selected from the four Social Health Insurance institutions and from five Private Health Insurance companies. The study was conducted in January and February 2017. In-depth individual interviews were conducted with a convenient sample of key executives from the different health insurers. Ideas and themes were identified and analysed using thematic analysis. The result showed that universal coverage was not achieved despite long time presence of Social Health Insurance and Private Health Insurance in Sudan. All participants described their services as comprehensive. All participants have good perception of the quality of the services they provide, although none of them investigated customer satisfaction. The main challenges facing Social Health Insurance are achieving universal coverage, ensuring sustainability and recruitment of the informal sector and self-employed population. Consumers' affordability of the premiums is the main obstacle for Private Health Insurance, while rising healthcare cost due to economic inflation is a challenge facing both Social Health Insurance and Private Health Insurance. In spite of the presence of Social Health Insurance and Private Health Insurance in Sudan, the country is still far from achieving universal coverage. Moreover, the sustainability of health insurance is questionable. The main reasons include low governmental financial resources and lack of affordability by beneficiaries especially for Private Health Insurance. This necessitates finding solutions to improve them or trying other types of health insurance. The quality of services provided by Social

The effects of health shocks on employment and health insurance: the role of employer-provided health insurance.

PubMed

Bradley, Cathy J; Neumark, David; Motika, Meryl

2012-12-01

Employment-contingent health insurance (ECHI) has been criticized for tying insurance to continued employment. Our research sheds light on two central issues regarding employment-contingent health insurance: whether such insurance "locks" people who experience a health shock into remaining at work; and whether it puts people at risk for insurance loss upon the onset of illness, because health shocks pose challenges to continued employment. We study how men's dependence on their own employer for health insurance affects labor supply responses and health insurance coverage following a health shock. We use the Health and Retirement Study (HRS) surveys from 1996 through 2008 to observe employment and health insurance status at interviews 2 years apart, and whether a health shock occurred in the intervening period between the interviews. All employed married men with health insurance either through their own employer or their spouse's employer, interviewed in at least two consecutive HRS waves with non-missing data on employment, insurance, health, demographic, and other variables, and under age 64 at the second interview are included in the study sample. We then limited the sample to men who were initially healthy. Our analytical sample consisted of 1,582 men of whom 1,379 had ECHI at the first interview, while 203 were covered by their spouse's employer. Hospitalization affected 209 men with ECHI and 36 men with spouse insurance. A new disease diagnosis was reported by 103 men with ECHI and 22 men with other insurance. There were 171 men with ECHI and 25 men with spouse employer insurance who had a self-reported health decline. Labor supply response differences associated with ECHI-with men with health shocks and ECHI more likely to continue working-appear to be driven by specific types of health shocks associated with future higher health care costs but not with immediate increases in morbidity that limit continued employment. Men with ECHI who have a self

Minimum Value of Eligible Employer-Sponsored Plans and Other Rules Regarding the Health Insurance Premium Tax Credit. Final regulations.

PubMed

2015-12-18

This document contains final regulations on the health insurance premium tax credit enacted by the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, as amended by the Medicare and Medicaid Extenders Act of 2010, the Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act of 2011, and the Department of Defense and Full-Year Continuing Appropriations Act, 2011. These final regulations affect individuals who enroll in qualified health plans through Affordable Insurance Exchanges (Exchanges, sometimes called Marketplaces) and claim the health insurance premium tax credit, and Exchanges that make qualified health plans available to individuals and employers.

Social integration and health insurance status among African American men and women.

PubMed

Williams, Beverly Rosa; Wang, Min Qi; Holt, Cheryl L; Schulz, Emily; Clark, Eddie M

2015-01-01

Using 2010 national data, we investigate the relationship between social integration and health insurance for African American adults. During the previous year 21.6% of men and 19.8% of women lacked continuous health insurance. The effect of marital status, income, and employment on insurance coverage differed by age and gender. Additionally, frequency of church attendance was positively associated with continuous health insurance for women aged 51-64. Spiritual/religious identity was marginally associated with insurance status for men aged 36-50. As provisions of the Affordable Care Act take effect, implementation programs should expand enrollment efforts to include the conjugal unit and the church.

The Effects of Health Shocks on Employment and Health Insurance: The Role of Employer-Provided Health Insurance

PubMed Central

Bradley, Cathy J.; Neumark, David; Motika, Meryl

2012-01-01

Background Employment-contingent health insurance (ECHI) has been criticized for tying insurance to continued employment. Our research sheds light on two central issues regarding employment-contingent health insurance: whether such insurance “locks” people who experience a health shock into remaining at work; and whether it puts people at risk for insurance loss upon the onset of illness, because health shocks pose challenges to continued employment. Objective To determine how men’s dependence on their own employer for health insurance affects labor supply responses and health insurance coverage following a health shock. Data Sources We use the Health and Retirement Study (HRS) surveys from 1996 through 2008 to observe employment and health insurance status at interviews two years apart, and whether a health shock occurred in the intervening period between the interviews. Study Selection All employed married men with health insurance either through their own employer or their spouse’s employer, interviewed in at least two consecutive HRS waves with non-missing data on employment, insurance, health, demographic, and other variables, and under age 64 at the second interview. We limited the sample to men who were initially healthy. Data Extraction Our analytical sample consisted of 1,582 men of whom 1,379 had ECHI at the first interview, while 203 were covered by their spouse’s employer. Hospitalization affected 209 men with ECHI and 36 men with spouse insurance. A new disease diagnosis was reported by 103 men with ECHI and 22 men with other insurance. There were 171 men with ECHI and 25 men with spouse employer insurance who had a self-reported health decline. Data Synthesis Labor supply response differences associated with ECHI – with men with health shocks and ECHI more likely to continue working – appear to be driven by specific types of health shocks associated with future higher health care costs but not with immediate increases in morbidity that

Infusing Adult Education Principles Into a Health Insurance Literacy Program.

PubMed

Brown, Virginia

2018-03-01

Health insurance literacy is an emerging concept in the health education and health promotion field. The passage of the Affordable Care Act highlighted the link between health insurance and health outcomes. However, the law does not specifically address how the public should be educated on choosing an appropriate health insurance plan. Research shows adults, regardless of previous health insurance status, are likely confused and uncertain about their selection. The University of Maryland Extension developed and created health insurance Smart Choice Health Insurance™ to reduce confusion and increase confidence and capability to make this decision. Andragogy, an adult learning theory, was used to guide the development of the program and help ensure best practices are used to achieve desired outcomes. Using the six principles of andragogy, the team incorporated reality-based case studies, allowed adults time to practice, and emphasized choice making and many other elements to create an atmosphere conducive to adult learning. Results from Smart Choice indicate the program is successful in reducing confusion and increasing confidence. Furthermore, feedback from participants and trained educators indicates that adults were engaged in the program and found the materials useful. Based on program success, creation of new health insurance literacy programs grounded in adult education principles is under way.

Exploring health insurance services in Sudan from the perspectives of insurers

PubMed Central

Salim, Anas Mustafa Ahmed; Hamed, Fatima Hashim Mahmoud

2018-01-01

Background: It has been 20 years since the introduction of health insurance in Sudan. This study was the first one that explored health insurance services in Sudan from the perspectives of the insurers. Methods: This was a qualitative, exploratory, interview study. The sampling frame was the list of Social Health Insurance and Private Health Insurance institutions in Sudan. Participants were selected from the four Social Health Insurance institutions and from five Private Health Insurance companies. The study was conducted in January and February 2017. In-depth individual interviews were conducted with a convenient sample of key executives from the different health insurers. Ideas and themes were identified and analysed using thematic analysis. Results: The result showed that universal coverage was not achieved despite long time presence of Social Health Insurance and Private Health Insurance in Sudan. All participants described their services as comprehensive. All participants have good perception of the quality of the services they provide, although none of them investigated customer satisfaction. The main challenges facing Social Health Insurance are achieving universal coverage, ensuring sustainability and recruitment of the informal sector and self-employed population. Consumers’ affordability of the premiums is the main obstacle for Private Health Insurance, while rising healthcare cost due to economic inflation is a challenge facing both Social Health Insurance and Private Health Insurance. Conclusion: In spite of the presence of Social Health Insurance and Private Health Insurance in Sudan, the country is still far from achieving universal coverage. Moreover, the sustainability of health insurance is questionable. The main reasons include low governmental financial resources and lack of affordability by beneficiaries especially for Private Health Insurance. This necessitates finding solutions to improve them or trying other types of health insurance

The Effect of the Affordable Care Act's Young Adult Insurance Expansions on Hospital-Based Behavioral Health Care

PubMed Central

Golberstein, Ezra; Busch, Susan H.; Zaha, Rebecca; Greenfield, Shelly F.; Beardslee, William R.; Meara, Ellen

2014-01-01

Objective Insurance coverage for young adults has increased since 2010, when the Affordable Care Act (ACA) required insurers to permit children on parental policies until age 26 as dependents. This study estimated changes in young adults’ use of hospital-based services with diagnosis codes for mental illness and substance abuse associated with the dependent coverage provision. Method Quasi-experimental comparison of national sample of non-birth hospital inpatient admissions to general hospitals (n=2,670,463 total, n=430,583 with primary behavioral health diagnosis) and California emergency department (ED) visits with behavioral health diagnoses (n=11,139,689). Data spanned 2005 to 2011. Estimates compared young adults who were and were not targeted by the ACA dependent coverage provision (19 to 25 versus 26 to 29 year olds), estimating changes in utilization before and after 2010. Primary outcomes included: quarterly inpatient admissions for primary diagnosis of any behavioral health disorder per 1000 population; ED visits with any behavioral health diagnosis per 1000 population; and payer source. Results Dependent coverage expansion was associated with 0.14 per 1000 more (p<0.001) inpatient admissions for behavioral health for 19-25 (ACA covered) versus 26-29 (then ACA uncovered) year olds. The coverage expansion was associated with 0.45 fewer behavioral health ED visits per 1000 (p=0.001) in California. The probability that inpatient admissions nationally, and ED visits in California were uninsured, decreased significantly (p<0.001). Conclusions ACA dependent coverage provisions produced modest increases in general hospital psychiatric inpatient admissions and higher rates of insurance coverage for young adult children nationally. Lower ED visit rates were observed in California. PMID:25263817

Do more health insurance options lead to higher wages? Evidence from states extending dependent coverage.

PubMed

Dillender, Marcus

2014-07-01

Little is known about how health insurance affects labor market decisions for young adults. This is despite the fact that expanding coverage for people in their early 20s is an important component of the Affordable Care Act. This paper studies how having an outside source of health insurance affects wages by using variation in health insurance access that comes from states extending dependent coverage to young adults. Using American Community Survey and Census data, I find evidence that extending health insurance to young adults raises their wages. The increases in wages can be explained by increases in human capital and the increased flexibility in the labor market that comes from people no longer having to rely on their own employers for health insurance. The estimates from this paper suggest the Affordable Care Act will lead to wage increases for young adults. Copyright © 2014 Elsevier B.V. All rights reserved.

48 CFR 652.228-71 - Worker's Compensation Insurance (Defense Base Act)-Services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Insurance (Defense Base Act)-Services. 652.228-71 Section 652.228-71 Federal Acquisition Regulations System... Clauses 652.228-71 Worker's Compensation Insurance (Defense Base Act)—Services. As prescribed in 628.309-70(b), insert the following clause: Workers' Compensation Insurance (Defense Base Act)—Services (JUN...

48 CFR 652.228-71 - Worker's Compensation Insurance (Defense Base Act)-Services.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Insurance (Defense Base Act)-Services. 652.228-71 Section 652.228-71 Federal Acquisition Regulations System... Clauses 652.228-71 Worker's Compensation Insurance (Defense Base Act)—Services. As prescribed in 628.309-70(b), insert the following clause: Workers' Compensation Insurance (Defense Base Act)—Services (JUN...

48 CFR 652.228-71 - Worker's Compensation Insurance (Defense Base Act)-Services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Insurance (Defense Base Act)-Services. 652.228-71 Section 652.228-71 Federal Acquisition Regulations System... Clauses 652.228-71 Worker's Compensation Insurance (Defense Base Act)—Services. As prescribed in 628.309-70(b), insert the following clause: Workers' Compensation Insurance (Defense Base Act)—Services (JUN...

48 CFR 652.228-71 - Worker's Compensation Insurance (Defense Base Act)-Services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Insurance (Defense Base Act)-Services. 652.228-71 Section 652.228-71 Federal Acquisition Regulations System... Clauses 652.228-71 Worker's Compensation Insurance (Defense Base Act)—Services. As prescribed in 628.309-70(b), insert the following clause: Workers' Compensation Insurance (Defense Base Act)—Services (JUN...

48 CFR 652.228-71 - Worker's Compensation Insurance (Defense Base Act)-Services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Insurance (Defense Base Act)-Services. 652.228-71 Section 652.228-71 Federal Acquisition Regulations System... Clauses 652.228-71 Worker's Compensation Insurance (Defense Base Act)—Services. As prescribed in 628.309-70(b), insert the following clause: Workers' Compensation Insurance (Defense Base Act)—Services (JUN...

Barriers to Homeless Persons Acquiring Health Insurance Through the Affordable Care Act.

PubMed

Fryling, Lauren R; Mazanec, Peter; Rodriguez, Robert M

2015-11-01

Medicaid expansion under the Affordable Care Act (ACA) is intended to provide a framework for increasing health care access for vulnerable populations, including the 1.2 million who experience homelessness each year in the United States. We sought to characterize homeless persons' knowledge of the ACA, identify barriers to their ACA enrollment, and determine access to various forms of communication that could be used to facilitate enrollment. At an urban county Level I trauma center, we interviewed all noncritically ill adults who presented to the emergency department (ED) during daytime hours and were able to provide consent. We assessed access to communication, awareness of the ACA, insurance status, and barriers preventing subjects from enrolling in health insurance and compared homeless persons' responses with concomitantly enrolled housed individuals. Of the 650 enrolled subjects, 134 (20.2%) were homeless. Homeless subjects were more likely to have never heard of the ACA (26% vs. 10%). "Not being aware if they qualify for Medicaid" was the most common (70%) and most significant (30%) barrier to enrollment reported by uninsured homeless persons. Of homeless subjects who were unsure if they qualified for Medicaid, 91% reported an income < 138% of the federal poverty level, likely qualifying them for enrollment. Although 99% of housed subjects reported access to either phone or internet, only 74% of homeless subjects reported access. Homeless persons report having less knowledge of the ACA than their housed counterparts, poor understanding of ACA qualification criteria, and limited access to phone and internet. ED-based outreach and education regarding ACA eligibility may increase their enrollment. Copyright © 2015 Elsevier Inc. All rights reserved.

75 FR 70114 - Amendment to the Interim Final Rules for Group Health Plans and Health Insurance Coverage...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-17

...This document contains an amendment to interim final regulations implementing the rules for group health plans and health insurance coverage in the group and individual markets under provisions of the Patient Protection and Affordable Care Act regarding status as a grandfathered health plan; the amendment permits certain changes in policies, certificates, or contracts of insurance without loss of grandfathered status.

Self-insured health plans

PubMed Central

McDonnell, Patricia; Guttenberg, Abbie; Greenberg, Leonard; Arnett, Ross H.

1986-01-01

Nationwide, 8 percent of all employment-related health plans were self-insured in 1984, which translates into more than 175,000 self-insured plans according to our latest study of independent health plans. The propensity of an organization to self-insure differs primarily by its size, with large establishments more likely to self-insure. In the overwhelming majority of cases, the self-insured benefit was hospital and/or medical. Among employers who self-insure, 23 percent self-administer, and the remaining 77 percent hire a commercial insurance company, Blue Cross/Blue Shield plan, or an independent third-party administrator to administer the health plan. PMID:10312008

Developing health insurance in transitional Asia.

PubMed

Ensor, T

1999-04-01

Many European and Asian economies are currently undergoing a process of economic transition away from state based command systems to market led economies. The impact of transition, such as a decline in public expenditure, break up of state enterprises and economic recession, has affected levels of funding available for social sectors. In the health sector, health insurance is being introduced as a way of alleviating the decline in funding arising from these processes. Most of the Former Soviet Union and a number of other Asian transition economies are currently introducing, extending or considering payroll based systems of health insurance. Comparisons with many Latin American countries, where social security based insurance has been encouraged since the first World War, can be illuminating. Experience suggests that, various factors have impeded or permitted development in these countries. General processes of economic change (transition factors) tend to affect all economies attempting to change the basis for public funding of services. Structural factors, such as urbanisation and the level of state or industrial employment, act as longer term inhibitors to the extension of coverage. These factors vary considerably across transition economies. This suggests that while a social security base for insurance may be a viable option for smaller industrialised European transitional economies, this is not the case for many of larger less industrialised economies. It is unclear how insurance will develop in the future. If a separate insurance fund is maintained it is important that its' purchasing function is developed. Otherwise it is not clear what value is added to the current health system. If entitlement is to be based on contribution, with the fund based on geographic or employment groups, systems for ensuring access for those not in employment and not classified as socially protected must be developed.

The Changing Dynamics Of US Health Insurance And Implications For The Future Of The Affordable Care Act.

PubMed

Graves, John A; Nikpay, Sayeh S

2017-02-01

The introduction of Medicaid expansions and state Marketplaces under the Affordable Care Act (ACA) have reduced the uninsurance rate to historic lows, changing the choices Americans make about coverage. In this article we shed light on these changing dynamics. We drew upon multistate transition models fit to nationally representative longitudinal data to estimate coverage transition probabilities between major insurance types in the years leading up to and including 2014. We found that the ACA's unprecedented coverage changes increased transitions to Medicaid and nongroup coverage among the uninsured, while strengthening the existing employer-sponsored insurance system and improving retention of public coverage. However, our results suggest possible weakness of state Marketplaces, since people gaining nongroup coverage were disproportionately older than other potential enrollees. We identified key opportunities for policy makers and insurers to improve underlying Marketplace risk pools by focusing on people transitioning from employer-sponsored coverage; these people are disproportionately younger and saw almost no change in their likelihood of becoming uninsured in 2014 compared to earlier years. Project HOPE—The People-to-People Health Foundation, Inc.

Geographic variation in premiums in health insurance marketplaces.

PubMed

Barker, Abigail R; McBride, Timothy D; Kemper, Leah M; Mueller, Keith

2014-08-01

This policy brief analyzes the 2014 premiums associated with qualified health plans (QHPs) made available through new health insurance marketplaces (HIMs), an implementation of the Patient Protection and Affordable Care Act (ACA) of 2010. We report differences in premiums by insurance rating areas while controlling for other important factors such as the actuarial value of the plan (metal level), cost-of-living differences, and state-level decisions over type of rating area. While market equilibrium, based on experience and understanding of the characteristics of the new market, should not be expected this soon, preliminary results give policymakers key issues to monitor.

Medicaid expansion under the Affordable Care Act. Implications for insurance-related disparities in pulmonary, critical care, and sleep.

PubMed

Lyon, Sarah M; Douglas, Ivor S; Cooke, Colin R

2014-05-01

The Affordable Care Act was intended to address systematic health inequalities for millions of Americans who lacked health insurance. Expansion of Medicaid was a key component of the legislation, as it was expected to provide coverage to low-income individuals, a population at greater risk for disparities in access to the health care system and in health outcomes. Several studies suggest that expansion of Medicaid can reduce insurance-related disparities, creating optimism surrounding the potential impact of the Affordable Care Act on the health of the poor. However, several impediments to the implementation of Medicaid's expansion and inadequacies within the Medicaid program itself will lessen its initial impact. In particular, the Supreme Court's decision to void the Affordable Care Act's mandate requiring all states to accept the Medicaid expansion allowed half of the states to forego coverage expansion, leaving millions of low-income individuals without insurance. Moreover, relative to many private plans, Medicaid is an imperfect program suffering from lower reimbursement rates, fewer covered services, and incomplete acceptance by preventive and specialty care providers. These constraints will reduce the potential impact of the expansion for patients with respiratory and sleep conditions or critical illness. Despite its imperfections, the more than 10 million low-income individuals who gain insurance as a result of Medicaid expansion will likely have increased access to health care, reduced out-of-pocket health care spending, and ultimately improvements in their overall health.

The Role of Public Health Insurance in Reducing Child Poverty.

PubMed

Wherry, Laura R; Kenney, Genevieve M; Sommers, Benjamin D

2016-04-01

Over the past 30 years, there have been major expansions in public health insurance for low-income children in the United States through Medicaid, the Children's Health Insurance Program (CHIP), and other state-based efforts. In addition, many low-income parents have gained Medicaid coverage since 2014 under the Affordable Care Act. Most of the research to date on health insurance coverage among low-income populations has focused on its effect on health care utilization and health outcomes, with much less attention to the financial protection it offers families. We review a growing body of evidence that public health insurance provides important financial benefits to low-income families. Expansions in public health insurance for low-income children and adults are associated with reduced out of pocket medical spending, increased financial stability, and improved material well-being for families. We also review the potential poverty-reducing effects of public health insurance coverage. When out of pocket medical expenses are taken into account in defining the poverty rate, Medicaid plays a significant role in decreasing poverty for many children and families. In addition, public health insurance programs connect families to other social supports such as food assistance programs that also help reduce poverty. We conclude by reviewing emerging evidence that access to public health insurance in childhood has long-term effects for health and economic outcomes in adulthood. Exposure to Medicaid and CHIP during childhood has been linked to decreased mortality and fewer chronic health conditions, better educational attainment, and less reliance on government support later in life. In sum, the nation's public health insurance programs have many important short- and long-term poverty-reducing benefits for low-income families with children. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

How Have Health Insurers Performed Financially Under the ACA' Market Rules?

PubMed

McCue, Michael J; Hall, Mark A

2017-10-01

The Affordable Care Act (ACA) transformed the market for individual health insurance, so it is not surprising that insurers' transition was not entirely smooth. Insurers, with no previous experience under these market conditions, were uncertain how to price their products. As a result, they incurred significant losses. Based on this experience, some insurers have decided to leave the ACA’s subsidized market, although others appear to be thriving. Examine the financial performance of health insurers selling through the ACA's marketplace exchanges in 2015--the market’s most difficult year to date. Analysis of financial data for 2015 reported by insurers from 48 states and D.C. to the Centers for Medicare and Medicaid Services. Although health insurers were profitable across all lines of business, they suffered a 10 percent loss in 2015 on their health plans sold through the ACA's exchanges. The top quarter of the ACA exchange market was comfortably profitable, while the bottom quarter did much worse than the ACA market average. This indicates that some insurers were able to adapt to the ACA's new market rules much better than others, suggesting the ACA's new market structure is sustainable, if supported properly by administrative policy.

Coverage for Gender-Affirming Care: Making Health Insurance Work for Transgender Americans.

PubMed

Padula, William V; Baker, Kellan

2017-08-01

Many transgender Americans continue to remain uninsured or are underinsured because of payers' refusal to cover medically necessary, gender-affirming healthcare services-such as hormone therapy, mental health counseling, and reconstructive surgeries. Coverage refusal results in higher costs and poor health outcomes among transgender people who cannot access gender-affirming care. Research into the value of health insurance coverage for gender-affirming care for transgender individuals shows that the health benefits far outweigh the costs of insuring transition procedures. Although the Affordable Care Act explicitly protects health insurance for transgender individuals, these laws are being threatened; therefore, this article reviews their importance to transgender-inclusive healthcare coverage.

Theory of health insurance.

PubMed

Nyman, J A

1998-01-01

The conventional explanation for purchasing insurance is to transfer risk. Psychologists, however, have shown that this explanation does not match actual behavior. They find that people generally prefer the risk of no loss at all to the certainty of a smaller actuarially equivalent loss, a situation exactly opposite to the one represented by the purchase of insurance. Nevertheless, people do purchase insurance, so there must be an explanation other than risk transfer for purchasing it. Of the explanations so far advanced, however, none have yet developed a wide acceptance. Regardless of risk issues, people will be more likely to purchase insurance when the premium is low compared to the value of the coverage to the consumer. Moral hazard raises the premium, as does adverse selection. The presence of either makes the purchase of insurance less likely. With health insurance, the tax subsidy can reduce the effective premium to less than the actuarially fair cost of insurance. This would increase the likelihood that health insurance is purchased. Finally, because of the value we place on our health, we desire access to a full range of health care. Health insurance is often the only affordable way of gaining access to this care, given the high costs of many of these procedures.

Mental Health Insurance Parity and Provider Wages.

PubMed

Golberstein, Ezra; Busch, Susan H

2017-06-01

Policymakers frequently mandate that employers or insurers provide insurance benefits deemed to be critical to individuals' well-being. However, in the presence of private market imperfections, mandates that increase demand for a service can lead to price increases for that service, without necessarily affecting the quantity being supplied. We test this idea empirically by looking at mental health parity mandates. This study evaluated whether implementation of parity laws was associated with changes in mental health provider wages. Quasi-experimental analysis of average wages by state and year for six mental health care-related occupations were considered: Clinical, Counseling, and School Psychologists; Substance Abuse and Behavioral Disorder Counselors; Marriage and Family Therapists; Mental Health Counselors; Mental Health and Substance Abuse Social Workers; and Psychiatrists. Data from 1999-2013 were used to estimate the association between the implementation of state mental health parity laws and the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act and average mental health provider wages. Mental health parity laws were associated with a significant increase in mental health care provider wages controlling for changes in mental health provider wages in states not exposed to parity (3.5 percent [95% CI: 0.3%, 6.6%]; p<.05). Mental health parity laws were associated with statistically significant but modest increases in mental health provider wages. Health insurance benefit expansions may lead to increased prices for health services when the private market that supplies the service is imperfect or constrained. In the context of mental health parity, this work suggests that part of the value of expanding insurance benefits for mental health coverage was captured by providers. Given historically low wage levels of mental health providers, this increase may be a first step in bringing mental health provider wages in line with parallel

Value-Based Payment Reform and the Medicare Access and Children's Health Insurance Program Reauthorization Act of 2015: A Primer for Plastic Surgeons.

PubMed

Squitieri, Lee; Chung, Kevin C

2017-07-01

In 2015, the U.S. Congress passed the Medicare Access and Children's Health Insurance Program Reauthorization Act, which effectively repealed the Centers for Medicare and Medicaid Services sustainable growth rate formula and established the Centers for Medicare and Medicaid Services Quality Payment Program. The Medicare Access and Children's Health Insurance Program Reauthorization Act represents an unparalleled acceleration toward value-based payment models and a departure from traditional volume-driven fee-for-service reimbursement. The Quality Payment Program includes two paths for provider participation: the Merit-Based Incentive Payment System and Advanced Alternative Payment Models. The Merit-Based Incentive Payment System pathway replaces existing quality reporting programs and adds several new measures to create a composite performance score for each provider (or provider group) that will be used to adjust reimbursed payment. The advanced alternative payment model pathway is available to providers who participate in qualifying Advanced Alternative Payment Models and is associated with an initial 5 percent payment incentive. The first performance period for the Merit-Based Incentive Payment System opens January 1, 2017, and closes on December 31, 2017, and is associated with payment adjustments in January of 2019. The Centers for Medicare and Medicaid Services estimates that the majority of providers will begin participation in 2017 through the Merit-Based Incentive Payment System pathway, but aims to have 50 percent of payments tied to quality or value through Advanced Alternative Payment Models by 2018. In this article, the authors describe key components of the Medicare Access and Children's Health Insurance Program Reauthorization Act to providers navigating through the Quality Payment Program and discuss how plastic surgeons may optimize their performance in this new value-based payment program.

Microsimulation of private health insurance and medicaid take-up following the U.S. Supreme court decision upholding the Affordable Care Act.

PubMed

Parente, Stephen T; Feldman, Roger

2013-04-01

To predict take-up of private health insurance and Medicaid following the U.S. Supreme Court decision upholding the Affordable Care Act (ACA). Data came from three large employers and a sampling of premiums from ehealthinsurance.com. We supplemented the employer data with information on state Medicaid eligibility and costs from the Kaiser Family Foundation. National predictions were based on the MEPS Household Component. We estimated a conditional logit model of health plan choice in the large group market. Using the coefficients from the choice model, we predicted take-up in the group and individual health insurance markets. Following ACA implementation, we added choices to the individual market corresponding to plans that will be available in state and federal exchanges. Depending on eligibility for premium subsidies, we reduced the out-of-pocket premiums for those choices. We simulated several possible patterns for states opting out of the Medicaid expansion, as allowed by the Supreme Court. The ACA will increase coverage substantially in the private insurance market and Medicaid. HSAs will remain desirable in both the individual and employer markets. If states opt out of the Medicaid expansion, this could increase the federal cost of health reform, while reducing the number of newly covered lives. © Health Research and Educational Trust.

Tobacco use and health insurance literacy among vulnerable populations: implications for health reform.

PubMed

Braun, Robert T; Hanoch, Yaniv; Barnes, Andrew J

2017-11-15

Under the Affordable Care Act (ACA), millions of Americans have been enrolling in the health insurance marketplaces. Nearly 20% of them are tobacco users. As part of the ACA, tobacco users may face up to 50% higher premiums that are not eligible for tax credits. Tobacco users, along with the uninsured and racial/ethnic minorities targeted by ACA coverage expansions, are among those most likely to suffer from low health literacy - a key ingredient in the ability to understand, compare, choose, and use coverage, referred to as health insurance literacy. Whether tobacco users choose enough coverage in the marketplaces given their expected health care needs and are able to access health care services effectively is fundamentally related to understanding health insurance. However, no studies to date have examined this important relationship. Data were collected from 631 lower-income, minority, rural residents of Virginia. Health insurance literacy was assessed by asking four factual questions about the coverage options presented to them. Adjusted associations between tobacco use and health insurance literacy were tested using multivariate linear regression, controlling for numeracy, risk-taking, discount rates, health status, experiences with the health care system, and demographics. Nearly one third (31%) of participants were current tobacco users, 80% were African American and 27% were uninsured. Average health insurance literacy across all participants was 2.0 (SD 1.1) out of a total possible score of 4. Current tobacco users had significantly lower HIL compared to non-users (-0.22, p < 0.05) after adjustment. Participants who were less educated, African American, and less numerate reported more difficulty understanding health insurance (p < 0.05 each.) CONCLUSIONS: Tobacco users face higher premiums for health coverage than non-users in the individual insurance marketplace. Our results suggest they may be less equipped to shop for plans that provide them

Addressing Health Insurance Literacy Gaps in an Urban African American Population: A Qualitative Study.

PubMed

Ali, Nida M; Combs, Ryan M; Muvuka, Baraka; Ayangeakaa, Suur D

2018-06-20

Health insurance and health systems literacy needs are evolving with changes to the U.S. healthcare system. Following the implementation of the Affordable Care Act, many residents in West Louisville, Kentucky, a predominantly African American community, gained health insurance coverage for the first time. A qualitative study was conducted to assess residents' health insurance and health systems needs and to identify ways of assisting residents with navigating the healthcare system and utilizing their health insurance coverage. Twelve focus groups were conducted with a total of eighty-seven residents. Round one explored participants' experiences with health insurance, and round two examined their health information delivery preferences. An inductive thematic analysis was performed. Participants revealed the complexity of the health insurance system, many citing difficulty understanding health insurance concepts and finding suitable healthcare providers. High costs, mistrust in the healthcare system, and perceived public-private disparities were barriers to effective health insurance utilization. Health insurance materials in their current form have limited value in translating health insurance and health systems information to the West Louisville population. Alternative forms of information delivery, such as locally accessible and culturally competent community health workers may be better received and more successfully utilized by the community.

77 FR 18309 - Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-27

...This final rule will implement the new Affordable Insurance Exchanges (``Exchanges''), consistent with title I of the Patient Protection and Affordable Care Act of 2010 as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. The Exchanges will provide competitive marketplaces for individuals and small employers to directly compare available private health insurance options on the basis of price, quality, and other factors. The Exchanges, which will become operational by January 1, 2014, will help enhance competition in the health insurance market, improve choice of affordable health insurance, and give small businesses the same purchasing clout as large businesses.

Recent Changes in Health Insurance Coverage for Urban and Rural Veterans: Evidence from the First Year of the Affordable Care Act.

PubMed

Boudreaux, Michel; Barath, Deanna; Blewett, Lynn A

2018-04-25

Prior to the Affordable Care Act, as many as 1.3 million veterans lacked health insurance. With the passage of the Affordable Care Act, veterans now have new pathways to coverage through Medicaid expansion in those states that chose to expand Medicaid and through private coverage options offered through the Health Insurance Marketplace. We examined the impact of the ACA on health insurance coverage for veterans in expansion and non-expansion states and for urban and rural veterans. We examined changes in veterans' health insurance coverage following the first year of the ACA, focusing on whether they lived in an urban or rural area and whether they live in a Medicaid expansion state. We used data on approximately 200,000 non-elderly community-dwelling veterans, obtained from the 2013-2014 American Community Survey and estimated differences in the adjusted probability of being uninsured between 2013 and 2014 for both urban and rural areas. Adjusted probabilities were computed by fitting logistic regressions controlling for age, gender, race, marital status, poverty status, education, and employment. There were an estimated 10.1 million U.S. non-elderly veterans in 2013; 82% lived in predominantly urban areas (8.3 million), and the remaining 18% (1.8 million) lived in predominately rural areas. Most veterans lived in the South (43.6%), and rural veterans were more likely to be Southerners than their urban counterparts. On every marker of economic well-being, rural veterans fared worse than urban veterans. They had a statistically significant higher chance of having incomes below 138% of FPG (20.0% versus 17.0%), of being out of the labor force (29.1% versus 23.0%), and of having no more than a high school education (39.6% versus 28.8%). Rural veterans were also more likely to experience at least one functional limitation. Overall, veterans in Medicaid expansion states experienced a significantly larger increase in insurance compared to veterans living in non

Individual insurance: health insurers try to tap potential market growth.

PubMed

November, Elizabeth A; Cohen, Genna R; Ginsburg, Paul B; Quinn, Brian C

2009-11-01

Individual insurance is the only source of health coverage for people without access to employer-sponsored insurance or public insurance. Individual insurance traditionally has been sought by older, sicker individuals who perceive the need for insurance more than younger, healthier people. The attraction of a sicker population to the individual market creates adverse selection, leading insurers to employ medical underwriting--which most states allow--to either avoid those with the greatest health needs or set premiums more reflective of their expected medical use. Recently, however, several factors have prompted insurers to recognize the growth potential of the individual market: a declining proportion of people with employer-sponsored insurance, a sizeable population of younger, healthier people forgoing insurance, and the likelihood that many people receiving subsidies to buy insurance under proposed health insurance reforms would buy individual coverage. Insurers are pursuing several strategies to expand their presence in the individual insurance market, including entering less-regulated markets, developing lower-cost, less-comprehensive products targeting younger, healthy consumers, and attracting consumers through the Internet and other new distribution channels, according to a new study by the Center for Studying Health System Change (HSC). Insurers' strategies in the individual insurance market are unlikely to meet the needs of less-than-healthy people seeking affordable, comprehensive coverage. Congressional health reform proposals, which envision a larger role for the individual market under a sharply different regulatory framework, would likely supersede insurers' current individual market strategies.

Redressing the limitations of the Affordable Care Act for Mexican immigrants through bi-national health insurance: a willingness to pay study in Los Angeles.

PubMed

González Block, Miguel Angel; Vargas Bustamante, Arturo; de la Sierra, Luz Angélica; Martínez Cardoso, Aresha

2014-04-01

The 12.4 million Mexican migrants in the United States (US) face considerable barriers to access health care, with 45% of them being uninsured. The Affordable Care Act (ACA) does not address lack of insurance for some immigrants, and the excluded groups are a large proportion of the Mexican-American community. To redress this, innovative forms of health insurance coverage have to be explored. This study analyses factors associated with willingness to pay for cross-border, bi-national health insurance (BHI) among Mexican immigrants in the US. Surveys were administered to 1,335 Mexican migrants in the Mexican Consulate of Los Angeles to assess their health status, healthcare utilization, and willingness to purchase BHI. Logistic regression was used to identify predictors of willingness to pay for BHI. Having a job, not having health insurance in the US, and relatives in Mexico attending public health services were significant predictors of willingness to pay for BHI. In addition, individuals identified quality as the most important factor when considering BHI. In spite of the interest for BHI among 54% of the sampled population, our study concludes that this type of coverage is unlikely to solve access to care challenges due to ACA eligibility among different Mexican immigrant populations.

What Can Massachusetts Teach Us about National Health Insurance Reform?

ERIC Educational Resources Information Center

Couch, Kenneth A., Ed.; Joyce, Theodore J., Ed.

2011-01-01

The Patient Protection and Affordable Care Act (PPACA) is the most significant health policy legislation since Medicare in 1965. The need to address rising health care costs and the lack of health insurance coverage is widely accepted. Health care spending is approaching 17 percent of gross domestic product and yet 45 million Americans remain…

78 FR 42159 - Medicaid and Children's Health Insurance Programs: Essential Health Benefits in Alternative...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-15

...This final rule implements provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act. This final rule finalizes new Medicaid eligibility provisions; finalizes changes related to electronic Medicaid and the Children's Health Insurance Program (CHIP) eligibility notices and delegation of appeals; modernizes and streamlines existing Medicaid eligibility rules; revises CHIP rules relating to the substitution of coverage to improve the coordination of CHIP coverage with other coverage; and amends requirements for benchmark and benchmark- equivalent benefit packages consistent with sections 1937 of the Social Security Act (which we refer to as ``alternative benefit plans'') to ensure that these benefit packages include essential health benefits and meet certain other minimum standards. This rule also implements specific provisions including those related to authorized representatives, notices, and verification of eligibility for qualifying coverage in an eligible employer-sponsored plan for Affordable Insurance Exchanges. This rule also updates and simplifies the complex Medicaid premium and cost sharing requirements, to promote the most effective use of services, and to assist states in identifying cost sharing flexibilities. It includes transition policies for 2014 as applicable.

The ethics of the affordability of health insurance.

PubMed

Saloner, Brendan; Daniels, Norman

2011-10-01

In this essay we argue that the concept of affordable health insurance is rooted in a social obligation to protect fair equality of opportunity. Specifically, health insurance plays a limited but significant role in protecting opportunity in two ways: it helps keep people functioning normally and it protects their financial security. Together these benefits enable household members to exercise reasonable choices about their plans of life. To achieve truly affordable coverage, society must be able to contain the overall cost of health care, and health insurance must be progressively financed, meaning that those who are best able to pay for coverage should pay the largest share. While the recently passed Patient Protection and Affordable Care Act (ACA) falls short on both of these counts, we argue that it makes important contributions toward household affordability through the use of subsidies and regulations. The main shortcoming of the ACA is an insufficient protection against burdensome cost sharing, which we illustrate using several hypothetical scenarios. We conclude with recommendations about how to make opportunity-enhancing expansions to the current coverage subsidies.

Demand for Self-Employed Health Insurance.

PubMed

Emamgholipour, Sara; Arab, Mohammad; Ebrahimzadeh, Javad

2016-10-01

Health insurance provides financial support for health care expenditures. There are two types of health insurance: compulsory and voluntary. Voluntary health insurance can be divided into two categories: self-employed and supplementary. In this study, the main factors that affect the demand for self-employed health insurance in Iran were determined. In this cross-sectional study, data were derived from the 2013 Household Income and Expenditure Survey from the Statistical Center of Iran. Then, a logistic regression model was designed to determine the factors influencing health insurance demand. The age, income, and education level of the head of the household directly correlated with the demand for self-employed health insurance. There was no significant relationship between the demand for health insurance and the gender or marital status of the head of the household. In addition, there were no significant relationships between occupation or house ownership and the demand for health insurance in rural households. To promote voluntary health insurance, it is helpful to identify effective factors that stimulate the health insurance demand.

The U.S. health insurance marketplace: are premiums truly affordable?

PubMed

Graetz, Ilana; Kaplan, Cameron M; Kaplan, Erin K; Bailey, James E; Waters, Teresa M

2014-10-21

The Patient Protection and Affordable Care Act requires that individuals have health insurance or pay a penalty. Individuals are exempt from paying this penalty if the after-subsidy cost of the least-expensive plan available to them is greater than 8% of their income. For this study, premium data for all health plans offered on the state and federal health insurance marketplaces were collected; the after-subsidy cost of premiums for the least-expensive bronze plan for every county in the United States was calculated; and variations in premium affordability by age, income, and geographic area were assessed. Results indicated that-although marketplace subsidies ensure affordable health insurance for most persons in the United States-many individuals with incomes just above the subsidy threshold will lack affordable coverage and will be exempt from the mandate. Furthermore, young individuals with low incomes often pay as much as or more than older individuals for bronze plans. If substantial numbers of younger, healthier adults choose to remain uninsured because of cost, health insurance premiums across all ages may increase over time.

Smart Choice Health Insurance©: A New, Interdisciplinary Program to Enhance Health Insurance Literacy.

PubMed

Brown, Virginia; Russell, Mia; Ginter, Amanda; Braun, Bonnie; Little, Lynn; Pippidis, Maria; McCoy, Teresa

2016-03-01

Smart Choice Health Insurance© is a consumer education program based on the definition and emerging measurement of health insurance literacy and a review of literature and appropriate theoretical frameworks. An interdisciplinary team of financial and health educators was formed to develop and pilot the program, with the goal of reducing confusion and increasing confidence in the consumer's ability to make a smart health insurance decision. Educators in seven states, certified to teach the program, conducted workshops for 994 consumers. Results show statistically significant evidence of increased health insurance literacy, confidence, and capacity to make a smart choice health insurance choice. Discussion centers on the impact the program had on specific groups, next steps to reach a larger audience, and implications for educators, consumers, and policymakers nationwide. © 2015 Society for Public Health Education.

Microsimulation of Private Health Insurance and Medicaid Take-Up Following the U.S. Supreme Court Decision Upholding the Affordable Care Act

PubMed Central

Parente, Stephen T; Feldman, Roger

2013-01-01

Objective To predict take-up of private health insurance and Medicaid following the U.S. Supreme Court decision upholding the Affordable Care Act (ACA). Data Sources Data came from three large employers and a sampling of premiums from http://ehealthinsurance.com. We supplemented the employer data with information on state Medicaid eligibility and costs from the Kaiser Family Foundation. National predictions were based on the MEPS Household Component. Study Design We estimated a conditional logit model of health plan choice in the large group market. Using the coefficients from the choice model, we predicted take-up in the group and individual health insurance markets. Following ACA implementation, we added choices to the individual market corresponding to plans that will be available in state and federal exchanges. Depending on eligibility for premium subsidies, we reduced the out-of-pocket premiums for those choices. We simulated several possible patterns for states opting out of the Medicaid expansion, as allowed by the Supreme Court. Principal Findings The ACA will increase coverage substantially in the private insurance market and Medicaid. HSAs will remain desirable in both the individual and employer markets. Conclusions If states opt out of the Medicaid expansion, this could increase the federal cost of health reform, while reducing the number of newly covered lives. PMID:23398372

The Health Insurance Portability and Accountability Act Privacy Rule: a practical guide for researchers.

PubMed

Gunn, Patrick P; Fremont, Allen M; Bottrell, Melissa; Shugarman, Lisa R; Galegher, Jolene; Bikson, Tora

2004-04-01

The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule, intended to address potential threats to patient privacy posed by the computerization and standardization of medical records, provides a new floor level of federal protection for health information in all 50 states. In most cases, compliance with the Privacy Rule was required as of April 2003. Yet considerable confusion and concern remain about the Privacy Rule and the specific changes it requires in the way healthcare providers, health plans, and others use, maintain, and disclose health information. Researchers worry that the Privacy Rule could hinder their access to health information needed to conduct their research. In this article, we explain how the final version of the Privacy Rule governs disclosure of health information, assess implications of the Privacy Rule for research, and offer practical suggestions for researchers who require access to health information. The Privacy Rule is fundamentally changing the way that healthcare providers, health plans, and others use, maintain, and disclose health information and the steps that researchers must take to obtain health data. The Privacy Rule requires researchers who seek access to identifiable health information to obtain written authorization from subjects, or, alternatively, to demonstrate that their research protocols meet certain Privacy Rule requirements that permit access without written authorization. To ensure continued access to data, researchers will need to work more closely than before with healthcare providers, health plans, and other institutions that generate and maintain health information.

Financial Performance of Health Insurers: State-Run Versus Federal-Run Exchanges.

PubMed

Hall, Mark A; McCue, Michael J; Palazzolo, Jennifer R

2018-06-01

Many insurers incurred financial losses in individual markets for health insurance during 2014, the first year of Affordable Care Act mandated changes. This analysis looks at key financial ratios of insurers to compare profitability in 2014 and 2013, identify factors driving financial performance, and contrast the financial performance of health insurers operating in state-run exchanges versus the federal exchange. Overall, the median loss of sampled insurers was -3.9%, no greater than their loss in 2013. Reduced administrative costs offset increases in medical losses. Insurers performed better in states with state-run exchanges than insurers in states using the federal exchange in 2014. Medical loss ratios are the underlying driver more than administrative costs in the difference in performance between states with federal versus state-run exchanges. Policy makers looking to improve the financial performance of the individual market should focus on features that differentiate the markets associated with state-run versus federal exchanges.

An analysis of the management and leadership roles of nurses relative to the health insurance portability and accountability act.

PubMed

Kiel, Joan M

2015-01-01

Nurses have a great deal of interaction with patients. Given this, nurses play a vital role in conveying to patients knowledge of their privacy, security, and confidentiality of patient health information rights under the Health Insurance Portability and Accountability Act (HIPAA). Nurses also can be "at the head of the table" in their own organization and professional organizations in regard to facilitating the implementation of the HIPAA and making access to patient information more "consumer friendly." This article discusses the role that nurses can develop into concerning HIPAA implementation in an ever-burgeoning arena of consumer advocacy and consumer information.

Medicaid Expansion Under the Affordable Care Act and Insurance Coverage in Rural and Urban Areas.

PubMed

Soni, Aparna; Hendryx, Michael; Simon, Kosali

2017-04-01

To analyze the differential rural-urban impacts of the Affordable Care Act Medicaid expansion on low-income childless adults' health insurance coverage. Using data from the American Community Survey years 2011-2015, we conducted a difference-in-differences regression analysis to test for changes in the probability of low-income childless adults having insurance in states that expanded Medicaid versus states that did not expand, in rural versus urban areas. Analyses employed survey weights, adjusted for covariates, and included a set of falsification tests as well as sensitivity analyses. Medicaid expansion under the Affordable Care Act increased the probability of Medicaid coverage for targeted populations in rural and urban areas, with a significantly greater increase in rural areas (P < .05), but some of these gains were offset by reductions in individual purchased insurance among rural populations (P < .01). Falsification tests showed that the insurance increases were specific to low-income childless adults, as expected, and were largely insignificant for other populations. The Medicaid expansion increased the probability of having "any insurance" for the pooled urban and rural low-income populations, and it specifically increased Medicaid coverage more in rural versus urban populations. There was some evidence that the expansion was accompanied by some shifting from individual purchased insurance to Medicaid in rural areas, and there is a need for future work to understand the implications of this shift on expenditures, access to care and utilization. © 2017 National Rural Health Association.

Identifying health insurance predictors and the main reported reasons for being uninsured among US immigrants by legal authorization status

PubMed Central

Bustamante, Arturo Vargas; Chen, Jie; Fang, Hai; Rizzo, John A.; Ortega, Alexander N.

2014-01-01

SUMMARY This study identifies differences in health insurance predictors and investigates the main reported reasons for lacking health insurance coverage between short-stayed (≤ 10 years) and long-stayed (> 10 years) US immigrant adults to parse the possible consequences of the Affordable Care Act among immigrants by length of stay and documentation status. Foreign-born adults (18–64 years of age) from the 2009 California Health Interview Survey are the study population. Health insurance coverage predictors and the main reasons for being uninsured are compared across cohorts and by documentation status. A logistic-regression two-part multivariate model is used to adjust for confounding factors. The analyses determine that legal status is a strong health insurance predictor, particularly among long-stayed undocumented immigrants. Immigration status is the main reported reason for lacking health insurance. Although long-stayed documented immigrants are likely to benefit from the Affordable Care Act implementation, undocumented immigrants and short-stayed documented immigrants may encounter difficulties getting health insurance coverage. PMID:24038524

Understanding health insurance plans

MedlinePlus

... page: //medlineplus.gov/ency/patientinstructions/000879.htm Understanding health insurance plans To use the sharing features on this ... plan for you and your family. Types of Health Insurance Plans Depending on how you get your health ...

Women's health insurance coverage 1980-2005.

PubMed

Glied, Sherry; Jack, Kathrine; Rachlin, Jason

2008-01-01

In the fragmented US health insurance system, women's health insurance coverage is an outcome both of changes in the availability of private and public health insurance and of changing patterns of labor force participation and household formation. Over the past 2 decades, women's socioeconomic circumstances have changed and public policy around health insurance coverage for low-income women has also undergone substantial modification. This study examines the roles of these changes in circumstances and policy on the level and composition of women's health insurance. Using the Census Bureau's March Current Population Survey 1980-2005, the government's principal source of nationally representative labor market and health insurance data, we examine how changes in marriage, full-time and part-time labor force participation, and public policy around coverage affected the level and source of women's health insurance coverage over 3 periods: 1980-1987, 1988-1994, and 1995-2005. Health insurance coverage rates have fallen for both women and men since 1980. What makes women different is that, in addition to the decline in coverage, the composition of health insurance coverage for women has also changed markedly. More women now obtain health insurance on their own, rather than as dependents, than did in 1980. A larger fraction of insured women are now enrolled in Medicaid than were in 1980. Women's routes to coverage have changed as their social and economic circumstances have changed and as policy, especially Medicaid policy, has evolved. Women's channels for obtaining health insurance coverage are more fragmented than those of men. The availability of multiple sources of coverage, and the possibility of moving amongst them, have not, however, insulated women from the overall declines in health insurance coverage caused by the rising cost of private health insurance.

Insurance Incentives for Health Promotion.

ERIC Educational Resources Information Center

Hosokawa, Michael C.

1984-01-01

To reduce the cost of reimbursements, many insurance companies have begun to use insurance incentives as a way to motivate individuals to participate in health promotion activities. Traditional health education, research and demonstration, and policy-premium incentives are methods of health promotion used by life and health insurance companies.…

How do health insurer market concentration and bargaining power with hospitals affect health insurance premiums?

PubMed

Trish, Erin E; Herring, Bradley J

2015-07-01

The US health insurance industry is highly concentrated, and health insurance premiums are high and rising rapidly. Policymakers have focused on the possible link between the two, leading to ACA provisions to increase insurer competition. However, while market power may enable insurers to include higher profit margins in their premiums, it may also result in stronger bargaining leverage with hospitals to negotiate lower payment rates to partially offset these higher premiums. We empirically examine the relationship between employer-sponsored fully-insured health insurance premiums and the level of concentration in local insurer and hospital markets using the nationally-representative 2006-2011 KFF/HRET Employer Health Benefits Survey. We exploit a unique feature of employer-sponsored insurance, in which self-insured employers purchase only administrative services from managed care organizations, to disentangle these different effects on insurer concentration by constructing one concentration measure representing fully-insured plans' transactions with employers and the other concentration measure representing insurers' bargaining with hospitals. As expected, we find that premiums are indeed higher for plans sold in markets with higher levels of concentration relevant to insurer transactions with employers, lower for plans in markets with higher levels of insurer concentration relevant to insurer bargaining with hospitals, and higher for plans in markets with higher levels of hospital market concentration. Copyright © 2015 Elsevier B.V. All rights reserved.

76 FR 46621 - Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services Under...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-03

...This document contains amendments to the interim final regulations implementing the rules for group health plans and health insurance coverage in the group and individual markets under provisions of the Patient Protection and Affordable Care Act regarding preventive health services.

Not All Insurance Is Equal: Differential Treatment and Health Outcomes by Insurance Coverage Among Nonelderly Adult Patients With Heart Attack.

PubMed

Niedzwiecki, Matthew J; Hsia, Renee Y; Shen, Yu-Chu

2018-06-05

The Affordable Care Act has provided health insurance to a large portion of the uninsured in the United States. However, different types of health insurance provide varying amounts of reimbursements to providers, which may lead to different types of treatment, potentially worsening health outcomes in patients covered by low-reimbursement insurance plans, such as Medicaid. The objective was to determine differences in access, treatment, and health outcomes by insurance type, using hospital fixed effects. We conducted a multivariate regression analysis using patient-level data for nonelderly adult patients with acute myocardial infarction in California from January 1, 2001, to December 31, 2014, as well as hospital-level information to control for differences between hospitals. The probability of Medicaid-insured and uninsured patients having access to catheterization laboratory was higher by 4.50 and 3.75 percentage points, respectively, relative to privately insured patients. When controlling for access to percutaneous coronary intervention facilities, however, Medicaid-insured and uninsured patients had a 4.24- and 0.85-percentage point lower probability, respectively, in receiving percutaneous coronary intervention treatment compared with privately insured patients. They also had higher mortality and readmission rates relative to privately insured patients. Although Medicaid-insured and uninsured patients with acute myocardial infarction had better access to catheterization laboratories, they had significantly lower probabilities of receiving percutaneous coronary intervention treatment and a higher likelihood of death and readmission compared with privately insured patients. This provides empirical evidence that treatment received and health outcomes strongly vary between Medicaid-insured, uninsured, and privately insured patients, with Medicaid-insured patients most disproportionately affected, despite having better access to cardiac technology. © 2018 The

How Do Health Insurer Market Concentration and Bargaining Power with Hospitals Affect Health Insurance Premiums?

PubMed Central

Trish, Erin E.; Herring, Bradley J.

2017-01-01

The US health insurance industry is highly concentrated, and health insurance premiums are high and rising rapidly. Policymakers have focused on the possible link between the two, leading to ACA provisions to increase insurer competition. However, while market power may enable insurers to include higher profit margins in their premiums, it may also result in stronger bargaining leverage with hospitals to negotiate lower payment rates to partially offset these higher premiums. We empirically examine the relationship between employer-sponsored fully-insured health insurance premiums and the level of concentration in local insurer and hospital markets using the nationally-representative 2006–2011 KFF/HRET Employer Health Benefits Survey. We exploit a unique feature of employer-sponsored insurance, in which self-insured employers purchase only administrative services from managed care organizations, to disentangle these different effects on insurer concentration by constructing one concentration measure representing fully-insured plans’ transactions with employers and the other concentration measure representing insurers’ bargaining with hospitals. As expected, we find that premiums are indeed higher for plans sold in markets with higher levels of concentration relevant to insurer transactions with employers, lower for plans in markets with higher levels of insurer concentration relevant to insurer bargaining with hospitals, and higher for plans in markets with higher levels of hospital market concentration. PMID:25910690

The Turkish commercial health insurance industry.

PubMed

Kisa, A

2001-08-01

Turkey has experienced significant development in the private health insurance market since 1991. Improvements in private health services, increased public awareness, and insufficient service delivery by the social security organizations have encouraged more people to buy private health insurance. The number of people covered by private health insurance has reached 600,000, forming a $200 million market. The Turkish insurance industry is targeting 6-8 million insurance holders before the year 2005. This study examines the structure of the commercial health insurance industry of Turkey and gives the latest policy and legal changes made in the insurance market by the Turkish government to affect supply and demand.

The impact of health insurance reform on insurance instability.

PubMed

Freund, Karen M; Isabelle, Alexis P; Hanchate, Amresh D; Kalish, Richard L; Kapoor, Alok; Bak, Sharon; Mishuris, Rebecca G; Shroff, Swati M; Battaglia, Tracy A

2014-02-01

We investigated the impact of the 2006 Massachusetts health care reform on insurance coverage and stability among minority and underserved women. We examined 36 months of insurance claims among 1,946 women who had abnormal cancer screening at six community health centers pre-(2004-2005) and post-(2007-2008) insurance reform. We examined frequency of switches in insurance coverage as measures of longitudinal insurance instability. On the date of their abnormal cancer screening test, 36% of subjects were publicly insured and 31% were uninsured. Post-reform, the percent ever uninsured declined from 39% to 29% (p .001) and those consistently uninsured declined from 23% to 16%. To assess if insurance instability changed between the pre- and post-reform periods, we conducted Poisson regression models, adjusted for patient demographics and length of time in care. These revealed no significant differences from the pre- to post-reform period in annual rates of insurance switches, incident rate ratio 0.98 (95%- CI 0.88-1.09). Our analysis is limited by changes in the populations in the pre- and post-reform period and inability to capture care outside of the health system network. Insurance reform increased stability as measured by decreasing uninsured rates without increasing insurance switches.

Health insurance exchanges bring potential opportunities.

PubMed

Jacobs, M Orry; Eggbeer, Bill

2012-11-01

The introduction of the state health insurance exchanges, as provided for in the Affordable Care Act, has many strategic implications for healthcare providers: Unprecedented transparency; The "Walmart Effect", with patients playing a greater role as healthcare consumers; A rise in narrow networks spurred by low prices and narrow geographies; The potential end of the cross subsidy of Medicare and Medicaid by commercial plans; The possible end of not-for-profit status for hospitals

Health Insurance Literacy: How People Understand and Make Health Insurance Purchase Decisions

ERIC Educational Resources Information Center

Vardell, Emily Johanna

2017-01-01

The concept of health insurance literacy, which can be defined as "the extent to which consumers can make informed purchase and use decisions" (Kim, Braun, & Williams, 2013, p. 3), has only recently become a focus of health literacy research. Though employees have been making health insurance decisions for many years, the Affordable…

Patient Protection and Affordable Care Act; establishment of the multi-state plan program for the Affordable Insurance Exchanges.

PubMed

2013-03-11

The U.S. Office of Personnel Management (OPM) is issuing a final regulation establishing the Multi-State Plan Program (MSPP) pursuant to the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. Through contracts with OPM, health insurance issuers will offer at least two multi-State plans (MSPs) on each of the Affordable Insurance Exchanges (Exchanges). One of the issuers must be non-profit. Under the law, an MSPP issuer may phase in the States in which it offers coverage over 4 years, but it must offer MSPs on Exchanges in all States and the District of Columbia by the fourth year in which the MSPP issuer participates in the MSPP. This rule aims to balance adhering to the statutory goals of MSPP while aligning its standards to those applying to qualified health plans to promote a level playing field across health plans.

Acceptability of, and willingness to pay for, community health insurance in rural India.

PubMed

Jain, Ankit; Swetha, Selva; Johar, Zeena; Raghavan, Ramesh

2014-09-01

To understand the acceptability of, and willingness to pay for, community health insurance coverage among residents of rural India. We conducted a mixed methods study of 33 respondents located in 8 villages in southern India. Interview domains focused on health-seeking behaviors of the family for primary healthcare, household expenditures on primary healthcare, interest in pre-paid health insurance, and willingness to pay for such a product. Most respondents reported that they would seek care only when symptoms were manifest; only 6 respondents recognized the importance of preventative services. None reported impoverishment due to health expenditures. Few viewed health insurance as necessary either because they did not wish to be early adopters, because they had alternate sources of financial support, or because of concerns with the design of insurance coverage or the provider. Those who were interested reported being willing to pay Rs. 1500 ($27) as the modal annual insurance premium. Penetration of community health insurance programs in rural India will require education of the consumer base, careful attention to premium rate setting, and deeper understanding of social networks that may act as financial substitutes for health insurance. Copyright © 2013 Ministry of Health, Saudi Arabia. Published by Elsevier Ltd. All rights reserved.

Small employer perspectives on the Affordable Care Act's premiums, SHOP exchanges, and self-insurance.

PubMed

Gabel, Jon R; Whitmore, Heidi; Pickreign, Jeremy; Satorius, Jennifer L; Stromberg, Sam

2013-11-01

Beginning January 1, 2014, small businesses having no more than fifty full-time-equivalent workers will be able to obtain health insurance for their employees through Small Business Health Options Program (SHOP) exchanges in every state. Although the Affordable Care Act intended the exchanges to make the purchasing of insurance more attractive and affordable to small businesses, it is not yet known how they will respond to the exchanges. Based on a telephone survey of 604 randomly selected private firms having 3-50 employees, we found that both firms that offered health coverage and those that did not rated most features of SHOP exchanges highly but were also very price sensitive. More than 92 percent of nonoffering small firms said that if they were to offer coverage, it would be "very" or "somewhat" important to them that premium costs be less than they are today. Eighty percent of offering firms use brokers who commonly perform functions of benefit managers--functions that the SHOP exchanges may assume. Twenty-six percent of firms using brokers reported discussing self-insuring with their brokers. An increase in the number of self-insured small employers could pose a threat to SHOP exchanges and other small-group insurance reforms.

Employer-sponsored health insurance coverage limitations: results from the Childhood Cancer Survivor Study.

PubMed

Kirchhoff, Anne C; Kuhlthau, Karen; Pajolek, Hannah; Leisenring, Wendy; Armstrong, Greg T; Robison, Leslie L; Park, Elyse R

2013-02-01

The Affordable Care Act (ACA) will expand health insurance options for cancer survivors in the USA. It is unclear how this legislation will affect their access to employer-sponsored health insurance (ESI). We describe the health insurance experiences for survivors of childhood cancer with and without ESI. We conducted a series of qualitative interviews with 32 adult survivors from the Childhood Cancer Survivor Study to assess their employment-related concerns and decisions regarding health insurance coverage. Interviews were performed from August to December 2009 and were recorded, transcribed, and content analyzed using NVivo 8. Uninsured survivors described ongoing employment limitations, such as being employed at part-time capacity, which affected their access to ESI coverage. These survivors acknowledged they could not afford insurance without employer support. Survivors on ESI had previously been denied health insurance due to their preexisting health conditions until they obtained coverage through an employer. Survivors feared losing their ESI coverage, which created a disincentive to making career transitions. Others reported worries about insurance rescission if their cancer history was discovered. Survivors on ESI reported financial barriers in their ability to pay for health care. Childhood cancer survivors face barriers to obtaining ESI. While ACA provisions may mitigate insurance barriers for cancer survivors, many will still face cost barriers to affording health care without employer support.

The Effect of Child Health Insurance Access on Schooling: Evidence from Public Insurance Expansions. NBER Working Paper No. 20178

ERIC Educational Resources Information Center

Cohodes, Sarah; Kleiner, Samuel; Lovenheim, Michael F.; Grossman, Daniel

2014-01-01

Public health insurance programs comprise a large share of federal and state government expenditure, and these programs are due to be expanded as part of the 2010 Affordable Care Act. Despite a large literature on the effects of these programs on health care utilization and health outcomes, little prior work has examined the long-term effects of…

Identifying health insurance predictors and the main reported reasons for being uninsured among US immigrants by legal authorization status.

PubMed

Vargas Bustamante, Arturo; Chen, Jie; Fang, Hai; Rizzo, John A; Ortega, Alexander N

2014-01-01

This study identifies differences in health insurance predictors and investigates the main reported reasons for lacking health insurance coverage between short-stayed (≤ 10 years) and long-stayed (>10 years) US immigrant adults to parse the possible consequences of the Affordable Care Act among immigrants by length of stay and documentation status. Foreign-born adults (18-64 years of age) from the 2009 California Health Interview Survey are the study population. Health insurance coverage predictors and the main reasons for being uninsured are compared across cohorts and by documentation status. A logistic-regression two-part multivariate model is used to adjust for confounding factors. The analyses determine that legal status is a strong health insurance predictor, particularly among long-stayed undocumented immigrants. Immigration status is the main reported reason for lacking health insurance. Although long-stayed documented immigrants are likely to benefit from the Affordable Care Act implementation, undocumented immigrants and short-stayed documented immigrants may encounter difficulties getting health insurance coverage. Copyright © 2013 John Wiley & Sons, Ltd.

The Association of Generation Status and Health Insurance Among US Children

PubMed Central

Miranda, Patricia Y.; Elewonibi, Bilikisu Reni; Hillemeier, Marianne M.

2014-01-01

BACKGROUND: The Patient Protection and Affordable Care Act (ACA) has the potential to reduce the number of uninsured children in the United States by as much as 40%. The extent to which immigrant families are aware of and interested in obtaining insurance for their children is unclear. METHODS: Data from the 2011–2012 National Survey of Children’s Health were analyzed to examine differences by immigrant generational status in awareness of children’s health insurance options. Adjusted odds ratios (AORs) were calculated for each outcome variable that showed statistical significance by generation status. RESULTS: Barriers to obtaining insurance for children in immigrant (first- and second-generation) families include awareness of and experience with various health insurance options, perceived costs and benefits of insurance, structural/policy restrictions on eligibility, and lower likelihood of working in large organizations that offer employee insurance coverage. Although noncitizen immigrants are not covered by ACA insurance expansions, only 38% of first-generation families report being uninsured because of the inability to meet citizenship requirements. Most families in this sample also worked for employers with <50 employees, making them less likely to benefit from expansions in employer-based insurance. In multivariate analyses, third-generation families have increased odds of knowing how to enroll in health insurance (AOR 7.1 [3.6–13.0]) and knowing where to find insurance information (AOR 7.7 [3.8–15.4]) compared with first-generation families. CONCLUSIONS: ACA navigators and health services professionals should be aware of potential unique challenges to helping immigrant families negotiate Medicaid expansions and state and federal exchanges. PMID:25002670

Disability, Health Insurance and Psychological Distress among US Adults: An Application of the Stress Process.

PubMed

Alang, Sirry M; McAlpine, Donna D; Henning-Smith, Carrie E

2014-11-01

Structural resources, including access to health insurance, are understudied in relation to the stress process. Disability increases the likelihood of mental health problems, but health insurance may moderate this relationship. We explore health insurance coverage as a moderator of the relationship between disability and psychological distress. A pooled sample from 2008-2010 (N=57,958) was obtained from the Integrated Health Interview Series. Chow tests were performed to assess insurance group differences in the association between disability and distress. Results indicated higher levels of distress associated with disability among uninsured adults compared to their peers with public or private insurance. The strength of the relationship between disability and distress was weaker for persons with public compared to private insurance. As the Affordable Care Act is implemented, decision-makers should be aware of the potential for insurance coverage, especially public, to ameliorate secondary conditions such as psychological distress among persons who report a physical disability.

Disability, Health Insurance and Psychological Distress among US Adults: An Application of the Stress Process

PubMed Central

Alang, Sirry M.; McAlpine, Donna D.; Henning-Smith, Carrie E.

2014-01-01

Structural resources, including access to health insurance, are understudied in relation to the stress process. Disability increases the likelihood of mental health problems, but health insurance may moderate this relationship. We explore health insurance coverage as a moderator of the relationship between disability and psychological distress. A pooled sample from 2008–2010 (N=57,958) was obtained from the Integrated Health Interview Series. Chow tests were performed to assess insurance group differences in the association between disability and distress. Results indicated higher levels of distress associated with disability among uninsured adults compared to their peers with public or private insurance. The strength of the relationship between disability and distress was weaker for persons with public compared to private insurance. As the Affordable Care Act is implemented, decision-makers should be aware of the potential for insurance coverage, especially public, to ameliorate secondary conditions such as psychological distress among persons who report a physical disability. PMID:25767740

Trends in Health Insurance Coverage of Title X Family Planning Program Clients, 2005-2015.

PubMed

Decker, Emily J; Ahrens, Katherine A; Fowler, Christina I; Carter, Marion; Gavin, Loretta; Moskosky, Susan

2018-05-01

The federal Title X Family Planning Program supports the delivery of family planning services and related preventive care to 4 million individuals annually in the United States. The implementation of the 2010 Affordable Care Act's (ACA's) Medicaid expansion and provisions expanding access to health insurance, which took effect in January 2014, resulted in higher rates of health insurance coverage in the U.S. population; the ACA's impact on individuals served by the Title X program has not yet been evaluated. Using administrative data we examined changes in health insurance coverage among Title X clinic patients during 2005-2015. We found that the percentage of clients without health insurance decreased from 60% in 2005 to 48% in 2015, with the greatest annual decrease occurring between 2013 and 2014 (63% to 54%). Meanwhile, between 2005 and 2015, the percentage of clients with Medicaid or other public health insurance increased from 20% to 35% and the percentage of clients with private health insurance increased from 8% to 15%. Although clients attending Title X clinics remained uninsured at substantially higher rates compared with the national average, the increase in clients with health insurance coverage aligns with the implementation of ACA-related provisions to expand access to affordable health insurance.

Survey of social health insurance structure in selected countries; providing framework for basic health insurance in Iran

PubMed Central

Mohammadi, Effat; Raissi, Ahmad Reza; Barooni, Mohsen; Ferdoosi, Massoud; Nuhi, Mojtaba

2014-01-01

Introduction and Objectives: Health system reforms are the most strategic issue that has been seriously considered in healthcare systems in order to reduce costs and increase efficiency and effectiveness. The costs of health system finance in our country, lack of universal coverage in health insurance, and related issues necessitate reforms in our health system financing. The aim of this research was to prepare a structure of framework for social health insurance in Iran and conducting a comparative study in selected countries with social health insurance. Materials and Methods: This comparative descriptive study was conducted in three phases. The first phase of the study examined the structure of health social insurance in four countries – Germany, South Korea, Egypt, and Australia. The second phase was to develop an initial model, which was designed to determine the shared and distinguishing points of the investigated structures, for health insurance in Iran. The third phase was to validate the final research model. The developed model by the Delphi method was given to 20 professionals in financing of the health system, health economics and management of healthcare services. Their comments were collected in two stages and its validity was confirmed. Findings: The study of the structure of health insurance in the selected countries shows that health social insurance in different countries have different structures. Based on the findings of the present study, the current situation of the health system, and the conducted surveys, the following framework is suitable for the health social insurance system in Iran. The Health Social Insurance Organization has a unique service by having five funds of governmental employees, companies and NGOs, self-insured, villagers, and others, which serves as a nongovernmental organization under the supervision of public law and by decision- and policy-making of the Health Insurance Supreme Council. Membership in this organization

Survey of social health insurance structure in selected countries; providing framework for basic health insurance in Iran.

PubMed

Mohammadi, Effat; Raissi, Ahmad Reza; Barooni, Mohsen; Ferdoosi, Massoud; Nuhi, Mojtaba

2014-01-01

Health system reforms are the most strategic issue that has been seriously considered in healthcare systems in order to reduce costs and increase efficiency and effectiveness. The costs of health system finance in our country, lack of universal coverage in health insurance, and related issues necessitate reforms in our health system financing. The aim of this research was to prepare a structure of framework for social health insurance in Iran and conducting a comparative study in selected countries with social health insurance. This comparative descriptive study was conducted in three phases. The first phase of the study examined the structure of health social insurance in four countries - Germany, South Korea, Egypt, and Australia. The second phase was to develop an initial model, which was designed to determine the shared and distinguishing points of the investigated structures, for health insurance in Iran. The third phase was to validate the final research model. The developed model by the Delphi method was given to 20 professionals in financing of the health system, health economics and management of healthcare services. Their comments were collected in two stages and its validity was confirmed. The study of the structure of health insurance in the selected countries shows that health social insurance in different countries have different structures. Based on the findings of the present study, the current situation of the health system, and the conducted surveys, the following framework is suitable for the health social insurance system in Iran. The Health Social Insurance Organization has a unique service by having five funds of governmental employees, companies and NGOs, self-insured, villagers, and others, which serves as a nongovernmental organization under the supervision of public law and by decision- and policy-making of the Health Insurance Supreme Council. Membership in this organization is based on the nationality or residence, which the insured by

Community health events for enrolling uninsured into public health insurance programs: implications for health reform.

PubMed

Cheng, Scott; Tsai, Kai-ya; Nascimento, Lori M; Cousineau, Michael R

2014-01-01

To determine whether enrollment events may serve as a venue to identify eligible individuals, enroll them into health insurance programs, and educate them about the changes the Patient Protection and Affordable Care Act will bring about. More than 2900 surveys were administered to attendees of 7 public health insurance enrollment events in California. Surveys were used to identify whether participants had any change in understanding of health reform after participating in the event. More than half of attendees at nearly all events had no knowledge about health reform before attending the event. On average, more than 80% of attendees knew more about health reform following the event and more than 80% believed that the law would benefit their families. Enrollment events can serve as an effective method to educate the public on health reform. Further research is recommended to explore in greater detail the impact community enrollment events can have on expanding public understanding of health reform.

Show Me My Health Plans: Using a Decision Aid to Improve Decisions in the Federal Health Insurance Marketplace

PubMed Central

Politi, Mary C.; Kuzemchak, Marie D.; Liu, Jingxia; Barker, Abigail R.; Peters, Ellen; Ubel, Peter A.; Kaphingst, Kimberly A.; McBride, Timothy; Kreuter, Matthew W.; Shacham, Enbal; Philpott, Sydney E.

2017-01-01

Introduction Since the Affordable Care Act was passed, more than 12 million individuals have enrolled in the health insurance marketplace. Without support, many struggle to make an informed plan choice that meets their health and financial needs. Methods We designed and evaluated a decision aid, Show Me My Health Plans (SMHP), that provides education, preference assessment, and an annual out-of-pocket cost calculator with plan recommendations produced by a tailored, risk-adjusted algorithm incorporating age, gender, and health status. We evaluated whether SMHP compared to HealthCare.gov improved health insurance decision quality and the match between plan choice, needs, and preferences among 328 Missourians enrolling in the marketplace. Results Participants who used SMHP had higher health insurance knowledge (LS-Mean = 78 vs. 62; P < 0.001), decision self-efficacy (LS-Mean = 83 vs. 75; P < 0.002), confidence in their choice (LS-Mean = 3.5 vs. 2.9; P < 0.001), and improved health insurance literacy (odds ratio = 2.52, P <0.001) compared to participants using HealthCare.gov. Those using SMHP were 10.3 times more likely to select a silver- or gold-tier plan (P < 0.0001). Discussion SMHP can improve health insurance decision quality and the odds that consumers select an insurance plan with coverage likely needed to meet their health needs. This study represents a unique context through which to apply principles of decision support to improve health insurance choices. PMID:28804780

Pricing behaviour of nonprofit insurers in a weakly competitive social health insurance market.

PubMed

Douven, Rudy C H M; Schut, Frederik T

2011-03-01

In this paper we examine the pricing behaviour of nonprofit health insurers in the Dutch social health insurance market. Since for-profit insurers were not allowed in this market, potential spillover effects from the presence of for-profit insurers on the behaviour of nonprofit insurers were absent. Using a panel data set for all health insurers operating in the Dutch social health insurance market over the period 1996-2004, we estimate a premium model to determine which factors explain the price setting behaviour of nonprofit health insurers. We find that financial stability rather than profit maximisation offers the best explanation for health plan pricing behaviour. In the presence of weak price competition, health insurers did not set premiums to maximize profits. Nevertheless, our findings suggest that regulations on financial reserves are needed to restrict premiums. Copyright © 2011 Elsevier B.V. All rights reserved.

Impact of the Health Insurance Portability and Accountability Act on participant recruitment and retention.

PubMed

Wipke-Tevis, Deidre D; Pickett, Melissa A

2008-02-01

Recruiting and retaining an adequate sample is critical to the success of any research project involving humans. Recent reports indicate that the Health Insurance Portability and Accountability Act (HIPAA) privacy rule has adversely affected research. Few resources are available to help researchers navigate the challenges to recruitment and retention after HIPAA privacy rule implementation. This article addresses obstacles to recruitment in prospective clinical research studies related to the HIPAA privacy rule, as well as HIPAA-compliant strategies to enhance recruitment and retention. Recruitment challenges discussed include evolving interpretations of the HIPAA regulations, inability to directly contact potential participants, complexity of HIPAA-required documents, increased costs of recruitment, and an expanding administrative burden. Among the strategies addressed are preparatory research reviews, using clinical collaborators and staff liaisons, prescreening potential participants, minimizing participant burden during the consent process, enhancing participant follow-up, facilitating recruitment for future studies, and streamlining compliance training for staff.

Health Insurance Enrollment and Availability of Medications for Substance Use Disorders.

PubMed

Abraham, Amanda J; Rieckmann, Traci; Andrews, Christina M; Jayawardhana, Jayani

2017-01-01

Medications for treatment of substance use disorders are underutilized in treatment programs in the United States. Little is known about how insurance enrollment within states affects treatment program decisions about whether to offer medications. The primary objective of the study was to examine the impact of health insurance enrollment on availability of substance use disorder medications among treatment programs. Data from the 2012 National Survey of Substance Abuse Treatment Services, National Survey on Drug Use and Health, American Community Survey, Area Health Resource File, and the Substance Abuse and Mental Health Services Administration were combined to examine the impact of state insurance enrollment on availability of substance use disorder medications in treatment programs (N=9,888). A two-level, random-intercept logistic regression model was estimated to account for potential unobserved heterogeneity among treatment programs nested in states. The percentage of state residents with employer-based insurance and Medicaid was associated with greater odds of offering at least one medication among treatment programs. A 5% increase in the rate of private insurance enrollment was associated with a 7.7% increase in the probability of offering at least one medication, and a 5% increase in the rate of state Medicaid enrollment was associated with a 9.3% increase in the probability of offering at least one medication. Results point to the potential significance of health insurance enrollment in shaping the availability of substance use disorder medications. Significant expansions in health insurance enrollment spurred by the Affordable Care Act have the potential to increase access to medications for many Americans.

Guaranteed renewability and the problem of risk variation in individual health insurance markets.

PubMed

Patel, Vip; Pauly, Mark V

2002-01-01

Consumers should be protected against fluctuations in premiums for private individual health insurance associated with the onset of high-cost chronic conditions. The most commonly discussed way to do so is through community rating, which provides protection but can require a heavy regulatory burden and can create incentives for adverse selection and cream skimming. This paper describes an alternative method of providing the same type of protection: insurance contract provisions that guarantee renewability for the next coverage period at class-average rates. Drawing on recent work in insurance theory, the paper shows that such protection is feasible in competitive insurance markets. Guaranteed renewability, which is required of all individual health insurance by the Health Insurance Portability and Accountability Act (HIPAA) of 1996, is incomplete because the law fails to require that premiums be the same for all insured persons in a rating class. However, the paper reports the results of a recent survey of state insurance regulation, which indicates that all but three state insurance departments report having such a requirement. The paper concludes with a discussion of possible threats to the protection guaranteed renewability provides against risk segmentation.

Employment-based health insurance: a look at tax issues and public opinion.

PubMed

Fronstin, P

1999-07-01

This Issue Brief provides background information on the employment-based health insurance system and its alternatives. The report discusses the advantages and disadvantages of the current employment-based health insurance system, the current tax treatment of health insurance, and the strength and weaknesses of recent proposals to introduce tax credits. It presents findings from the public opinion survey conducted by the Employee Benefit Research Institute on public attitudes toward health insurance and summarizes recent research on the effects of tax changes on employment-based health benefits and the uninsured. Employment-based health plans are the most common source of health insurance among nonelderly individuals in the United States, providing coverage to nearly two-thirds of this population in 1997. Health insurance is probably the benefit most used and valued by workers and their families. Sixty-four percent of respondents to a recent survey rated employment-based health insurance benefits as the most important benefit. Despite essentially five years of very low health care cost increases and the recent increase in the percentage of Americans with employment-based health insurance coverage, the uninsured population has continued to rise. This has resulted in a new interest among policymakers in finding ways to reverse this trend. One question that continues to be asked is whether the employment-based health insurance system is the appropriate mechanism for expanding health insurance to the uninsured. Employment-based health plans are popular because they offer many advantages over other forms of health insurance and types of delivery systems. However, there are also potential drawbacks to the employment-based system. The advantages include reduced risk of adverse selection, group-purchasing efficiencies, employers acting as a workers' advocate, delivery innovation, and health care quality. The disadvantages include an unfair tax treatment, lack of portability

Tobacco Surcharges on 2015 Health Insurance Plans Sold in Federally Facilitated Marketplaces: Variations by Age and Geography and Implications for Health Equity.

PubMed

Liber, Alex C; Drope, Jeffrey M; Graetz, Ilana; Waters, Teresa M; Kaplan, Cameron M

2015-11-01

In 2014, few health insurance plans sold in the Affordable Care Act's Federally Facilitated Marketplaces had age-dependent tobacco surcharges, possibly because of a system glitch. The 2015 tobacco surcharges show wide variation, with more plans implementing tobacco surcharges that increase with age. This underscores concerns that older tobacco users will find postsubsidy health insurance premiums difficult to afford. Future monitoring of enrollment will determine whether tobacco surcharges cause adverse selection by dissuading tobacco users, particularly older users, from buying health insurance.

Rents From the Essential Health Benefits Mandate of Health Insurance Reform.

PubMed

Mendoza, Roger Lee

2015-01-01

The essential health benefits mandate constitutes one of the most controversial health care reforms introduced under the U.S. Affordable Care Act of 2010. It bears important theoretical and practical implications for health care risk and insurance management. These essential health benefits are examined in this study from a rent-seeking perspective, particularly in terms of three interrelated questions: Is there an economic rationale for standardized, minimum health care coverage? How is the scope of essential health services and treatments determined? What are the attendant and incidental costs and benefits of such determination/s? Rents offer ample incentives to business interests to expend considerable resources for health care marketing, particularly when policy processes are open to contestation. Welfare losses inevitably arise from these incentives. We rely on five case studies to illustrate why and how rents are created, assigned, extracted, and dissipated in equilibrium. We also demonstrate why rents depend on persuasive marketing and the bargained decisions of regulators and rentiers, as conditioned by the Tullock paradox. Insights on the intertwining issues of consumer choice, health care marketing, and insurance reform are offered by way of conclusion.

One-fifth of nonelderly Californians do not have access to job-based health insurance coverage.

PubMed

Lavarreda, Shana Alex; Cabezas, Livier

2010-11-01

Lack of job-based health insurance does not affect just workers, but entire families who depend on job-based coverage for their health care. This policy brief shows that in 2007 one-fifth of all Californians ages 0-64 who lived in households where at least one family member was employed did not have access to job-based coverage. Among adults with no access to job-based coverage through their own or a spouse's job, nearly two-thirds remained uninsured. In contrast, the majority of children with no access to health insurance through a parent obtained public health insurance, highlighting the importance of such programs. Low-income, Latino and small business employees were more likely to have no access to job-based insurance. Provisions enacted under national health care reform (the Patient Protection and Affordable Care Act of 2010) will aid some of these populations in accessing health insurance coverage.

Diabetes in employer-sponsored health insurance.

PubMed

Peele, Pamela B; Lave, Judith R; Songer, Thomas J

2002-11-01

To examine medical and mental health care expenditures for large numbers of individuals with diabetes enrolled in employment-sponsored insurance plans. Health insurance billing data for approximately 1.3 million individuals enrolled in health insurance plans sponsored by 862 large self-insured employers nationwide were used to examine employer expenditures and consumer out-of-pocket payments for 20,937 people identified with diabetes. These expenditures were compared with expenditures for individuals with other chronic illnesses. Main outcome measures were covered charges, insurance plan reimbursements, and estimated consumer out-of-pocket payments for both medical and mental health services. A total of 1.7% of enrollees were identified as having diabetes and approximately 11% of those used at least one mental health service during 1996. Health care expenditures were three times higher for those with diabetes compared with all health care consumers in these insurance plans, but when compared with individuals with other chronic illnesses such as heart disease, HIV/AIDS, cancer, and asthma, those with diabetes were not more expensive for employers' insurance plans. Diabetes accounts for 6.5% of total health plan expenditures. Diabetes is not more expensive for either consumers or their employer-sponsored insurance plans than other chronic illnesses.

Health insurance coverage and use of family planning services among current and former foster youth: implications of the health care reform law.

PubMed

Dworsky, Amy; Ahrens, Kym; Courtney, Mark

2013-04-01

This research uses data from a longitudinal study to examine how two provisions in the Patient Protection and Affordable Care Act could affect health insurance coverage among young women who have aged out of foster care. It also explores how allowing young people to remain in foster care until age twenty-one affects their health insurance coverage, use of family planning services, and information about birth control. We find that young women are more likely to have health insurance if they remain in foster care until their twenty-first birthday and that having health insurance is associated with an increase in the likelihood of receiving family planning services. Our results also suggest that many young women who would otherwise lack health insurance after aging out of foster care will be eligible for Medicaid under the health care reform law. Because having health insurance is associated with use of family planning services, this increase in Medicaid eligibility may result in fewer unintended pregnancies among this high-risk population.

Private health insurance: implications for developing countries.

PubMed

Sekhri, Neelam; Savedoff, William

2005-02-01

Private health insurance is playing an increasing role in both high- and low-income countries, yet is poorly understood by researchers and policy-makers. This paper shows that the distinction between private and public health insurance is often exaggerated since well regulated private insurance markets share many features with public insurance systems. It notes that private health insurance preceded many modern social insurance systems in western Europe, allowing these countries to develop the mechanisms, institutions and capacities that subsequently made it possible to provide universal access to health care. We also review international experiences with private insurance, demonstrating that its role is not restricted to any particular region or level of national income. The seven countries that finance more than 20% of their health care via private health insurance are Brazil, Chile, Namibia, South Africa, the United States, Uruguay and Zimbabwe. In each case, private health insurance provides primary financial protection for workers and their families while public health-care funds are targeted to programmes covering poor and vulnerable populations. We make recommendations for policy in developing countries, arguing that private health insurance cannot be ignored. Instead, it can be harnessed to serve the public interest if governments implement effective regulations and focus public funds on programmes for those who are poor and vulnerable. It can also be used as a transitional form of health insurance to develop experience with insurance institutions while the public sector increases its own capacity to manage and finance health-care coverage.

Building public trust in uses of Health Insurance Portability and Accountability Act de-identified data.

PubMed

McGraw, Deven

2013-01-01

The aim of this paper is to summarize concerns with the de-identification standard and methodologies established under the Health Insurance Portability and Accountability Act (HIPAA) regulations, and report some potential policies to address those concerns that were discussed at a recent workshop attended by industry, consumer, academic and research stakeholders. The target audience includes researchers, industry stakeholders, policy makers and consumer advocates concerned about preserving the ability to use HIPAA de-identified data for a range of important secondary uses. HIPAA sets forth methodologies for de-identifying health data; once such data are de-identified, they are no longer subject to HIPAA regulations and can be used for any purpose. Concerns have been raised about the sufficiency of HIPAA de-identification methodologies, the lack of legal accountability for unauthorized re-identification of de-identified data, and insufficient public transparency about de-identified data uses. Although there is little published evidence of the re-identification of properly de-identified datasets, such concerns appear to be increasing. This article discusses policy proposals intended to address de-identification concerns while maintaining de-identification as an effective tool for protecting privacy and preserving the ability to leverage health data for secondary purposes.

Expenditures and use of wraparound health insurance for employed people with disabilities.

PubMed

Gettens, John; Hoffman, Denise; Henry, Alexis D

2016-04-01

The Affordable Care Act (ACA) provides health insurance to many working-age adults with disabilities, but we do not expect the new coverage or existing insurance options to fully meet their employment-related health care needs. Wraparound services have the potential to foster employment among people with disabilities. We use Massachusetts, which implemented health care reform in 2006, as a case study to estimate the wraparound health care expenditures and use for workers with disabilities. We identified a group of employed, working-age people with disabilities whose primary health insurance is Medicare or private insurance and who use the Medicaid Buy-In Program for wraparound coverage. We analyzed claims to estimate expenditures and use. Wraparound expenditures averaged $427 per member per month. Community-based services for both mental and non-mental health, which are generally not covered by Medicare or private insurance, accounted for 63% of all expenditures. The number who used community-based services was low, but the expenditures were high. The majority of the remaining expenditures were for services usually covered by primary insurance including: inpatient and outpatient, pharmacy and professional services. Expenditures were higher for people with Medicare compared to private insurance. This case study suggests that, from a total program cost perspective, wraparound demand is greatest for community-based services. From a member utilization perspective, the demand is greatest for coverage that alleviates out-of-pocket costs for services provided by primary insurance. Additional analysis is needed to further assess the design options for wraparound programs and their feasibility. Copyright © 2016 Elsevier Inc. All rights reserved.

An early look at changes in employer-sponsored insurance under the Affordable Care Act.

PubMed

Blavin, Fredric; Shartzer, Adele; Long, Sharon K; Holahan, John

2015-01-01

Critics frequently characterize the Affordable Care Act (ACA) as a threat to the survival of employer-sponsored insurance. The Medicaid expansion and Marketplace subsidies could adversely affect employers' incentives to offer health insurance and workers' incentives to take up such offers. This article takes advantage of timely data from the Health Reform Monitoring Survey for June 2013 through September 2014 to examine, from the perspective of workers, early changes in offer, take-up, and coverage rates for employer-sponsored insurance under the ACA. We found no evidence that any of these rates have declined under the ACA. They have, in fact, remained constant: around 82 percent, 86 percent, and 71 percent, respectively, for all workers and around 63 percent, 71 percent, and 45 percent, respectively, for low-income workers. To date, the ACA has had no effect on employer coverage. Economic incentives for workers to obtain coverage from employers remain strong. Project HOPE—The People-to-People Health Foundation, Inc.

Patient Protection and Affordable Care Act; exchange and insurance market standards for 2015 and beyond. Final rule.

PubMed

2014-05-27

This final rule addresses various requirements applicable to health insurance issuers, Affordable Insurance Exchanges (``Exchanges''), Navigators, non-Navigator assistance personnel, and other entities under the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act). Specifically, the rule establishes standards related to product discontinuation and renewal, quality reporting, non-discrimination standards, minimum certification standards and responsibilities of qualified health plan (QHP) issuers, the Small Business Health Options Program, and enforcement remedies in Federally-facilitated Exchanges. It also finalizes: A modification of HHS's allocation of reinsurance collections if those collections do not meet our projections; certain changes to allowable administrative expenses in the risk corridors calculation; modifications to the way we calculate the annual limit on cost sharing so that we round this parameter down to the nearest $50 increment; an approach to index the required contribution used to determine eligibility for an exemption from the shared responsibility payment under section 5000A of the Internal Revenue Code; grounds for imposing civil money penalties on persons who provide false or fraudulent information to the Exchange and on persons who improperly use or disclose information; updated standards for the consumer assistance programs; standards related to the opt-out provisions for self-funded, non-Federal governmental plans and related to the individual market provisions under the Health Insurance Portability and Accountability Act of 1996 including excepted benefits; standards regarding how enrollees may request access to non-formulary drugs under exigent circumstances; amendments to Exchange appeals standards and coverage enrollment and termination standards; and time-limited adjustments to the standards relating to the medical loss ratio

Private health insurance: implications for developing countries.

PubMed Central

Sekhri, Neelam; Savedoff, William

2005-01-01

Private health insurance is playing an increasing role in both high- and low-income countries, yet is poorly understood by researchers and policy-makers. This paper shows that the distinction between private and public health insurance is often exaggerated since well regulated private insurance markets share many features with public insurance systems. It notes that private health insurance preceded many modern social insurance systems in western Europe, allowing these countries to develop the mechanisms, institutions and capacities that subsequently made it possible to provide universal access to health care. We also review international experiences with private insurance, demonstrating that its role is not restricted to any particular region or level of national income. The seven countries that finance more than 20% of their health care via private health insurance are Brazil, Chile, Namibia, South Africa, the United States, Uruguay and Zimbabwe. In each case, private health insurance provides primary financial protection for workers and their families while public health-care funds are targeted to programmes covering poor and vulnerable populations. We make recommendations for policy in developing countries, arguing that private health insurance cannot be ignored. Instead, it can be harnessed to serve the public interest if governments implement effective regulations and focus public funds on programmes for those who are poor and vulnerable. It can also be used as a transitional form of health insurance to develop experience with insurance institutions while the public sector increases its own capacity to manage and finance health-care coverage. PMID:15744405

The association of generation status and health insurance among U.S. children.

PubMed

BeLue, Rhonda; Miranda, Patricia Y; Elewonibi, Bilikisu Reni; Hillemeier, Marianne M

2014-08-01

The Patient Protection and Affordable Care Act (ACA) has the potential to reduce the number of uninsured children in the United States by as much as 40%. The extent to which immigrant families are aware of and interested in obtaining insurance for their children is unclear. Data from the 2011-2012 National Survey of Children's Health were analyzed to examine differences by immigrant generational status in awareness of children's health insurance options. Adjusted odds ratios (AORs) were calculated for each outcome variable that showed statistical significance by generation status. Barriers to obtaining insurance for children in immigrant (first- and second-generation) families include awareness of and experience with various health insurance options, perceived costs and benefits of insurance, structural/policy restrictions on eligibility, and lower likelihood of working in large organizations that offer employee insurance coverage. Although noncitizen immigrants are not covered by ACA insurance expansions, only 38% of first-generation families report being uninsured because of the inability to meet citizenship requirements. Most families in this sample also worked for employers with <50 employees, making them less likely to benefit from expansions in employer-based insurance. In multivariate analyses, third-generation families have increased odds of knowing how to enroll in health insurance (AOR 7.1 [3.6-13.0]) and knowing where to find insurance information (AOR 7.7 [3.8-15.4]) compared with first-generation families. ACA navigators and health services professionals should be aware of potential unique challenges to helping immigrant families negotiate Medicaid expansions and state and federal exchanges. Copyright © 2014 by the American Academy of Pediatrics.

Employer contribution and premium growth in health insurance.

PubMed

Liu, Yiyan; Jin, Ginger Zhe

2015-01-01

We study whether employer premium contribution schemes could impact the pricing behavior of health plans and contribute to rising premiums. Using 1991-2011 data before and after a 1999 premium subsidy policy change in the Federal Employees Health Benefits Program (FEHBP), we find that the employer premium contribution scheme has a differential impact on health plan pricing based on two market incentives: 1) consumers are less price sensitive when they only need to pay part of the premium increase, and 2) each health plan has an incentive to increase the employer's premium contribution to that plan. Both incentives are found to contribute to premium growth. Counterfactual simulation shows that average premium would have been 10% less than observed and the federal government would have saved 15% per year on its premium contribution had the subsidy policy change not occurred in the FEHBP. We discuss the potential of similar incentives in other government-subsidized insurance systems such as the Medicare Part D and the Health Insurance Marketplace under the Affordable Care Act. Copyright © 2014 Elsevier B.V. All rights reserved.

iPad integration in plastic surgical training: optimizing clinical efficiency, education, and compliance with the health insurance portability and accountability act.

PubMed

Gerstle, Theodore; Hassanein, Aladdin H; Eriksson, Elof

2015-01-01

The authors share their experience with the issuance of iPads to all residents, faculty, and physician extenders in their plastic surgical division. They found that these devices (1) optimized compliance with the Health Insurance Portability and Accountability Act by eliminating the use of paper service lists; (2) improved clinical efficiency; and (3) promoted resident education. They believe the use of these devices in residency is cost-effective when considering mitigating patient privacy risk and enriching educational value.

The Affordable Care Act and health insurance exchanges: effects on the pediatric dental benefit.

PubMed

Orynich, C Ashley; Casamassimo, Paul S; Seale, N Sue; Reggiardo, Paul; Litch, C Scott

2015-01-01

To examine the relationship between state health insurance Exchange selection and pediatric dental benefit design, regulation and cost. Medical and dental plans were analyzed across three types of state health insurance Exchanges: State-based (SB), State-partnered (SP), and Federally-facilitated (FF). Cost-analysis was completed for 10,427 insurance plans, and health policy expert interviews were conducted. One-way ANOVA compared the cost-sharing structure of stand-alone dental plans (SADP). T-test statistics compared differences in average total monthly pediatric premium costs. No causal relationships were identified between Exchange selection and the pediatric dental benefit's design, regulation or cost. Pediatric medical and dental coverage offered through the embedded plan design exhibited comparable average total monthly premium costs to aggregate cost estimates for the separately purchased SADP and traditional medical plan (P=0.11). Plan designs and regulatory policies demonstrated greater correlation between the SP and FF Exchanges, as compared to the SB Exchange. Parameters defining the pediatric dental benefit are complex and vary across states. Each state Exchange was subject to barriers in improving the quality of the pediatric dental benefit due to a lack of defined, standardized policy parameters and further legislative maturation is required.

Insuring the uninsured: potential impact of Health Care Reform Act of 2010 on trauma centers.

PubMed

Shafi, Shahid; Ogola, Gerald; Fleming, Neil; Rayan, Nadine; Kudyakov, Rustam; Barnes, Sunni A; Ballard, David J

2012-11-01

Viability of trauma centers is threatened by cost of care provided to patients without health insurance. The health care reform of 2010 is likely to benefit trauma centers by mandating universal health insurance by 2014. However, the financial benefit of this mandate will depend on the reimbursement provided. The study hypothesis was that compensation for the care of uninsured trauma patients at Medicare or Medicaid rates will lead to continuing losses for trauma centers. Financial data for first hospitalization were obtained from an urban Level I trauma center for 3 years (n = 6,630; 2006-2008) and linked with clinical information. Patients were grouped into five payments categories: commercial (29%), Medicaid (8%), Medicare (20%), workers' compensation (6%), and uninsured (37%). Prediction models for costs and payments were developed for each category using multiple regression models, adjusting for patient demographics, injury characteristics, complications, and survival. These models were used to predict payments that could be expected if uninsured patients were covered by different insurance types. Results are reported as net margin per patient (payments minus total costs) for each insurance type, with 95% confidence intervals, discounted to 2008 dollar values. Patients were typical for an urban trauma center (median age of 43 years, 66% men, 82% blunt, 5% mortality, and median length of stay 4 days). Overall, the trauma center lost $5,655 per patient, totaling $37.5 million over 3 years. These losses were encountered for patients without insurance ($14,343), Medicare ($4,838), and Medicaid ($15,740). Patients with commercial insurance were profitable ($5,295) as were those with workers' compensation ($6,860). Payments for the care of the uninsured at Medicare/Medicaid levels would lead to continued losses at $2,267 to $4,143 per patient. The health care reforms of 2010 would lead to continued losses for trauma centers if uninsured are covered with Medicare

Uninsured veterans who will need to obtain insurance coverage under the patient protection and affordable care act.

PubMed

Tsai, Jack; Rosenheck, Robert

2014-03-01

We examined the number and clinical needs of uninsured veterans, including those who will be eligible for the Medicaid expansion and health insurance exchanges in 2014. We analyzed weighted data for 8710 veterans from the 2010 National Survey of Veterans, classifying it by veterans' age, income, household size, and insurance status. Of 22 million veterans, about 7%, or more than 1.5 million, were uninsured and will need to obtain coverage by enrolling in US Department of Veterans Affairs (VA) care or the Medicaid expansion or by participating in the health insurance exchanges. Of those uninsured, 55%, or more than 800 000, are likely eligible for the Medicaid expansion if states implement it. Compared with veterans with any health coverage, those who were uninsured were younger and more likely to be single, Black, and low income and to have been deployed to Iraq and Afghanistan. The Patient Protection and Affordable Care Act is likely to have a considerable impact on uninsured veterans, which may have implications for the VA, the Medicaid expansion, and the health insurance exchanges.

Gain in Insurance Coverage and Residual Uninsurance Under the Affordable Care Act: Texas, 2013-2016.

PubMed

Pickett, Stephen; Marks, Elena; Ho, Vivian

2017-01-01

To examine the effects of the Affordable Care Act's (ACA's) Marketplace on Texas residents and determine which population subgroups benefited the most and which the least. We analyzed insurance coverage rates among nonelderly Texas adults using the Health Reform Monitoring Survey-Texas from September 2013, just before the first open enrollment period in the Marketplace, through March 2016. Texas has experienced a roughly 6-percentage-point increase in insurance coverage (from 74.7% to 80.6%; P = .012) after implementation of the major insurance provisions of the ACA. The 4 subgroups with the largest increases in adjusted insurance coverage between 2013 and 2016 were persons aged 50 to 64 years (12.1 percentage points; P = .002), Hispanics (10.9 percentage points; P = .002), persons reporting fair or poor health status (10.2 percentage points; P = .038), and those with a high school diploma as their highest educational attainment (9.2 percentage points; P = .023). Many population subgroups have benefited from the ACA's Marketplace, but approximately 3 million Texas residents still lack health coverage. Adopting the ACA's Medicaid expansion is a means to address the lack of coverage.

Effects of ACA Medicaid Expansions on Health Insurance Coverage and Labor Supply.

PubMed

Kaestner, Robert; Garrett, Bowen; Chen, Jiajia; Gangopadhyaya, Anuj; Fleming, Caitlyn

We examined the effect of the expansion of Medicaid eligibility under the Affordable Care Act on health insurance coverage and labor supply of low-educated and low-income adults. We found that the Medicaid expansions were associated with large increases in Medicaid coverage, for example, 50 percent among childless adults, and corresponding decreases in the proportion uninsured. There was relatively little change in private insurance coverage, although the expansions tended to decrease such coverage slightly. In terms of labor supply, estimates indicated that the Medicaid expansions had little effect on work effort despite the substantial changes in health insurance coverage. Most estimates suggested that the expansions increased work effort, although not significantly.

Assessing Alternative Modifications to the Affordable Care Act: Impact on Individual Market Premiums and Insurance Coverage.

PubMed

Eibner, Christine; Saltzman, Evan

2015-03-20

The goals of the Affordable Care Act (ACA) are to enable all legal U.S. residents to have access to affordable health insurance and to prevent sicker individuals (such as those with preexisting conditions) from being priced out of the market. The ACA also instituted several policies to stabilize premiums and to encourage enrollment among healthy individuals of all ages. The law's tax credits and cost-sharing subsidies offer a "carrot" that may encourage enrollment among some young and healthy individuals who would otherwise remain uninsured, while the individual mandate acts as a "stick" by imposing penalties on individuals who choose not to enroll. In this article, the authors use the COMPARE microsimulation model, an analytic tool that uses economic theory and data to predict the effects of health policy reforms, to estimate how eliminating the ACA's individual mandate, eliminating the law's tax credits, and combined scenarios that change these and other provisions of the act might affect 2015 individual market premiums and overall insurance coverage. Underlying these estimates is a COMPARE-based analysis of how premiums and insurance coverage outcomes depend on young adults' propensity to enroll in insurance coverage. The authors find that eliminating the ACA's tax credits and eliminating the individual mandate both increase premiums and reduce enrollment on the individual market. They also find that these key features of the ACA help to protect against adverse selection and stabilize the market by encouraging healthy people to enroll and, in the case of the tax credit, shielding subsidized enrollees from premium increases. Further, they find that individual market premiums are only modestly sensitive to young adults' propensity to enroll in insurance coverage, and ensuring market stability does not require that young adults make up a particular share of enrollees.

41 CFR 60-300.25 - Health insurance, life insurance and other benefit plans.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 1 2010-07-01 2010-07-01 true Health insurance, life... VETERANS, AND ARMED FORCES SERVICE MEDAL VETERANS Discrimination Prohibited § 60-300.25 Health insurance, life insurance and other benefit plans. (a) An insurer, hospital, or medical service company, health...

41 CFR 60-250.25 - Health insurance, life insurance and other benefit plans.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 1 2010-07-01 2010-07-01 true Health insurance, life... SEPARATED VETERANS, AND OTHER PROTECTED VETERANS Discrimination Prohibited § 60-250.25 Health insurance, life insurance and other benefit plans. (a) An insurer, hospital, or medical service company, health...

Federal enforcement in group and individual health insurance markets. Final rule.

PubMed

2005-11-25

This rule makes final an interim final rule that details procedures we use for enforcing title XXVII of the Public Health Service Act as added by the Health Insurance Portability and Accountability Act of 1996, and as amended by the Mental Health Parity Act of 1996, the Newborns' and Mothers' Health Protection Act of 1996, and the Women's Health and Cancer Rights Act of 1998. Specifically, we are responsible for enforcing title XXVII requirements in States that do not enact the legislation necessary to enforce those requirements, or otherwise fail to substantially enforce the requirements. We are also responsible for taking enforcement actions against non-Federal governmental plans. The regulation describes the process we use in both enforcement contexts. This final rule deletes an appendix to the interim rule that listed examples of violations of title XXVII and corrects the description of a cross-reference, but makes no substantive changes to the interim final rule.

Risk segmentation in Chilean social health insurance.

PubMed

Hidalgo, Hector; Chipulu, Maxwell; Ojiako, Udechukwu

2013-01-01

The objective of this study is to identify how risk and social variables are likely to be impacted by an increase in private sector participation in health insurance provision. The study focuses on the Chilean health insurance industry, traditionally dominated by the public sector. Predictive risk modelling is conducted using a database containing over 250,000 health insurance policy records provided by the Superintendence of Health of Chile. Although perceived with suspicion in some circles, risk segmentation serves as a rational approach to risk management from a resource perspective. The variables that have considerable impact on insurance claims include the number of dependents, gender, wages and the duration a claimant has been a customer. As shown in the case study, to ensure that social benefits are realised, increased private sector participation in health insurance must be augmented by regulatory oversight and vigilance. As it is clear that a "community-rated" health insurance provision philosophy impacts on insurance firm's ability to charge "market" prices for insurance provision, the authors explore whether risk segmentation is a feasible means of predicting insurance claim behaviour in Chile's private health insurance industry.

Health insurance and health services utilization in Ireland.

PubMed

Harmon, C; Nolan, B

2001-03-01

The numbers buying private health insurance in Ireland have continued to grow, despite a broadening in entitlement to public care. About 40% of the population now have insurance, although everyone has entitlement to public hospital care. In this paper, we examine in detail the growth in insurance coverage and the factors underlying the demand for insurance. Attitudinal responses reveal the importance of perceptions about waiting times for public care, as well as some concerns about the quality of that care. Individual characteristics, such as education, age, gender, marital status, family composition and income all influence the probability of purchasing private insurance. We also examine the relationship between insurance and utilization of hospital in-patient services. The positive effect of private insurance appears less than that of entitlement to full free health care from the state, although the latter is means-tested, and may partly represent health status. Copyright 2001 John Wiley & Sons, Ltd.

Why not private health insurance? 1. Insurance made easy

PubMed Central

Deber, R; Gildiner, A; Baranek, P

1999-01-01

How realistic are proposals to expand the financing of Canadian health care through private insurance, either in a parallel stream or an expanded supplementary tier? Any successful business requires that revenues exceed expenditures. Under a voluntary health insurance plan those at highest risk would be the most likely to seek coverage; insurers working within a competitive market would have to limit their financial risk through such mechanisms as "risk selection" to avoid clients likely to incur high costs and/or imposing caps on the costs covered. It is unlikely that parallel private plans will have a market if a comprehensive public insurance system continues to exist and function well. Although supplementary plans are more congruous with insurance principles, they would raise costs for purchasers and would probably not provide full open-ended coverage to all potential clients. Insurance principles suggest that voluntary insurance plans that shift costs to the private sector would damage the publicly funded system and would be unable to cover costs for all services required. PMID:10497613

Regulating self-selection into private health insurance in Chile and the United States.

PubMed

Vargas Bustamante, Arturo; Méndez, Claudio A

2016-07-01

In the 1980s, Chile adopted a mixed (public and private) model for health insurance coverage similar to the one recently outlined by the Affordable Care Act in the United States (US). In such a system, a mix of public and private health plans offer nearly universal coverage using a combined approach of managed competition and subsidies for low-income individuals. This paper uses a "most different" case study design to compare policies implemented in Chile and the US to address self-selection into private insurance. We argue that the implementation of a mixed health insurance system in Chile without the appropriate regulations was complex, and it generated a series of inequities and perverse incentives. The comparison of Chile and the US healthcare reforms examines the different approaches that both countries have used to manage economic competition, address health insurance self-selection and promote solidarity. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

The German Statutory Health Insurance Program.

ERIC Educational Resources Information Center

Stassen, Manfred

1993-01-01

Describes the German health insurance system which is mandatory for nearly all German citizens. Explains that, along with pension, accident, and unemployment insurance, health insurance is one of four pillars of the German national social security system. Asserts that controlling costs while maintaining high health care standards is a national…

Maintaining health insurance during a recession: likely COBRA eligibility: an updated analysis using the Commonwealth Fund 2007 Biennial Health Insurance Survey.

PubMed

Doty, Michelle; Rustgi, Sheila D; Schoen, Cathy; Collins, Sara R

2009-01-01

As the U.S. economic downturn continues and job losses mount, more working Americans are likely to lose access to affordable health benefits subsidized by their employers. Analysis of the 2007 Commonwealth Fund Biennial Health Insurance Survey finds that two of three working adults would be eligible to extend job-based coverage, under the 1985 Consolidated Omnibus Budget Reconciliation Act (COBRA) if they became unemployed. Under COBRA, however, unemployed workers would have to pay four to six times their current contribution at a time of sharply reduced income. In fact, the latest national figures indicate that, because of high premiums, only 9 percent of unemployed workers have COBRA coverage. Substantial financial assistance of 75 percent to 85 percent of premiums could help laid-off workers maintain coverage. In addition, expansion of Medicaid and the State Children's Health Insurance Program would benefit low-income, laid-off workers and their families who are ineligible for COBRA.

75 FR 24470 - Health Care Reform Insurance Web Portal Requirements

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-05

... Health Care Reform Insurance Web Portal Requirements AGENCY: Office of the Secretary, HHS. ACTION... Affordable Care Act) was enacted on March 23, 2010. It requires the establishment of an internet Web site (hereinafter referred to as a Web portal) through which individuals and small businesses can obtain information...

Disparities in Insurance Coverage, Health Services Use, and Access Following Implementation of the Affordable Care Act: A Comparison of Disabled and Nondisabled Working-Age Adults

PubMed Central

Kennedy, Jae; Wood, Elizabeth Geneva; Frieden, Lex

2017-01-01

The objective of this study was to assess trends in health insurance coverage, health service utilization, and health care access among working-age adults with and without disabilities before and after full implementation of the Affordable Care Act (ACA), and to identify current disability-based disparities following full implementation of the ACA. The ACA was expected to have a disproportionate impact on working-age adults with disabilities, because of their high health care usage as well as their previously limited insurance options. However, most published research on this population does not systematically look at effects before and after full implementation of the ACA. As the US Congress considers new health policy reforms, current and accurate data on this vulnerable population are essential. Weighted estimates, trend analyses and analytic models were conducted using the 1998-2016 National Health Interview Surveys (NHIS) and the 2014 Medical Expenditure Panel Survey. Compared with working-age adults without disabilities, those with disabilities are less likely to work, more likely to earn below the federal poverty level, and more likely to use public insurance. Average health costs for this population are 3 to 7 times higher, and access problems are far more common. Repeal of key features of the ACA, like Medicaid expansion and marketplace subsidies, would likely diminish health care access for working-age adults with disabilities. PMID:29166812

Disparities in Insurance Coverage, Health Services Use, and Access Following Implementation of the Affordable Care Act: A Comparison of Disabled and Nondisabled Working-Age Adults.

PubMed

Kennedy, Jae; Wood, Elizabeth Geneva; Frieden, Lex

2017-01-01

The objective of this study was to assess trends in health insurance coverage, health service utilization, and health care access among working-age adults with and without disabilities before and after full implementation of the Affordable Care Act (ACA), and to identify current disability-based disparities following full implementation of the ACA. The ACA was expected to have a disproportionate impact on working-age adults with disabilities, because of their high health care usage as well as their previously limited insurance options. However, most published research on this population does not systematically look at effects before and after full implementation of the ACA. As the US Congress considers new health policy reforms, current and accurate data on this vulnerable population are essential. Weighted estimates, trend analyses and analytic models were conducted using the 1998-2016 National Health Interview Surveys (NHIS) and the 2014 Medical Expenditure Panel Survey. Compared with working-age adults without disabilities, those with disabilities are less likely to work, more likely to earn below the federal poverty level, and more likely to use public insurance. Average health costs for this population are 3 to 7 times higher, and access problems are far more common. Repeal of key features of the ACA, like Medicaid expansion and marketplace subsidies, would likely diminish health care access for working-age adults with disabilities.

Health insurance coverage and healthcare utilization among homeless young adults in Venice, CA

PubMed Central

Winetrobe, H.; Rice, E.; Rhoades, H.; Milburn, N.

2016-01-01

Background Homeless young adults are a vulnerable population with great healthcare needs. Under the Affordable Care Act, homeless young adults are eligible for Medicaid, in some states, including California. This study assesses homeless young adults' health insurance coverage and healthcare utilization prior to Medicaid expansion. Methods All homeless young adults accessing services at a drop-in center in Venice, CA, were invited to complete a self-administered questionnaire; 70% of eligible clients participated (n = 125). Results Within this majority White, heterosexual, male sample, 70% of homeless young adults did not have health insurance in the prior year, and 39% reported their last healthcare visit was at an emergency room. Past year unmet healthcare needs were reported by 31%, and financial cost was the main reported barrier to receiving care. Multivariable logistic regression found that homeless young adults with health insurance were almost 11 times more likely to report past year healthcare utilization. Conclusions Health insurance coverage is the sole variable significantly associated with healthcare utilization among homeless young adults, underlining the importance of insurance coverage within this vulnerable population. Service providers can play an important role by assisting homeless young adults with insurance applications and facilitating connections with regular sources of health care. PMID:25635142

Development of the Health Insurance Literacy Measure (HILM): Conceptualizing and Measuring Consumer Ability to Choose and Use Private Health Insurance

PubMed Central

Paez, Kathryn A.; Mallery, Coretta J.; Noel, HarmoniJoie; Pugliese, Christopher; McSorley, Veronica E.; Lucado, Jennifer L.; Ganachari, Deepa

2014-01-01

Understanding health insurance is central to affording and accessing health care in the United States. Efforts to support consumers in making wise purchasing decisions and using health insurance to their advantage would benefit from the development of a valid and reliable measure to assess health insurance literacy. This article reports on the development of the Health Insurance Literacy Measure (HILM), a self-assessment measure of consumers' ability to select and use private health insurance. The authors developed a conceptual model of health insurance literacy based on formative research and stakeholder guidance. Survey items were drafted using the conceptual model as a guide then tested in two rounds of cognitive interviews. After a field test with 828 respondents, exploratory factor analysis revealed two HILM scales, choosing health insurance and using health insurance, each of which is divided into a confidence subscale and likelihood of behavior subscale. Correlations between the HILM scales and an objective measure of health insurance knowledge and skills were positive and statistically significant which supports the validity of the measure. PMID:25315595

Development of the Health Insurance Literacy Measure (HILM): conceptualizing and measuring consumer ability to choose and use private health insurance.

PubMed

Paez, Kathryn A; Mallery, Coretta J; Noel, HarmoniJoie; Pugliese, Christopher; McSorley, Veronica E; Lucado, Jennifer L; Ganachari, Deepa

2014-01-01

Understanding health insurance is central to affording and accessing health care in the United States. Efforts to support consumers in making wise purchasing decisions and using health insurance to their advantage would benefit from the development of a valid and reliable measure to assess health insurance literacy. This article reports on the development of the Health Insurance Literacy Measure (HILM), a self-assessment measure of consumers' ability to select and use private health insurance. The authors developed a conceptual model of health insurance literacy based on formative research and stakeholder guidance. Survey items were drafted using the conceptual model as a guide then tested in two rounds of cognitive interviews. After a field test with 828 respondents, exploratory factor analysis revealed two HILM scales, choosing health insurance and using health insurance, each of which is divided into a confidence subscale and likelihood of behavior subscale. Correlations between the HILM scales and an objective measure of health insurance knowledge and skills were positive and statistically significant which supports the validity of the measure.

41 CFR 60-741.25 - Health insurance, life insurance and other benefit plans.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 41 Public Contracts and Property Management 1 2010-07-01 2010-07-01 true Health insurance, life insurance and other benefit plans. 60-741.25 Section 60-741.25 Public Contracts and Property Management... Health insurance, life insurance and other benefit plans. (a) An insurer, hospital, or medical service...

Reproductive Health-Care Utilization of Young Adults Insured as Dependents.

PubMed

Andrasfay, Theresa

2018-05-01

The common practice of sending an explanation of benefits to policyholders may inadvertently disclose sensitive services to the parents of dependents, making confidentiality a potential barrier to reproductive health care. This study compares the reproductive health-care utilization of young adult dependents and young adult policyholders using nationally representative data collected after full implementation of the Affordable Care Act. Data from 2,108 young adults aged 18-25 years in the 2015 National Health Interview Survey were analyzed. Logistic regressions predicted utilization of two preventive services (general doctor visit and flu vaccination) and four reproductive health services (HIV testing, obstetrician/gynecologist visit, hormonal contraceptive use, and Pap testing) from the insurance type of the young adult (dependent, privately insured policyholder, or Medicaid). In unadjusted analyses, young adult dependents had lower utilization of HIV tests than their peers who were privately insured or Medicaid policyholders. Young women dependents had lower utilization of Pap tests than young women on Medicaid. Once controls were included, young adult dependents did not have significantly lower odds of obtaining reproductive health care than privately insured policyholders. Dependent young men still had marginally lower odds of ever having an HIV test (adjusted odds ratio = .65, p = .08) and dependent young women still had marginally lower odds of ever having a Pap test (adjusted odds ratio = .58, p = .06) than comparable Medicaid policyholders. Despite confidentiality concerns, young adults insured as dependents have utilization of several reproductive health services similar to that of comparable young adult policyholders. Copyright © 2017 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Health Insurance and Children with Disabilities

ERIC Educational Resources Information Center

Szilagyi, Peter G.

2012-01-01

Few people would disagree that children with disabilities need adequate health insurance. But what kind of health insurance coverage would be optimal for these children? Peter Szilagyi surveys the current state of insurance coverage for children with special health care needs and examines critical aspects of coverage with an eye to helping policy…

Regulated Medicare Advantage And Marketplace Individual Health Insurance Markets Rely On Insurer Competition.

PubMed

Frank, Richard G; McGuire, Thomas G

2017-09-01

Two important individual health insurance markets-Medicare Advantage and the Marketplaces-are tightly regulated but rely on competition among insurers to supply and price health insurance products. Many local health insurance markets have little competition, which increases prices to consumers. Furthermore, both markets are highly subsidized in ways that can exacerbate the impact of market power-that is, the ability to set price above cost-on health insurance prices. Policy makers need to foster robust competition in both sectors and avoid designing subsidies that make the market-power problem worse. Project HOPE—The People-to-People Health Foundation, Inc.

A political history of federal mental health and addiction insurance parity.

PubMed

Barry, Colleen L; Huskamp, Haiden A; Goldman, Howard H

2010-09-01

This article chronicles the political history of efforts by the U.S. Congress to enact a law requiring "parity" for mental health and addiction benefits and medical/surgical benefits in private health insurance. The goal of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity (MHPAE) Act of 2008 is to eliminate differences in insurance coverage for behavioral health. Mental health and addiction treatment advocates have long viewed parity as a means of increasing fairness in the insurance market, whereas employers and insurers have opposed it because of concerns about its cost. The passage of this law is viewed as a legislative success by both consumer and provider advocates and the employer and insurance groups that fought against it for decades. Twenty-nine structured interviews were conducted with key informants in the federal parity debate, including members of Congress and their staff; lobbyists for consumer, provider, employer, and insurance groups; and other key contacts. Historical documentation, academic research on the effects of parity regulations, and public comment letters submitted to the U.S. Departments of Labor, Health and Human Services, and Treasury before the release of federal guidance also were examined. Three factors were instrumental to the passage of this law: the emergence of new evidence regarding the costs of parity, personal experience with mental illness and addiction, and the political strategies adopted by congressional champions in the Senate and House of Representatives. Challenges to implementing the federal parity policy warrant further consideration. This law raises new questions about the future direction of federal policymaking on behavioral health. © 2010 Milbank Memorial Fund. Published by Wiley Periodicals Inc.

A Political History of Federal Mental Health and Addiction Insurance Parity

PubMed Central

Barry, Colleen L; Huskamp, Haiden A; Goldman, Howard H

2010-01-01

Context: This article chronicles the political history of efforts by the U.S. Congress to enact a law requiring “parity” for mental health and addiction benefits and medical/surgical benefits in private health insurance. The goal of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity (MHPAE) Act of 2008 is to eliminate differences in insurance coverage for behavioral health. Mental health and addiction treatment advocates have long viewed parity as a means of increasing fairness in the insurance market, whereas employers and insurers have opposed it because of concerns about its cost. The passage of this law is viewed as a legislative success by both consumer and provider advocates and the employer and insurance groups that fought against it for decades. Methods: Twenty-nine structured interviews were conducted with key informants in the federal parity debate, including members of Congress and their staff; lobbyists for consumer, provider, employer, and insurance groups; and other key contacts. Historical documentation, academic research on the effects of parity regulations, and public comment letters submitted to the U.S. Departments of Labor, Health and Human Services, and Treasury before the release of federal guidance also were examined. Findings: Three factors were instrumental to the passage of this law: the emergence of new evidence regarding the costs of parity, personal experience with mental illness and addiction, and the political strategies adopted by congressional champions in the Senate and House of Representatives. Conclusions: Challenges to implementing the federal parity policy warrant further consideration. This law raises new questions about the future direction of federal policymaking on behavioral health. PMID:20860577

National health insurance reform in South Africa: estimating the implications for demand for private health insurance.

PubMed

Okorafor, Okore Apia

2012-05-01

A recent health reform proposal in South Africa proposes universal access to a comprehensive package of healthcare services in the public sector, through the implementation of a national health insurance (NHI) scheme. Implementation of the scheme is likely to involve the introduction of a payroll tax. It is implied that the introduction of the payroll tax will significantly reduce the size of the private health insurance market. The objective of this study was to estimate the impact of an NHI payroll tax on the demand for private health insurance in South Africa, and to explore the broader implications for health policy. The study applies probit regression analysis on household survey data to estimate the change in demand for private health insurance as a result of income shocks arising from the proposed NHI. The introduction of payroll taxes for the proposed NHI was estimated to result in a reduction to private health insurance membership of 0.73%. This suggests inelasticity in the demand for private health insurance. In the literature on the subject, this inelasticity is usually due to quality differences between alternatives. In the South African context, there may be other factors at play. An NHI tax may have a very small impact on the demand for private health insurance. Although additional financial resources will be raised through a payroll tax under the proposed NHI reform, systemic problems within the South African health system can adversely affect the ability of the NHI to translate additional finances into better quality healthcare. If these systemic challenges are not adequately addressed, the introduction of a payroll tax could introduce inefficiencies within the South African health system.

Health Insurance Coverage and Use of Family Planning Services among Current and Former Foster Youth: Implications of the Health Care Reform Law

PubMed Central

Dworsky, Amy; Ahrens, Kym; Courtney, Mark

2013-01-01

This research uses data from a longitudinal study to examine how two provisions in the Patient Protection and Affordable Care Act could affect health insurance coverage among young women who have aged out of foster care. It also explores how allowing young people to remain in foster care until age twenty-one affects their health insurance coverage, use of family planning services, and information about birth control. We find that young women are more likely to have health insurance if they remain in foster care until their twenty-first birthday and that having health insurance is associated with an increase in the likelihood of receiving family planning services. Our results also suggest that many young women who would otherwise lack health insurance after aging out of foster care will be eligible for Medicaid under the health care reform law. Because having health insurance is associated with use of family planning services, this increase in Medicaid eligibility may result in fewer unintended pregnancies among this high-risk population. PMID:23262773

What Explains Divorced Women’s Poorer Health?: The Mediating Role of Health Insurance and Access to Health Care in a Rural Iowan Sample*

PubMed Central

Lavelle, Bridget; Lorenz, Frederick O.; Wickrama, K. A. S.

2012-01-01

The economic restructuring in rural areas in recent decades has been accompanied by rising marital instability. To examine the implications of the increase in divorce for the health of rural women, we examine how marital status predicts adequacy of health insurance coverage and health care access, and whether these factors help to account for the documented association between divorce and later illness. Analyzing longitudinal data from a cohort of over 400 married and recently divorced rural Iowan women, we decompose the total effect of divorce on physical illness a decade later using structural equation modeling. Divorced women are less likely to report adequate health insurance in the years following divorce, inhibiting their access to medical care and threatening their physical health. Full-time employment acts as a buffer against insurance loss for divorced women. The growth of marital instability in rural areas has had significant ramifications for women’s health; the decline of adequate health insurance coverage following divorce explains a component of the association between divorced status and poorer long-term health outcomes. PMID:23457418

Change in Health Insurance Coverage in Massachusetts and Other New England States by Perceived Health Status: Potential Impact of Health Reform

PubMed Central

Zack, Matthew M.; Strine, Tara W.; Druss, Benjamin G.; Simoes, Eduardo

2013-01-01

Objectives. We examined the impact of Massachusetts health reform and its public health component (enacted in 2006) on change in health insurance coverage by perceived health. Methods. We used 2003–2009 Behavioral Risk Factor Surveillance System data. We used a difference-in-differences framework to examine the experience in Massachusetts to predict the outcomes of national health care reform. Results. The proportion of adults aged 18 to 64 years with health insurance coverage increased more in Massachusetts than in other New England states (4.5%; 95% confidence interval [CI] = 3.5%, 5.6%). For those with higher perceived health care need (more recent mentally and physically unhealthy days and activity limitation days [ALDs]), the postreform proportion significantly exceeded prereform (P < .001). Groups with higher perceived health care need represented a disproportionate increase in health insurance coverage in Massachusetts compared with other New England states—from 4.3% (95% CI = 3.3%, 5.4%) for fewer than 14 ALDs to 9.0% (95% CI = 4.5%, 13.5%) for 14 or more ALDs. Conclusions. On the basis of the Massachusetts experience, full implementation of the Affordable Care Act may increase health insurance coverage especially among populations with higher perceived health care need. PMID:23597359

The 'graying' of group health insurance.

PubMed

Keenan, Patricia Seliger; Cutler, David M; Chernew, Michael

2006-01-01

We examine differential declines in private insurance by income and age. We show that older, higher-income people in working families are more likely to retain private coverage as premiums rise, and we project these effects on future coverage rates. The analysis suggests that trends are leading to the "graying" of the employment-based health insurance system, where older, higher-income people get private health insurance, and others increasingly have public coverage or go without. These changes raise questions about the private health care system's ability to pool health risks. Population aging could interact with rising premiums and place additional pressure on an already strained employment-based health insurance system.

The Big Five Health Insurers' Membership And Revenue Trends: Implications For Public Policy.

PubMed

Schoen, Cathy; Collins, Sara R

2017-12-01

The five largest US commercial health insurance companies together enroll 125 million members, or 43 percent of the country's insured population. Over the past decade these insurers have become increasingly dependent for growth and profitability on public programs, according to an analysis of corporate reports. In 2016 Medicare and Medicaid accounted for nearly 60 percent of the companies' health care revenues and 20 percent of their comprehensive plan membership. Although headlines have focused on losses in the state Marketplaces created by the Affordable Care Act (ACA), the Marketplaces represent only a small fraction of insurers' members. Overall, the five largest insurers have remained profitable since passage of the ACA as a result of profits in other market segments. Notably, companies with significant Medicare or Medicaid enrollment have continued to insure beneficiaries in states where the insurers do not participate in Marketplaces. Given the insurers' dependence on public programs, there is potential to improve access if federal or state governments, or both, required insurers that participate in Medicare or Medicaid to also participate in the Marketplaces in the same geographic area. Such requirements could ensure more viable and less volatile insurance, benefiting people insured within each market as well as those who cycle on and off public and private insurance.

Impact of medical loss regulation on the financial performance of health insurers.

PubMed

McCue, Michael; Hall, Mark; Liu, Xinliang

2013-09-01

The Affordable Care Act's regulation of medical loss ratios requires health insurers to use at least 80-85 percent of the premiums they collect for direct medical expenses (care delivery) or for efforts to improve the quality of care. To gauge this rule's effect on insurers' financial performance, we measured changes between 2010 and 2011 in key financial ratios reflecting insurers' operating profits, administrative costs, and medical claims. We found that the largest changes occurred in the individual market, where for-profit insurers reduced their median administrative cost ratio and operating margin by more than two percentage points each, resulting in a seven-percentage-point increase in their median medical loss ratio. Financial ratios changed much less for insurers in the small- and large-group markets.

Consumer price sensitivity in Dutch health insurance.

PubMed

van Dijk, Machiel; Pomp, Marc; Douven, Rudy; Laske-Aldershof, Trea; Schut, Erik; de Boer, Willem; de Boo, Anne

2008-12-01

To estimate the price sensitivity of consumer choice of health insurance firm. Using paneldata of the flows of insured between pairs of Dutch sickness funds during the period 1993-2002, we estimate the sensitivity of these flows to differences in insurance premium. The price elasticity of residual demand for health insurance was low during the period 1993-2002, confirming earlier findings based on annual changes in market share. We find small but significant elasticities for basic insurance but insignificant elasticities for supplementary insurance. Young enrollees are more price sensitive than older enrollees. Competition was weak in the market for health insurance during the period under study. For the market-based reforms that are currently under way, this implies that measures to promote competition in the health insurance industry may be needed.

Health insurance coverage and healthcare utilization among homeless young adults in Venice, CA.

PubMed

Winetrobe, H; Rice, E; Rhoades, H; Milburn, N

2016-03-01

Homeless young adults are a vulnerable population with great healthcare needs. Under the Affordable Care Act, homeless young adults are eligible for Medicaid, in some states, including California. This study assesses homeless young adults' health insurance coverage and healthcare utilization prior to Medicaid expansion. All homeless young adults accessing services at a drop-in center in Venice, CA, were invited to complete a self-administered questionnaire; 70% of eligible clients participated (n = 125). Within this majority White, heterosexual, male sample, 70% of homeless young adults did not have health insurance in the prior year, and 39% reported their last healthcare visit was at an emergency room. Past year unmet healthcare needs were reported by 31%, and financial cost was the main reported barrier to receiving care. Multivariable logistic regression found that homeless young adults with health insurance were almost 11 times more likely to report past year healthcare utilization. Health insurance coverage is the sole variable significantly associated with healthcare utilization among homeless young adults, underlining the importance of insurance coverage within this vulnerable population. Service providers can play an important role by assisting homeless young adults with insurance applications and facilitating connections with regular sources of health care. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Health care access among Mexican Americans with different health insurance coverage.

PubMed

Treviño, R P; Treviño, F M; Medina, R; Ramirez, G; Ramirez, R R

1996-05-01

This study describes the rates of health care access among Mexican Americans with different health insurance coverage. An interview questionnaire was used to collect information regarding sociodemographics, perceived health status, health insurance coverage, and sources of health care from a random sample of 501 Mexican Americans from San Antonio, Texas. Health care access was determined more by having health insurance coverage than by health care needs. Poor Mexican Americans with health insurance had higher health care access rates than did poor Mexican Americans without health insurance. Health care access may improve health care outcomes, but more comprehensive community-based campaigns to promote health and better use of health services in underprivileged populations should be developed.

Building public trust in uses of Health Insurance Portability and Accountability Act de-identified data

PubMed Central

2013-01-01

Objectives The aim of this paper is to summarize concerns with the de-identification standard and methodologies established under the Health Insurance Portability and Accountability Act (HIPAA) regulations, and report some potential policies to address those concerns that were discussed at a recent workshop attended by industry, consumer, academic and research stakeholders. Target audience The target audience includes researchers, industry stakeholders, policy makers and consumer advocates concerned about preserving the ability to use HIPAA de-identified data for a range of important secondary uses. Scope HIPAA sets forth methodologies for de-identifying health data; once such data are de-identified, they are no longer subject to HIPAA regulations and can be used for any purpose. Concerns have been raised about the sufficiency of HIPAA de-identification methodologies, the lack of legal accountability for unauthorized re-identification of de-identified data, and insufficient public transparency about de-identified data uses. Although there is little published evidence of the re-identification of properly de-identified datasets, such concerns appear to be increasing. This article discusses policy proposals intended to address de-identification concerns while maintaining de-identification as an effective tool for protecting privacy and preserving the ability to leverage health data for secondary purposes. PMID:22735615

Optimal non-linear health insurance.

PubMed

Blomqvist, A

1997-06-01

Most theoretical and empirical work on efficient health insurance has been based on models with linear insurance schedules (a constant co-insurance parameter). In this paper, dynamic optimization techniques are used to analyse the properties of optimal non-linear insurance schedules in a model similar to one originally considered by Spence and Zeckhauser (American Economic Review, 1971, 61, 380-387) and reminiscent of those that have been used in the literature on optimal income taxation. The results of a preliminary numerical example suggest that the welfare losses from the implicit subsidy to employer-financed health insurance under US tax law may be a good deal smaller than previously estimated using linear models.

Patient Protection and Affordable Care Act; establishment of exchanges and qualified health plans; exchange standards for employers. Final rule, Interim final rule.

PubMed

2012-03-27

This final rule will implement the new Affordable Insurance Exchanges ("Exchanges"), consistent with title I of the Patient Protection and Affordable Care Act of 2010 as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. The Exchanges will provide competitive marketplaces for individuals and small employers to directly compare available private health insurance options on the basis of price, quality, and other factors. The Exchanges, which will become operational by January 1, 2014, will help enhance competition in the health insurance market, improve choice of affordable health insurance, and give small businesses the same purchasing clout as large businesses.

Health seeking behavior in karnataka: does micro-health insurance matter?

PubMed

Savitha, S; Kiran, Kb

2013-10-01

Health seeking behaviour in the event of illness is influenced by the availability of good health care facilities and health care financing mechanisms. Micro health insurance not only promotes formal health care utilization at private providers but also reduces the cost of care by providing the insurance coverage. This paper explores the impact of Sampoorna Suraksha Programme, a micro health insurance scheme on the health seeking behaviour of households during illness in Karnataka, India. The study was conducted in three randomly selected districts in Karnataka, India in the first half of the year 2011. The hypothesis was tested using binary logistic regression analysis on the data collected from randomly selected 1146 households consisting of 4961 individuals. Insured individuals were seeking care at private hospitals than public hospitals due to the reduction in financial barrier. Moreover, equity in health seeking behaviour among insured individuals was observed. Our finding does represent a desirable result for health policy makers and micro finance institutions to advocate for the inclusion of health insurance in their portfolio, at least from the HSB perspective.

3 CFR - State Children's Health Insurance Program

Code of Federal Regulations, 2010 CFR

2010-01-01

... 3 The President 1 2010-01-01 2010-01-01 false State Children's Health Insurance Program... Insurance Program Memorandum for the Secretary of Health and Human Services The State Children's Health Insurance Program (SCHIP) encourages States to provide health coverage for uninsured children in families...

Progressive segmented health insurance: Colombian health reform and access to health services.

PubMed

Ruiz, Fernando; Amaya, Liliana; Venegas, Stella

2007-01-01

Equal access for poor populations to health services is a comprehensive objective for any health reform. The Colombian health reform addressed this issue through a segmented progressive social health insurance approach. The strategy was to assure universal coverage expanding the population covered through payroll linked insurance, and implementing a subsidized insurance program for the poorest populations, those not affiliated through formal employment. A prospective study was performed to follow-up health service utilization and out-of-pocket expenses using a cohort design. It was representative of four Colombian cities (Cendex Health Services Use and Expenditure Study, 2001). A four part econometric model was applied. The model related medical service utilization and medication with different socioeconomic, geographic, and risk associated variables. Results showed that subsidized health insurance improves health service utilization and reduces the financial burden for the poorest, as compared to those non-insured. Other social health insurance schemes preserved high utilization with variable out-of-pocket expenditures. Family and age conditions have significant effect on medical service utilization. Geographic variables play a significant role in hospital inpatient service utilization. Both, geographic and income variables also have significant impact on out-of-pocket expenses. Projected utilization rates and a simulation favor a dual policy for two-stage income segmented insurance to progress towards the universal insurance goal. Copyright (c) 2006 John Wiley & Sons, Ltd.

Uninsured Veterans Who Will Need to Obtain Insurance Coverage Under the Patient Protection and Affordable Care Act

PubMed Central

Rosenheck, Robert

2014-01-01

Objectives. We examined the number and clinical needs of uninsured veterans, including those who will be eligible for the Medicaid expansion and health insurance exchanges in 2014. Methods. We analyzed weighted data for 8710 veterans from the 2010 National Survey of Veterans, classifying it by veterans’ age, income, household size, and insurance status. Results. Of 22 million veterans, about 7%, or more than 1.5 million, were uninsured and will need to obtain coverage by enrolling in US Department of Veterans Affairs (VA) care or the Medicaid expansion or by participating in the health insurance exchanges. Of those uninsured, 55%, or more than 800 000, are likely eligible for the Medicaid expansion if states implement it. Compared with veterans with any health coverage, those who were uninsured were younger and more likely to be single, Black, and low income and to have been deployed to Iraq and Afghanistan. Conclusions. The Patient Protection and Affordable Care Act is likely to have a considerable impact on uninsured veterans, which may have implications for the VA, the Medicaid expansion, and the health insurance exchanges. PMID:24432934

Patients' rights to care under Clinton's Health Security Act: the structure of reform.

PubMed Central

Mariner, W K

1994-01-01

Like most reform proposals, President Clinton's proposed Health Security Act offers universal access to care but does not significantly alter the nature of patients' legal rights to services. The act would create a system of delegated federal regulation in which the states would act like federal administrative agencies to carry out reform. To achieve uniform, universal coverage, the act would establish a form of mandatory health insurance, with federal law controlling the minimum services to which everyone would be entitled. Because there is no constitutionally protected right to health care and no independent constitutional standard for judging what insurance benefits are appropriate, the federal government would retain considerable freedom to decide what services would and would not be covered. If specific benefits are necessary for patients, they will have to be stated in the legislation that produces reform. PMID:8059899

Patient satisfaction with primary health care - a comparison between the insured and non-insured under the National Health Insurance Policy in Ghana.

PubMed

Fenny, Ama Pokuaa; Enemark, Ulrika; Asante, Felix A; Hansen, Kristian S

2014-04-01

Ghana has initiated various health sector reforms over the past decades aimed at strengthening institutions, improving the overall health system and increasing access to healthcare services by all groups of people. The National Health Insurance Scheme (NHIS) instituted in 2005, is an innovative system aimed at making health care more accessible to people who need it. Currently, there is a growing amount of concern about the capacity of the NHIS to make quality health care accessible to its clients. A number of studies have concentrated on the effect of health insurance status on demand for health services, but have been quiet on supply side issues. The main aim of this study is to examine the overall satisfaction with health care among the insured and uninsured under the NHIS. The second aim is to explore the relations between overall satisfaction and socio-demographic characteristics, health insurance and the various dimensions of quality of care. This study employs logistic regression using household survey data in three districts in Ghana covering the 3 ecological zones (coastal, forest and savannah). It identifies the service quality factors that are important to patients' satisfaction and examines their links to their health insurance status. The results indicate that a higher proportion of insured patients are satisfied with the overall quality of care compared to the uninsured. The key predictors of overall satisfaction are waiting time, friendliness of staff and satisfaction of the consultation process. These results highlight the importance of interpersonal care in health care facilities. Feedback from patients' perception of health services and satisfaction surveys improve the quality of care provided and therefore effort must be made to include these findings in future health policies.

Health insurance--a challenge in India.

PubMed

Presswala, R G

2004-01-01

In India, indemnity health insurance started about 3 decades ago. Mediclaim was the most popular product. Indian insurers and multinational companies have not been enthusiastic about starting health insurance in spite of the availability of a good market because health insurers have historically incurred losses. Losses have been caused by poor administration. Because it is a small portion of their total businesses, insurers have never tried sincerely to improve deficiencies or taken special interest. Hospital management and medical specialists have the spirit of entrepreneurship and are prepared to learn quickly and follow managed care principles, though they are not currently practiced in India. Actuarial data from the health insurance industry is sparse, but data from alternative sources will be helpful for starting managed healthcare. In my opinion, if properly administered, a "limited" managed care product with appropriate precautions and premium levels will be successful and profitable and will compete with present indemnity products in India.

Is It Really Worse to Have Public Health Insurance than to Have No Insurance at All? Health Insurance and Adult Health in the United States

ERIC Educational Resources Information Center

Quesnel-Vallee, Amelie

2004-01-01

Using prospective cohort data from the 1979 National Longitudinal Survey of Youth, this study examines the extent to which health insurance coverage and the source of that coverage affect adult health. While previous research has shown that privately insured nonelderly individuals enjoy better health outcomes than their uninsured counterparts, the…

Future considerations for clinical dermatology in the setting of 21st century American policy reform: The Medicare Access and Children's Health Insurance Program Reauthorization Act and Alternative Payment Models in dermatology.

PubMed

Barbieri, John S; Miller, Jeffrey J; Nguyen, Harrison P; Forman, Howard P; Bolognia, Jean L; VanBeek, Marta J

2017-06-01

With the introduction of the Medicare Access and Children's Health Insurance Program Reauthorization Act, clinicians who are not eligible for an exemption must choose to participate in 1 of 2 new reimbursement models: the Merit-based Incentive Payment System or Alternative Payment Models (APMs). Although most dermatologists are expected to default into the Merit-based Incentive Payment System, some may have an interest in exploring APMs, which have associated financial incentives. However, for dermatologists interested in the APM pathway, there are currently no options other than joining a qualifying Accountable Care Organization, which make up only a small subset of Accountable Care Organizations overall. As a result, additional APMs relevant to dermatologists are needed to allow those interested in the APMs to explore this pathway. Fortunately, the Medicare Access and Children's Health Insurance Program Reauthorization Act establishes a process for new APMs to be approved and the creation of bundled payments for skin diseases may represent an opportunity to increase the number of APMs available to dermatologists. In this article, we will provide a detailed review of APMs under the Medicare Access and Children's Health Insurance Program Reauthorization Act and discuss the development and introduction of APMs as they pertain to dermatology. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Examining the influence of health insurance literacy and perception on the people preference to purchase private voluntary health insurance.

PubMed

Mathur, Tanuj; Das, Gurudas; Gupta, Hemendra

2018-01-01

Most studies have associated "un-affordability" as a plausible cause for the lower take-up of private voluntary health insurance plans. However, others refuted this claim on the pretext that when people can afford "inpatient-care" from pocket then insurance premium cost is far less than those payments. Thus, economic factors remain insufficient in clearly explaining the reason for poor private voluntary health insurance take-up. An attempt is being made by shifting the focus towards non-economic factors and understanding the role of perception and health insurance literacy in transforming people preferences to invest in private voluntary health insurance plans. The study findings will conspicuously support decision-makers in developing strategy to increase the private voluntary health insurance take-up.

Stakeholders' perceptions of ways to support decisions about health insurance marketplace enrollment: a qualitative study.

PubMed

Housten, A J; Furtado, K; Kaphingst, K A; Kebodeaux, C; McBride, T; Cusanno, B; Politi, M C

2016-11-08

Approximately 29 million individuals are expected to enroll in health insurance using the Patient Protection and Affordable Care Act (ACA) Marketplace by 2022. Those seeking health insurance struggle to understand insurance options and choose a plan that best suits their needs. We interviewed stakeholders to identify the challenges associated with the ACA Marketplace health insurance enrollment and elicited feedback about what to include in health insurance decision support tools. Interviews were transcribed and themes were identified using inductive thematic analysis. Stakeholders stated that consumers felt frustrated by unclear terminology, high plan costs, and complex calculations required to assess costs. Consumers felt anxious about making the wrong choice and being unable to change plans within a calendar year. Stakeholders recommended using plain language tables defining complex terms, grouping information, and using engaging graphics to communicate information about health insurance. Stakeholders thought that narratives of how others made decisions about insurance might be helpful to consumers, but recommended that they be tailored to the needs of specific consumers. Strategies that clarify health insurance terms using plain language and graphics, acknowledge concern associated with making the wrong choice, calculate and enable cost comparison, and tailor information to consumers' unique needs could benefit those enrolling in ACA Marketplace plans, Narratives developed should be simple and inclusive enough for diverse populations.

Estimating workers' marginal valuation of employer health benefits: would insured workers prefer more health insurance or higher wages?

PubMed

Royalty, Anne Beeson

2008-01-01

In recent years the cost of health insurance has been increasing much faster than wages. In the face of these rising costs, many employers will have to make difficult decisions about whether to cut back health benefits or to compensate workers with lower wages or lower wage growth. In this paper, we ask the question, "Which do workers value more -- one additional dollar's worth of health benefits or one more dollar in their pockets?" Using a new approach to obtaining estimates of insured workers' marginal valuation of health benefits this paper estimates how much, on average, employees value the marginal dollar paid by employers for their workers' health insurance. We find that insured workers value the marginal health premium dollar at significantly less than the marginal wage dollar. However, workers value insurance generosity very highly. The marginal dollar spent on health insurance that adds an additional dollar's worth of observable dimensions of plan generosity, such as lower deductibles or coverage of additional services, is valued at significantly more than one dollar.

"Aging Out" of Dependent Coverage and the Effects on US Labor Market and Health Insurance Choices.

PubMed

Dahlen, Heather M

2015-11-01

I examined how labor market and health insurance outcomes were affected by the loss of dependent coverage eligibility under the Patient Protection and Affordable Care Act (ACA). I used National Health Interview Survey (NHIS) data and regression discontinuity models to measure the percentage-point change in labor market and health insurance outcomes at age 26 years. My sample was restricted to unmarried individuals aged 24 to 28 years and to a period of time before the ACA's individual mandate (2011-2013). I ran models separately for men and women to determine if there were differences based on gender. Aging out of this provision increased employment among men, employer-sponsored health insurance offers for women, and reports that health insurance coverage was worse than it was 1 year previously (overall and for young women). Uninsured rates did not increase at age 26 years, but there was an increase in the purchase of non-group health coverage, indicating interest in remaining insured after age 26 years. Many young adults will turn to state and federal health insurance marketplaces for information about health coverage. Because young adults (aged 18-29 years) regularly use social media sites, these sites could be used to advertise insurance to individuals reaching their 26th birthdays.

Increasing Health Insurance Costs and the Decline in Insurance Coverage

PubMed Central

Chernew, Michael; Cutler, David M; Keenan, Patricia Seliger

2005-01-01

Objective To determine the impact of rising health insurance premiums on coverage rates. Data Sources & Study Setting Our analysis is based on two cohorts of nonelderly Americans residing in 64 large metropolitan statistical areas (MSAs) surveyed in the Current Population Survey in 1989–1991 and 1998–2000. Measures of premiums are based on data from the Health Insurance Association of America and the Kaiser Family Foundation/Health Research and Educational Trust Survey of Employer-Sponsored Health Benefits. Study Design Probit regression and instrumental variable techniques are used to estimate the association between rising local health insurance costs and the falling propensity for individuals to have any health insurance coverage, controlling for a rich array of economic, demographic, and policy covariates. Principal Findings More than half of the decline in coverage rates experienced over the 1990s is attributable to the increase in health insurance premiums (2.0 percentage points of the 3.1 percentage point decline). Medicaid expansions led to a 1 percentage point increase in coverage. Changes in economic and demographic factors had little net effect. The number of people uninsured could increase by 1.9–6.3 million in the decade ending 2010 if real, per capita medical costs increase at a rate of 1–3 percentage points, holding all else constant. Conclusions Initiatives aimed at reducing the number of uninsured must confront the growing pressure on coverage rates generated by rising costs. PMID:16033490

Designing Health Information Technology Tools to Prevent Gaps in Public Health Insurance.

PubMed

Hall, Jennifer D; Harding, Rose L; DeVoe, Jennifer E; Gold, Rachel; Angier, Heather; Sumic, Aleksandra; Nelson, Christine A; Likumahuwa-Ackman, Sonja; Cohen, Deborah J

2017-06-23

Changes in health insurance policies have increased coverage opportunities, but enrollees are required to annually reapply for benefits which, if not managed appropriately, can lead to insurance gaps. Electronic health records (EHRs) can automate processes for assisting patients with health insurance enrollment and re-enrollment. We describe community health centers' (CHC) workflow, documentation, and tracking needs for assisting families with insurance application processes, and the health information technology (IT) tool components that were developed to meet those needs. We conducted a qualitative study using semi-structured interviews and observation of clinic operations and insurance application assistance processes. Data were analyzed using a grounded theory approach. We diagramed workflows and shared information with a team of developers who built the EHR-based tools. Four steps to the insurance assistance workflow were common among CHCs: 1) Identifying patients for public health insurance application assistance; 2) Completing and submitting the public health insurance application when clinic staff met with patients to collect requisite information and helped them apply for benefits; 3) Tracking public health insurance approval to monitor for decisions; and 4) assisting with annual health insurance reapplication. We developed EHR-based tools to support clinical staff with each of these steps. CHCs are uniquely positioned to help patients and families with public health insurance applications. CHCs have invested in staff to assist patients with insurance applications and help prevent coverage gaps. To best assist patients and to foster efficiency, EHR based insurance tools need comprehensive, timely, and accurate health insurance information.

Multigroup Path Analysis of the Influence of Healthcare Quality, by Different Health Insurance Types.

PubMed

Hong, Yong-Rock; Holcomb, Derek; Ballard, Michael; Schwartz, Laurel

Winds of change have been blowing in the U.S. healthcare system since passage of the Affordable Care Act. Examining differences between individuals covered by different types of insurance is essential if healthcare executives are to develop new strategies in response to the emerging health insurance market. In this study, we used multigroup path analysis models to examine the moderating effects of health insurance on direct and indirect associations with general health status, satisfaction with received care, financial burden, and perceived value of the healthcare system. Data were obtained from the 2012 Medical Expenditure Panel Survey and analyzed according to the types of insurance: private, public, and military. With the satisfactory fit of the model (χ = 2,532.644, df = 96, p < .001; normed fit index = 0.943; incremental fit index = 0.945; comparative fit index = 0.957; root mean squared error of approximation = 0.044), higher healthcare quality was positively associated with better health status, greater satisfaction, and greater perceived value of the healthcare system in the three insurance groups. In addition, although all direct paths between health service quality and financial burden were not statistically significant, indirect effects were significant in all models through health status. Being married and earning higher incomes were also found to be strong predictors of better health status and health service quality. Efforts to improve the quality of health services are needed, which could contribute to a reduction in health disparities among insurance beneficiaries and result in less healthcare spending.

Effect of the accountable care act of 2010 on clinical trial insurance coverage.

PubMed

Kircher, Sheetal M; Benson, Al B; Farber, Matthew; Nimeiri, Halla S

2012-02-10

The Affordable Care Act (ACA) of 2010 implemented dramatic changes in our health care system. The new law requires that insurers and health plans provide coverage for individuals participating in clinical trials. Currently, there are states that already have laws or agreements requiring clinical trial coverage, but there remain deficiencies that will need to be addressed to achieve compliance with the new law. State mandates were reviewed to determine current laws and agreements. The ACA was reviewed to outline its provisions, and these were compared with current mandates to identify deficiencies. Eighteen states meet the requirements set forth by the ACA either through a state law or agreement; 33 states do not meet the requirements. Of these 33 states, 15 do not have any existing laws or agreements in place regarding clinical trials. In states that have deficient policies in place, the most common deficiency is the lack of phase I coverage. The second most common deficiency in policy is coverage of only therapeutic studies. Most states currently do not meet the requirements of the ACA and will be required to make changes by 2014. The implications of the ACA with regard to insurance coverage of clinical trials remain unclear as implementation of the legislation unfolds. State governments can take steps to ensure insurance coverage by creating and expanding agreements with insurance companies.

Immigrant children's reliance on public health insurance in the wake of immigration reform.

PubMed

Pati, Susmita; Danagoulian, Shooshan

2008-11-01

We sought to determine whether the reversal of the public charge rule of the Illegal Immigration Reform and Immigrant Responsibility Act, which may have required families to pay for benefits previously received at no cost, led to immigrant children becoming increasingly reliant on public health insurance programs. We conducted a secondary data analysis focusing on low-income children sampled in the 1997 through 2004 versions of the National Health Interview Survey. Between 1997 and 2004, public health insurance enrollments and the numbers of uninsured foreign-born children in the United States increased by 3.1% and 2.7%, respectively. Using multinomial logistic regression models to account for the substantial differences in socioeconomic status between foreign-born and US-born children, we found that low-income US-born children were just as likely as foreign-born children to have public health insurance coverage (odds ratio [OR] = 1.16; 95% confidence interval [CI] = 0.89, 1.52) and that, after 2000, foreign-born children were 1.59 times (95% CI = 1.24, 2.05) more likely than were US-born children to be uninsured (vs publicly insured). In the wake of the reversal of the public charge rule, immigrant children are increasingly likely to be uninsured as opposed to relying on public health insurance.

RISK CORRIDORS AND REINSURANCE IN HEALTH INSURANCE MARKETPLACES

PubMed Central

LAYTON, TIMOTHY J.; MCGUIRE, THOMAS G.; SINAIKO, ANNA D.

2016-01-01

Health Insurance Marketplaces established by the Affordable Care Act implement reinsurance and risk corridors. Reinsurance limits insurer costs associated with specific individuals, while risk corridors protect against aggregate losses. Both tighten the insurer’s distribution of expected costs. This paper compares the economic costs and consequences of reinsurance and risk corridors. We simulate the insurer’s cost distribution under reinsurance and risk corridors using data for a group of individuals likely to enroll in Marketplace plans from the Medical Expenditure Panel Survey. We compare reinsurance and risk corridors in terms of risk reduction and incentives for cost containment. We find that reinsurance and one-sided risk corridors achieve comparable levels of risk reduction for a given level of incentives. We also find that the policies being implemented in the Marketplaces (a mix of reinsurance and two-sided risk corridor policies) substantially limit insurer risk but perform similarly to a simpler stand-alone reinsurance policy. PMID:26973861

[The change of the health insurance policy and social welfare discourse in 1970s].

PubMed

Hwang, Byoung-joo

2011-12-31

This study is to analyze the change of the health insurance policy in the 1970s in relation to social welfare discourse. The public health care in Korea was in very poor condition around the first amendment of the National Health Insurance Act in 1970. Furthermore, due to the introduction of new medical technology, increasing number of big hospitals participating in the medical market, inflation, and other factors, medical expenses skyrocketed and made it hard for ordinary people to enjoy medical services. Accordingly, the social solution to the problem of medical expenses which an individual found hard to deal with became of demand. And as the way to the solution, it was inevitable to consider the introduction of health insurance as social insurance. In this condition, Park regime began to stress the social development from the 1960s. It was to aim to settle various social problems triggered by the rapid industrialization in the 1960s through social development as well as economic development. As the social development was emphasized, the matter of social welfare appeared of importance and led to the first amendment of the National Health Insurance Act in 1970. However, it was impossible for Korean government to enforce a nationwide health insurance. The key issue was how to fund it. Park regime was reluctant to use government fund; it was also hard to burden private companies. Even while the health insurance policy was not determined yet for this reason, the social demand for health insurance became large and large. In particular, in the midst of the first "Oil Shock" which gave a big blow to people's living condition from the late 1973, some reported issues in relation to health service, such as hospitals' rejection of the poor, became a big problem. Coupled with the social demand for a health insurance system, the changes occurred within the medical community was also important. Most of all, hospitals was facing the decrease of the effectiveness of their

[What characterizes companies that buy private health insurance?].

PubMed

Seim, Asbjørn; Løvaas, Linda; Hagen, Terje P

2007-10-18

Starting from a very low level, the number of Norwegian companies and individuals that buy private health insurance has increased during recent years. We ask: What characterizes companies that buy private health insurance? Data were collected through a postal survey to 2,500 companies with two or more employees during the spring of 2005. The response rate was 0.43. The probability of buying health insurance was analyzed by means of logistic regression. More than 80,000 individuals, or approximately 1.8% of the Norwegian population, bought private health insurance by the beginning of 2007. 75% were insured through collective insurance contracts through companies, while the rest had bought individual policies. The number of employees holding private health insurance through their employer comprised 2.5% of the total workforce. The probability for companies to buy private health insurance increased with the firm's profitability, by the share of younger employees and with the employees' average level of education. The probability of buying private health insurance is higher in branches with increased health risk such as agriculture and forestry, mining, building and constructions than in low risk branches. We assume that future demand for private health insurance in Norway will depend on the tax incentives, waiting time to elective treatment and the companies' profit margins.

The Experiences of State-Run Insurance Marketplaces That Use HealthCare.gov.

PubMed

Giovannelli, Justin; Lucia, Kevin

2015-09-01

States have flexibility in implementing the Affordable Care Act's health insurance marketplaces and may choose to become more (or less) involved in marketplace operations over time. Interest in new implementation approaches has increased as states seek to ensure the long-term financial stability of their exchanges and exercise local control over marketplace oversight. This brief explores the experiences of four states--Idaho, Nevada, New Mexico, and Oregon--that established their own exchanges but have operated them with support from the federal HealthCare.gov eligibility and enrollment platform. Drawing on discussions with policymakers, insurers, and brokers, we examine how these supported state-run marketplaces perform their key functions. We find that this model may offer states the ability to maximize their influence over their insurance markets, while limiting the financial risk of running an exchange.

Working families' health insurance coverage, 1997-2001.

PubMed

Strunk, Bradley C; Reschovsky, James D

2002-08-01

Despite a booming U.S. economy, falling unemployment and moderate health insurance premium growth, the percentage of working Americans and their families with employer-sponsored health insurance failed to increase substantially between 1997 and 2001, according to findings from the Center for Studying Health System Change (HSC) Community Tracking Study Household Survey. There were, however, dramatic changes in the insurance status of people who lacked access to or did not take up employer coverage: fewer uninsured, more public program enrollment and a decline in coverage by individual insurance and other sources. While the State Children's Health Insurance Program (SCHIP) clearly reduced uninsurance among low-income children, evidence also suggests a fair amount of substitution of public insurance for private coverage.

Health insurance theory: the case of the missing welfare gain.

PubMed

Nyman, John A

2008-11-01

An important source of value is missing from the conventional welfare analysis of moral hazard, namely, the effect of income transfers (from those who purchase insurance and remain healthy to those who become ill) on purchases of medical care. Income transfers are contained within the price reduction that is associated with standard health insurance. However, in contrast to the income effects contained within an exogenous price decrease, these income transfers act to shift out the demand for medical care. As a result, the consumer's willingness to pay for medical care increases and the resulting additional consumption is welfare increasing.

[The state and health insurance].

PubMed

Lagrave, Michel

2003-01-01

The relationship between the State and the health insurance passes through an institutional and financial crisis, leading the government to decide a new governance of the health care system and of the health insurance. The onset of the institutional crisis is the consequence of the confusion of the roles played by the State and the social partners. The social democracy installed by the French plan in 1945 and the autonomy of management of the health insurance established by the 1967 ordinances have failed. The administration parity (union and MEDEF) flew into pieces. The State had to step in by failing. The light is put on the financial crisis by the evolution of ONDAM (National Objective of the Health Insurance Expenses) which appears in the yearly law financing Social Security. The drift of the real expenses as compared to the passed ONDAM bill is constant and worsening. The question of reform includes the link between social democracy to be restored (social partners) and political democracy (Parliament and Government) to establish a contractual democracy. The Government made the announcement of an ONDAM sincere and medically oriented, based on tools agreed upon by all parties. The region could become a regulating step involving a regional health council. An accounting magistrate would be needed to consider not only the legal aspect but to include economic fallouts of health insurance. The role and the missions of the Social Security Accounting Committee should be reinforced.

Enhancing employee capacity to prioritize health insurance benefits.

PubMed

Danis, Marion; Goold, Susan Dorr; Parise, Carol; Ginsburg, Marjorie

2007-09-01

To demonstrate that employees can gain understanding of the financial constraints involved in designing health insurance benefits. While employees who receive their health insurance through the workplace have much at stake as the cost of health insurance rises, they are not necessarily prepared to constructively participate in prioritizing their health insurance benefits in order to limit cost. Structured group exercises. Employees of 41 public and private organizations in Northern California. Administration of the CHAT (Choosing Healthplans All Together) exercise in which participants engage in deliberation to design health insurance benefits under financial constraints. Change in priorities and attitudes about the need to exercise insurance cost constraints. Participants (N = 744) became significantly more cognizant of the need to limit insurance benefits for the sake of affordability and capable of prioritizing benefit options. Those agreeing that it is reasonable to limit health insurance coverage given the cost increased from 47% to 72%. It is both possible and valuable to involve employees in priority setting regarding health insurance benefits through the use of structured decision tools.

Private health insurance and access to healthcare.

PubMed

Duggal, Ravi

2011-01-01

The health insurance business in India has seen a growth of over 25% per annum in the last few years with the expansion of the private health insurance sector. The premium incomes of health insurance have crossed the Rs 8,000 crore mark with the share of private companies increasing to over 41%. This is despite the fact that from the perspective of patients, health insurance is not a good deal, especially when they need it most. This raises a number of ethical issues regarding how the health insurance business runs and how medical practice adjusts to it for profiteering. This article uses the personal experience of the author to argue that health insurance in an unregulated environment can only lead to unethical practices, further victimising the patient. Further, publicly financed healthcare which operates in an environment regulating both public and private healthcare provisioning is the only way to assure access to ethical and equitable healthcare to people.

Assessing barriers to health insurance and threats to equity in comparative perspective: The Health Insurance Access Database

PubMed Central

2012-01-01

Background Typologies traditionally used for international comparisons of health systems often conflate many system characteristics. To capture policy changes over time and by service in health systems regulation of public and private insurance, we propose a database containing explicit, standardized indicators of policy instruments. Methods The Health Insurance Access Database (HIAD) will collect policy information for ten OECD countries, over a range of eight health services, from 1990–2010. Policy indicators were selected through a comprehensive literature review which identified policy instruments most likely to constitute barriers to health insurance, thus potentially posing a threat to equity. As data collection is still underway, we present here the theoretical bases and methodology adopted, with a focus on the rationale underpinning the study instruments. Results These harmonized data will allow the capture of policy changes in health systems regulation of public and private insurance over time and by service. The standardization process will permit international comparisons of systems’ performance with regards to health insurance access and equity. Conclusion This research will inform and feed the current debate on the future of health care in developed countries and on the role of the private sector in these changes. PMID:22551599

Who will have health insurance in the future? An updated projection.

PubMed

Young, Richard A; DeVoe, Jennifer E

2012-01-01

The passage of the 2010 Patient Protection and Affordable Care Act (PPACA) in the United States put the issues of health care reform and health care costs back in the national spotlight. DeVoe and colleagues previously estimated that the cost of a family health insurance premium would equal the median household income by the year 2025. A slowdown in health care spending tied to the recent economic downturn and the passage of the PPACA occurred after this model was published. In this updated model, we estimate that this threshold will be crossed in 2033, and under favorable assumptions the PPACA may extend this date only to 2037. Continuing to make incremental changes in US health policy will likely not bend the cost curve, which has eluded policy makers for the past 50 years. Private health insurance will become increasingly unaffordable to low-to-middle-income Americans unless major changes are made in the US health care system.

Benefit requirements for substance use disorder treatment in state health insurance exchanges.

PubMed

Tran Smith, Bikki; Seaton, Kathleen; Andrews, Christina; Grogan, Colleen M; Abraham, Amanda; Pollack, Harold; Friedmann, Peter; Humphreys, Keith

2018-01-01

Established in 2014, state health insurance exchanges have greatly expanded substance use disorder (SUD) treatment coverage in the United States as qualified health plans (QHPs) within the exchanges are required to conform to parity provisions laid out by the Affordable Care Act and the Mental Health Parity and Addiction Equity Act (MHPAEA). Coverage improvements, however, have not been even as states have wide discretion over how they meet these regulations. How states regulate SUD treatment benefits offered by QHPs has implications for the accessibility and quality of care. In this study, we assessed the extent to which state insurance departments regulate the types of SUD services and medications plans must provide, as well as their use of utilization controls. Data were collected as part of the National Drug Abuse Treatment System Survey, a nationally-representative, longitudinal study of substance use disorder treatment. Data were obtained from state Departments of Insurance via a 15-minute internet-based survey. States varied widely in regulations on QHPs' administration of SUD treatment benefits. Some states required plans to cover all 11 SUD treatment services and medications we assessed in the study, whereas others did not require plans to cover anything at all. Nearly all states allowed the plans to employ utilization controls, but reported little guidance regarding how they should be used. Although some states have taken full advantage of the health insurance exchanges to increase access to SUD treatment, others seem to have done the bare minimum required by the ACA. By not requiring coverage for the entire SUD continuum of care, states are hindering client access to appropriate types of care necessary for recovery.

Ethical questions regarding health insurance in India.

PubMed

Mathur, Vineesh

2011-01-01

Improved health and healthcare are of vital concern to the welfare of Indian society. The nascent health insurance system of the country is experiencing an explosive expansion and various models of health insurance provision are under trial by different agencies. Since the country has been relatively late in introducing health insurance, it can study the effects of different systems of healthcare and insurance and develop a system of health coverage which addresses the unique social character of our country as well as the ethical questions of comprehensiveness and inclusion. This article seeks to explore these issues in detail.

US Farm households: joint decision making and impact of health insurance on labor market outcomes.

PubMed

Bharadwaj, Latika; Findeis, Jill; Chintawar, Sachin

2013-05-29

The paper attempts to answer a very simple question: how does a farm household respond as a unit in the labor market when benefits or health insurance is tied to employer provided jobs. One of the major changes affecting US agriculture has been a decline in the number of farms and an increase in the multiple job-holding, especially among farm women to fulfill various objectives ranging from helping out with farm expenses or securing benefits like health insurance. In addition to this, the new health care law or "The Patient Protection and Affordable Care Act (PPACA") to be operational by 2014 requires that all individuals be covered by a health plan. Hence, it's important to understand the relationship between health insurance and labor markets to appropriately identify the impact of health policy reform for farm families.

US Farm households: joint decision making and impact of health insurance on labor market outcomes

PubMed Central

2013-01-01

The paper attempts to answer a very simple question: how does a farm household respond as a unit in the labor market when benefits or health insurance is tied to employer provided jobs. One of the major changes affecting US agriculture has been a decline in the number of farms and an increase in the multiple job-holding, especially among farm women to fulfill various objectives ranging from helping out with farm expenses or securing benefits like health insurance. In addition to this, the new health care law or “The Patient Protection and Affordable Care Act (PPACA”) to be operational by 2014 requires that all individuals be covered by a health plan. Hence, it’s important to understand the relationship between health insurance and labor markets to appropriately identify the impact of health policy reform for farm families. PMID:23718543

What Americans think of the new insurance marketplaces and Medicaid expansion: findings from the Commonwealth Fund Health Insurance Marketplace Survey, 2013.

PubMed

Collins, Sara R; Rasmussen, Petra W; Doty, Michelle M; Garber, Tracy

2013-09-01

The Affordable Care Act's health insurance marketplaces are opening for enrollment on October 1, 2013. The Commonwealth Fund Health Insurance Marketplace Survey, 2013, finds that only two of five adults are aware of the marketplaces or of potential financial help that may be available to them to pay for plans purchased though the marketplaces. However, three of five adults who might be eligible for these new options said they were likely to take advantage of them. The survey also finds broad support for state expansion of the Medicaid program, even in states that have not yet decided to expand their programs. While outreach and education are critical to ensuring that those eligible for the new coverage options will enroll, the survey results suggest that eligible Americans will likely take advantage of the law's insurance reforms in the months and years to come.

42 CFR 403.220 - Supplemental Health Insurance Panel.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false Supplemental Health Insurance Panel. 403.220 Section 403.220 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Programs § 403.220 Supplemental Health Insurance Panel. (a) Membership. The Supplemental Health Insurance...

42 CFR 403.220 - Supplemental Health Insurance Panel.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 2 2014-10-01 2014-10-01 false Supplemental Health Insurance Panel. 403.220 Section 403.220 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Programs § 403.220 Supplemental Health Insurance Panel. (a) Membership. The Supplemental Health Insurance...

42 CFR 403.220 - Supplemental Health Insurance Panel.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Supplemental Health Insurance Panel. 403.220 Section 403.220 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Programs § 403.220 Supplemental Health Insurance Panel. (a) Membership. The Supplemental Health Insurance...

42 CFR 403.220 - Supplemental Health Insurance Panel.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Supplemental Health Insurance Panel. 403.220 Section 403.220 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Programs § 403.220 Supplemental Health Insurance Panel. (a) Membership. The Supplemental Health Insurance...

42 CFR 403.220 - Supplemental Health Insurance Panel.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Supplemental Health Insurance Panel. 403.220 Section 403.220 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Programs § 403.220 Supplemental Health Insurance Panel. (a) Membership. The Supplemental Health Insurance...

The spillover effects of health insurance benefit mandates on public insurance coverage: Evidence from veterans.

PubMed

Li, Xiaoxue; Ye, Jinqi

2017-09-01

This study examines how regulations in private health insurance markets affect coverage of public insurance. We focus on mental health parity laws, which mandate private health insurance to provide equal coverage for mental and physical health services. The implementation of mental health parity laws may improve a quality dimension of private health insurance but at increased costs. We graphically develop a conceptual framework and then empirically examine whether the regulations shift individuals from private to public insurance. We exploit state-by-year variation in policy implementation in 1999-2008 and focus on a sample of veterans, who have better access to public insurance than non-veterans. Using data from the Current Population Survey, we find that the parity laws reduce employer-sponsored insurance (ESI) coverage by 2.1% points. The drop in ESI is largely offset by enrollment gains in public insurance, namely through the Veterans Affairs (VA) benefit and Medicaid/Medicare programs. Copyright © 2017 Elsevier B.V. All rights reserved.

DIVORCE AND WOMEN'S RISK OF HEALTH INSURANCE LOSS*

PubMed Central

Lavelle, Bridget; Smock, Pamela J.

2012-01-01

This article bridges the literatures on the economic consequences of divorce for women with that on marital transitions and health by focusing on women's health insurance. Using a monthly calendar of marital status and health insurance coverage from 1,442 women in the Survey of Income and Program Participation, we examine how women's health insurance changes after divorce. Our estimates suggest that roughly 115,000 American women lose private health insurance annually in the months following divorce and that roughly 65,000 of these women become uninsured. The loss of insurance coverage we observe is not just a short-term disruption. Women's rates of insurance coverage remain depressed for more than two years after divorce. Insurance loss may compound the economic losses women experience after divorce, and contribute to as well as compound previously documented health declines following divorce. PMID:23147653

Divorce and women's risk of health insurance loss.

PubMed

Lavelle, Bridget; Smock, Pamela J

2012-01-01

This article bridges the literatures on the economic consequences of divorce for women with that on marital transitions and health by focusing on women's health insurance. Using a monthly calendar of marital status and health insurance coverage from 1,442 women in the Survey of Income and Program Participation, we examine how women's health insurance changes after divorce. Our estimates suggest that roughly 115,000 American women lose private health insurance annually in the months following divorce and that roughly 65,000 of these women become uninsured. The loss of insurance coverage we observe is not just a short-term disruption. Women's rates of insurance coverage remain depressed for more than two years after divorce. Insurance loss may compound the economic losses women experience after divorce and contribute to as well as compound previously documented health declines following divorce.

What should health insurance cover? A comparison of Israeli and US approaches to benefit design under national health reform.

PubMed

Nissanholtz Gannot, Rachel; Chinitz, David P; Rosenbaum, Sara

2018-04-01

What health insurance should cover and pay for represents one of the most complex questions in national health policy. Israel shares with the US reliance on a regulated insurance market and we compare the approaches of the two countries regarding determining health benefits. Based on review and analysis of literature, laws and policy in the United States and Israel. The Israeli experience consists of selection of a starting point for defining coverage; calculating the expected cost of covered benefits; and creating a mechanism for updating covered benefits within a defined budget. In implementing the Affordable Care Act, the US rejected a comprehensive and detailed approach to essential health benefits. Instead, federal regulators established broadly worded minimum standards that can be supplemented through more stringent state laws and insurer discretion. Notwithstanding differences between the two systems, the elements of the Israeli approach to coverage, which has stood the test of time, may provide a basis for the United States as it renews its health reform debate and considers delegating decisions about coverage to the states. Israel can learn to emulate the more forceful regulation of supplemental and private insurance that characterizes health policy in the United States.

A Randomized Trial Examining Three Strategies for Supporting Health Insurance Decisions among the Uninsured.

PubMed

Politi, Mary C; Kaphingst, Kimberly A; Liu, Jingxia Esther; Perkins, Hannah; Furtado, Karishma; Kreuter, Matthew W; Shacham, Enbal; McBride, Timothy

2016-10-01

The Affordable Care Act allows uninsured individuals to select health insurance from numerous private plans, a challenging decision-making process. This study examined the effectiveness of strategies to support health insurance decisions among the uninsured. Participants (N = 343) from urban, suburban, and rural areas were randomized to 1 of 3 conditions: 1) a plain language table; 2) a visual condition where participants chose what information to view and in what order; and 3) a narrative condition. We administered measures assessing knowledge (true/false responses about key features of health insurance), confidence in choices (uncertainty subscale of the Decisional Conflict Scale), satisfaction (items from the Health Information National Trends Survey), preferences for insurance features (measured on a Likert scale from not at all important to very important), and plan choice. Although we did not find significant differences in knowledge, confidence in choice, or satisfaction across condition, participants across conditions made value-consistent choices, selecting plans that aligned with their preferences for key insurance features. In addition, those with adequate health literacy skills as measured by the Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF) had higher knowledge overall ([Formula: see text] = 6.1 v. 4.8, P < 0.001) and preferred the plain language table to the visual (P = 0.04) and visual to narrative (P = 0.0002) conditions, while those with inadequate health literacy skills showed no preference for study condition. A similar pattern was seen for those with higher subjective numeracy skills and higher versus lower education with regard to health insurance knowledge. Individuals with higher income felt less confident in their choices ([Formula: see text] = 28.7 v. 10.0, where higher numbers indicate less confidence/more uncertainty; P = 0.004). Those developing materials about the health insurance marketplace to support health

Patient Satisfaction with Primary Health Care – A Comparison between the Insured and Non-Insured under the National Health Insurance Policy in Ghana

PubMed Central

Fenny, Ama P.; Enemark, Ulrika; Asante, Felix A.; Hansen, Kristian S.

2014-01-01

Ghana has initiated various health sector reforms over the past decades aimed at strengthening institutions, improving the overall health system and increasing access to healthcare services by all groups of people. The National Health Insurance Scheme (NHIS) instituted in 2005, is an innovative system aimed at making health care more accessible to people who need it. Currently, there is a growing amount of concern about the capacity of the NHIS to make quality health care accessible to its clients. A number of studies have concentrated on the effect of health insurance status on demand for health services, but have been quiet on supply side issues. The main aim of this study is to examine the overall satisfaction with health care among the insured and uninsured under the NHIS. The second aim is to explore the relations between overall satisfaction and socio-demographic characteristics, health insurance and the various dimensions of quality of care. This study employs logistic regression using household survey data in three districts in Ghana covering the 3 ecological zones (coastal, forest and savannah). It identifies the service quality factors that are important to patients’ satisfaction and examines their links to their health insurance status. The results indicate that a higher proportion of insured patients are satisfied with the overall quality of care compared to the uninsured. The key predictors of overall satisfaction are waiting time, friendliness of staff and satisfaction of the consultation process. These results highlight the importance of interpersonal care in health care facilities. Feedback from patients’ perception of health services and satisfaction surveys improve the quality of care provided and therefore effort must be made to include these findings in future health policies. PMID:24999137

Health insurance, cost expectations, and adverse job turnover.

PubMed

Ellis, Randall P; Albert Ma, Ching-To

2011-01-01

Because less healthy employees value health insurance more than the healthy ones, when health insurance is newly offered job turnover rates for healthier employees decline less than turnover rates for the less healthy. We call this adverse job turnover, and it implies that a firm's expected health costs will increase when health insurance is first offered. Health insurance premiums may fail to adjust sufficiently fast because state regulations restrict annual premium changes, or insurers are reluctant to change premiums rapidly. Even with premiums set at the long run expected costs, some firms may be charged premiums higher than their current expected costs and choose not to offer insurance. High administrative costs at small firms exacerbate this dynamic selection problem. Using 1998-1999 MEDSTAT MarketScan and 1997 Employer Health Insurance Survey data, we find that expected employee health expenditures at firms that offer insurance have lower within-firm and higher between-firm variance than at firms that do not. Turnover rates are systematically higher in industries in which firms are less likely to offer insurance. Simulations of the offer decision capturing between-firm health-cost heterogeneity and expected turnover rates match the observed pattern across firm sizes well. 2010 John Wiley & Sons, Ltd.

Informational privacy and the public's health: the Model State Public Health Privacy Act.

PubMed

Gostin, L O; Hodge, J G; Valdiserri, R O

2001-09-01

Protecting public health requires the acquisition, use, and storage of extensive health-related information about individuals. The electronic accumulation and exchange of personal data promises significant public health benefits but also threatens individual privacy; breaches of privacy can lead to individual discrimination in employment, insurance, and government programs. Individuals concerned about privacy invasions may avoid clinical or public health tests, treatments, or research. Although individual privacy protections are critical, comprehensive federal privacy protections do not adequately protect public health data, and existing state privacy laws are inconsistent and fragmented. The Model State Public Health Privacy Act provides strong privacy safeguards for public health data while preserving the ability of state and local public health departments to act for the common good.

Health Insurance as a Two-Part Pricing Contract *

PubMed Central

Lakdawalla, Darius; Sood, Neeraj

2013-01-01

Monopolies appear throughout health care. We show that health insurance operates like a conventional two-part pricing contract that allows monopolists to extract profits without inefficiently constraining quantity. When insurers are free to offer a range of insurance contracts to different consumer types, health insurance markets perfectly eliminate deadweight losses from upstream health care monopolies. Frictions limiting the sorting of different consumer types into different insurance contracts restore some of these upstream monopoly losses, which manifest as higher rates of uninsurance, rather than as restrictions in quantity utilized by insured consumers. Empirical analysis of pharmaceutical patent expiration supports the prediction that heavily insured markets experience little or no efficiency loss under monopoly, while less insured markets exhibit behavior more consistent with the standard theory of monopoly. PMID:23997354

How temporary insurance for high-risk individuals may play out under health reform.

PubMed

Chollet, Deborah J

2010-06-01

The Patient Protection and Affordable Care Act guarantees that people with health problems will be able to buy private health insurance as of 2014. In the interim, a new federal high-risk program will accept those who are denied private insurance and have not found coverage from any other source. Such sources include a state high-risk pool or, in a handful of states, a designated carrier of last resort. However, restricted eligibility for the federal program suggests that state high-risk pools, in particular, will continue to be critical yet problematic sources of coverage for the next few years.

Life cycle responses to health insurance status.

PubMed

Pelgrin, Florian; St-Amour, Pascal

2016-09-01

This paper studies the lifetime effects of exogenous changes in health insurance coverage (e.g. Medicare, PPACA, termination of employer-provided plans) on the dynamic optimal allocation (consumption, leisure, health expenditures), status (health and wealth), and welfare. We solve, simulate, and structurally estimate a parsimonious life cycle model with endogenous exposure to morbidity and mortality risks, and exogenous health insurance. By varying coverage, we identify the marginal effects of insurance when young and/or when old on allocations, statuses, and welfare. Our results highlight positive effects of insurance on health, wealth and welfare, as well as mid-life substitution away from healthy leisure in favor of more health expenses, caused by peaking wages, and accelerating health issues. Copyright © 2016 Elsevier B.V. All rights reserved.

Operationalizing universal health coverage in Nigeria through social health insurance

PubMed Central

Okpani, Arnold Ikedichi; Abimbola, Seye

2015-01-01

Nigeria faces challenges that delay progress toward the attainment of the national government's declared goal of universal health coverage (UHC). One such challenge is system-wide inequities resulting from lack of financial protection for the health care needs of the vast majority of Nigerians. Only a small proportion of Nigerians have prepaid health care. In this paper, we draw on existing evidence to suggest steps toward reforming health care financing in Nigeria to achieve UHC through social health insurance. This article sets out to demonstrate that a viable path to UHC through expanding social health insurance exists in Nigeria. We argue that encouraging the states which are semi-autonomous federating units to setup and manage their own insurance schemes presents a unique opportunity for rapidly scaling up prepaid coverage for Nigerians. We show that Nigeria's federal structure which prescribes a sharing of responsibilities for health care among the three tiers of government presents serious challenges for significantly extending social insurance to uncovered groups. We recommend that rather than allowing this governance structure to impair progress toward UHC, it should be leveraged to accelerate the process by supporting the states to establish and manage their own insurance funds while encouraging integration with the National Health Insurance Scheme. PMID:26778879

Reports of Insurance-Based Discrimination in Health Care and Its Association With Access to Care

PubMed Central

Call, Kathleen Thiede; Pintor, Jessie Kemmick; Alarcon-Espinoza, Giovann; Simon, Alisha Baines

2015-01-01

Objectives. We examined reports of insurance-based discrimination and its association with insurance type and access to care in the early years of the Patient Protection and Affordable Care Act. Methods. We used data from the 2013 Minnesota Health Access Survey to identify 4123 Minnesota adults aged 18 to 64 years who reported about their experiences of insurance-based discrimination. We modeled the association between discrimination and insurance type and predicted odds of having reduced access to care among those reporting discrimination, controlling for sociodemographic factors. Data were weighted to represent the state’s population. Results. Reports of insurance-based discrimination were higher among uninsured (25%) and publicly insured (21%) adults than among privately insured adults (3%), which held in the regression analysis. Those reporting discrimination had higher odds of lacking a usual source of care, lacking confidence in getting care, forgoing care because of cost, and experiencing provider-level barriers than those who did not. Conclusions. Further research and policy interventions are needed to address insurance-based discrimination in health care settings. PMID:25905821

Reports of insurance-based discrimination in health care and its association with access to care.

PubMed

Han, Xinxin; Call, Kathleen Thiede; Pintor, Jessie Kemmick; Alarcon-Espinoza, Giovann; Simon, Alisha Baines

2015-07-01

We examined reports of insurance-based discrimination and its association with insurance type and access to care in the early years of the Patient Protection and Affordable Care Act. We used data from the 2013 Minnesota Health Access Survey to identify 4123 Minnesota adults aged 18 to 64 years who reported about their experiences of insurance-based discrimination. We modeled the association between discrimination and insurance type and predicted odds of having reduced access to care among those reporting discrimination, controlling for sociodemographic factors. Data were weighted to represent the state's population. Reports of insurance-based discrimination were higher among uninsured (25%) and publicly insured (21%) adults than among privately insured adults (3%), which held in the regression analysis. Those reporting discrimination had higher odds of lacking a usual source of care, lacking confidence in getting care, forgoing care because of cost, and experiencing provider-level barriers than those who did not. Further research and policy interventions are needed to address insurance-based discrimination in health care settings.

45 CFR 147.102 - Fair health insurance premiums.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 1 2013-10-01 2013-10-01 false Fair health insurance premiums. 147.102 Section 147.102 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP AND INDIVIDUAL HEALTH INSURANCE MARKETS § 147...

45 CFR 147.145 - Student health insurance coverage.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 1 2013-10-01 2013-10-01 false Student health insurance coverage. 147.145 Section 147.145 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP AND INDIVIDUAL HEALTH INSURANCE MARKETS § 147...

45 CFR 147.102 - Fair health insurance premiums.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 1 2014-10-01 2014-10-01 false Fair health insurance premiums. 147.102 Section 147.102 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP AND INDIVIDUAL HEALTH INSURANCE MARKETS § 147...

45 CFR 147.145 - Student health insurance coverage.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 1 2012-10-01 2012-10-01 false Student health insurance coverage. 147.145 Section 147.145 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP AND INDIVIDUAL HEALTH INSURANCE MARKETS § 147...

45 CFR 147.145 - Student health insurance coverage.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 1 2014-10-01 2014-10-01 false Student health insurance coverage. 147.145 Section 147.145 Public Welfare Department of Health and Human Services REQUIREMENTS RELATING TO HEALTH CARE ACCESS HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP AND INDIVIDUAL HEALTH INSURANCE MARKETS § 147...

Changes in health insurance for US children and their parents: comparing 2003 to 2008.

PubMed

Angier, Heather; DeVoe, Jennifer E; Tillotson, Carrie; Wallace, Lorraine

2013-01-01

Recent policy changes have affected access to health insurance for families in the United States. Private health insurance premiums have increased, and state Medicaid programs have cut back coverage for adults. Concurrently, the Children's Health Insurance Program has made public insurance available to more children. We aimed to better understand how child and parent health insurance coverage patterns may have changed as a result of these policies. We analyzed data from the nationally representative Medical Expenditure Panel Survey, comparing cohorts from 2003 and 2008. We assessed cross-sectional and full-year coverage patterns for child/parent pairs, stratified by income. We conducted chi-square tests to assess significant differences in coverage over time. Middle-income child/parent pairs had the most significant changes in their coverage patterns. For example, those with full-year health insurance coverage significantly decreased from 85.4% in 2003 to 80.6% in 2008. There was also an increase in uninsured middle-income child/parent pairs for the full year (5.6% in 2003 to 8.3% in 2008) and an increase in pairs who had a gap in coverage (9.7% in 2003 to 13.0% in 2008). The percentage of middle-income child/parent pairs who were lacking insurance, for part or all of the year, has risen, suggesting that these families may be caught between affording private coverage and being eligible for public coverage. Unless private coverage becomes more affordable, insurance instability among middle-income families may persist despite the passage of the Patient Protection and Affordable Care Act.

Immigrant Children's Reliance on Public Health Insurance in the Wake of Immigration Reform

PubMed Central

Danagoulian, Shooshan

2008-01-01

Objectives. We sought to determine whether the reversal of the public charge rule of the Illegal Immigration Reform and Immigrant Responsibility Act, which may have required families to pay for benefits previously received at no cost, led to immigrant children becoming increasingly reliant on public health insurance programs. Methods. We conducted a secondary data analysis focusing on low-income children sampled in the 1997 through 2004 versions of the National Health Interview Survey. Results. Between 1997 and 2004, public health insurance enrollments and the numbers of uninsured foreign-born children in the United States increased by 3.1% and 2.7%, respectively. Using multinomial logistic regression models to account for the substantial differences in socioeconomic status between foreign-born and US-born children, we found that low-income US-born children were just as likely as foreign-born children to have public health insurance coverage (odds ratio [OR] = 1.16; 95% confidence interval [CI] = 0.89, 1.52) and that, after 2000, foreign-born children were 1.59 times (95% CI = 1.24, 2.05) more likely than were US-born children to be uninsured (vs publicly insured). Conclusions. In the wake of the reversal of the public charge rule, immigrant children are increasingly likely to be uninsured as opposed to relying on public health insurance. PMID:18799772

The Patient Protection and Affordable Care Act: opportunities for prevention and public health.

PubMed

Shaw, Frederic E; Asomugha, Chisara N; Conway, Patrick H; Rein, Andrew S

2014-07-05

The Patient Protection and Affordable Care Act, which was enacted by the US Congress in 2010, marks the greatest change in US health policy since the 1960s. The law is intended to address fundamental problems within the US health system, including the high and rising cost of care, inadequate access to health insurance and health services for many Americans, and low health-care efficiency and quality. By 2019, the law will bring health coverage--and the health benefits of insurance--to an estimated 25 million more Americans. It has already restrained discriminatory insurance practices, made coverage more affordable, and realised new provisions to curb costs (including tests of new health-care delivery models). The new law establishes the first National Prevention Strategy, adds substantial new funding for prevention and public health programmes, and promotes the use of recommended clinical preventive services and other measures, and thus represents a major opportunity for prevention and public health. The law also provides impetus for greater collaboration between the US health-care and public health systems, which have traditionally operated separately with little interaction. Taken together, the various effects of the Patient Protection and Affordable Care Act can advance the health of the US population. Copyright © 2014 Elsevier Ltd. All rights reserved.

Conceptualising the lack of health insurance coverage.

PubMed

Davis, J B

2000-01-01

This paper examines the lack of health insurance coverage in the US as a public policy issue. It first compares the problem of health insurance coverage to the problem of unemployment to show that in terms of the numbers of individuals affected lack of health insurance is a problem comparable in importance to the problem of unemployment. Secondly, the paper discusses the methodology involved in measuring health insurance coverage, and argues that the current method of estimation of the uninsured underestimates the extent that individuals go without health insurance. Third, the paper briefly introduces Amartya Sen's functioning and capabilities framework to suggest a way of representing the extent to which individuals are uninsured. Fourth, the paper sketches a means of operationalizing the Sen representation of the uninsured in terms of the disability-adjusted life year (DALY) measure.

41 CFR 60-250.25 - Health insurance, life insurance and other benefit plans.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 41 Public Contracts and Property Management 1 2011-07-01 2009-07-01 true Health insurance, life insurance and other benefit plans. 60-250.25 Section 60-250.25 Public Contracts and Property Management... SEPARATED VETERANS, AND OTHER PROTECTED VETERANS Discrimination Prohibited § 60-250.25 Health insurance...

41 CFR 60-250.25 - Health insurance, life insurance and other benefit plans.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 41 Public Contracts and Property Management 1 2013-07-01 2013-07-01 false Health insurance, life insurance and other benefit plans. 60-250.25 Section 60-250.25 Public Contracts and Property Management... SEPARATED VETERANS, AND OTHER PROTECTED VETERANS Discrimination Prohibited § 60-250.25 Health insurance...

41 CFR 60-250.25 - Health insurance, life insurance and other benefit plans.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 41 Public Contracts and Property Management 1 2012-07-01 2009-07-01 true Health insurance, life insurance and other benefit plans. 60-250.25 Section 60-250.25 Public Contracts and Property Management... SEPARATED VETERANS, AND OTHER PROTECTED VETERANS Discrimination Prohibited § 60-250.25 Health insurance...

Medicaid Expansion Produces Long-Term Impact on Insurance Coverage Rates in Community Health Centers

PubMed Central

Huguet, Nathalie; Hoopes, Megan J.; Angier, Heather; Marino, Miguel; Holderness, Heather; DeVoe, Jennifer E.

2017-01-01

Background:It is crucial to understand the impact of the Affordable Care Act (ACA). This study assesses changes in insurance status of patients visiting community health centers (CHCs) comparing states that expanded Medicaid to those that did not. Methods: Electronic health record data on 875,571 patients aged 19 to 64 years with ≥ 1 visit between 2012 and 2015 in 412 primary care CHCs in 9 expansion and 4 nonexpansion states. We assessed changes in rates of total, uninsured, Medicaid-insured, and privately insured primary care and preventive care visits; immunizations administered, and medications ordered. Results: Rates of uninsured visits decreased pre- to post-ACA, with greater drops in expansion (−57%) versus nonexpansion (−20%) states. Medicaid-insured visits increased 60% in expansion states while remaining unchanged in nonexpansion states. Privately insured visits were 2.7 times higher post-ACA in nonexpansion states with no increase in expansion states. Comparing 2015 with 2014: Uninsured visit rates continued to decrease in expansion (−28%) and nonexpansion states (−19%), Medicaid-insured rates did not significantly increase, and privately insured visits increased in nonexpansion states but did not change in expansion states. Conclusions: Medicaid expansion and subsidies to purchase private coverage likely increased the accessibility of health insurance for patients who had previously not been able to access coverage. PMID:28513249

Seeing Health Insurance and HealthCare.gov Through the Eyes of Young Adults.

PubMed

Wong, Charlene A; Asch, David A; Vinoya, Cjloe M; Ford, Carol A; Baker, Tom; Town, Robert; Merchant, Raina M

2015-08-01

We describe young adults' perspectives on health insurance and HealthCare.gov, including their attitudes toward health insurance, health insurance literacy, and benefit and plan preferences. We observed young adults aged 19-30 years in Philadelphia from January to March 2014 as they shopped for health insurance on HealthCare.gov. Participants were then interviewed to elicit their perceived advantages and disadvantages of insurance and factors considered important for plan selection. A 1-month follow-up interview assessed participants' plan enrollment decisions and intended use of health insurance. Data were analyzed using qualitative methodology, and salience scores were calculated for free-listing responses. We enrolled 33 highly educated young adults; 27 completed the follow-up interview. The most salient advantages of health insurance for young adults were access to preventive or primary care (salience score .28) and peace of mind (.27). The most salient disadvantage was the financial strain of paying for health insurance (.72). Participants revealed poor health insurance literacy with 48% incorrectly defining deductible and 78% incorrectly defining coinsurance. The most salient factors reported to influence plan selection were deductible (.48) and premium (.45) amounts as well as preventive care (.21) coverage. The most common intended health insurance use was primary care. Eight participants enrolled in HealthCare.gov plans: six selected silver plans, and three qualified for tax credits. Young adults' perspective on health insurance and enrollment via HealthCare.gov can inform strategies to design health insurance plans and communication about these plans in a way that engages and meets the needs of young adult populations. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

The effect of Health Savings Accounts on group health insurance coverage.

PubMed

Ye, Jinqi

2015-12-01

This paper presents new empirical evidence on the impact of tax subsidies for Health Savings Accounts (HSAs) on group insurance coverage. HSAs are tax-free health care expenditure savings accounts. Coupled with high deductible health insurance plans (HDHPs), they together represent new health insurance options. The tax advantage of HSAs expands the group health insurance market by making health care more affordable. Using individual level data from the Current Population Survey and exploiting policy variation by state and year from 2004 to 2012, I find that HSA tax subsidies increase small-group coverage by a statistically significant 2.5 percentage points, although not coverage in larger firms. Moreover, if the tax price of HSA contribution decreases by 10 cents, small-group insurance coverage increases by almost 2 percentage points. I also find that for older workers or less-educated workers, HSA subsidies are associated with 2-3 percentage point increase in their group insurance coverage. Copyright © 2015 Elsevier B.V. All rights reserved.

Jobs without benefits: the health insurance crisis faced by small businesses and their workers.

PubMed

Robertson, Ruth; Stremikis, Kristof; Collins, Sara R; Doty, Michelle M; Davis, Karen

2012-11-01

The share of U.S. workers in small firms who were offered, eligible for, and covered by health insurance through their jobs has declined over the past decade. Less than half of workers in companies with fewer than 50 employees were both offered and eligible for health insurance through their jobs in 2010, down from 58 percent in 2003. In contrast, about 90 percent of workers in companies with 100 or more employees were offered and eligible for their employer's health plans in both 2003 and 2010. Workers in the smallest firms--and those with the lowest wages--continue to be less likely to get coverage from their employers and more likely to be uninsured than workers in larger firms or with higher wages. The Affordable Care Act includes new subsidies that will lower the cost of health insurance for small businesses and workers who must purchase coverage on their own.

Shopping on the Public and Private Health Insurance Marketplaces: Consumer Decision Aids and Plan Presentation.

PubMed

Wong, Charlene A; Kulhari, Sajal; McGeoch, Ellen J; Jones, Arthur T; Weiner, Janet; Polsky, Daniel; Baker, Tom

2018-05-29

The design of the Affordable Care Act's (ACA) health insurance marketplaces influences complex health plan choices. To compare the choice environments of the public health insurance exchanges in the fourth (OEP4) versus third (OEP3) open enrollment period and to examine online marketplace run by private companies, including a total cost estimate comparison. In November-December 2016, we examined the public and private online health insurance exchanges. We navigated each site for "real-shopping" (personal information required) and "window-shopping" (no required personal information). Public (n = 13; 12 state-based marketplaces and HealthCare.gov ) and private (n = 23) online health insurance exchanges. Features included consumer decision aids (e.g., total cost estimators, provider lookups) and plan display (e.g., order of plans). We examined private health insurance exchanges for notable features (i.e., those not found on public exchanges) and compared the total cost estimates on public versus private exchanges for a standardized consumer. Nearly all studied consumer decision aids saw increased deployment in the public marketplaces in OEP4 compared to OEP3. Over half of the public exchanges (n = 7 of 13) had total cost estimators (versus 5 of 14 in OEP3) in window-shopping and integrated provider lookups (window-shopping: 7; real-shopping: 8). The most common default plan orders were by premium or total cost estimate. Notable features on private health insurance exchanges were unique data presentation (e.g., infographics) and further personalized shopping (e.g., recommended plan flags). Health plan total cost estimates varied substantially between the public and private exchanges (average difference $1526). The ACA's public health insurance exchanges offered more tools in OEP4 to help consumers select a plan. While private health insurance exchanges presented notable features, the total cost estimates for a standardized consumer varied widely on public

[What do company health insurance plans provide?

PubMed

Hamiki, R

2016-12-15

Company health insurance plans are a voluntary employer benefit and an increasingly important part of company pension and benefits systems. They enable employers to invest in the health of their employees. They are also a useful modular complement to both statutory and private health insurance. Company health insurance plans allow employers to attract first-rate staff and to retain them for the long term. Employees, in turn, are provided with a variety of attractive additional benefits, for instance treatment by chief physicians, single or double-room hospital accommodation, additional aids and remedies, and a variety of screenings and medical check ups. It is expected that, in the next few years, company health insurance will become very widespread.

Off-Marketplace Enrollment Remains An Important Part Of Health Insurance Under The ACA.

PubMed

Goddeeris, John H; McMorrow, Stacey; Kenney, Genevieve M

2017-08-01

The introduction of Marketplaces under the Affordable Care Act greatly expanded individual-market health insurance coverage in 2014, but millions of adults continued to purchase individual coverage outside of the Marketplaces. They were more likely to be male, be white, have higher incomes, and be in excellent or very good health, compared to Marketplace enrollees. Project HOPE—The People-to-People Health Foundation, Inc.

The mandatory health insurance system in Chile: explaining the choice between public and private insurance.

PubMed

Sapelli, C; Torche, A

2001-06-01

In Chile, dependent workers and retirees are mandated by law to purchase health insurance, and can choose between private and public health insurance. This paper studies the determinants of the choice of health insurance. Earnings are generally considered the key factor in this choice, and we confirm this, but find that other factors are also important. It is particularly interesting to analyze how the individual's characteristics interact with the design of the system to influence choice. Worse health, as signaled by age or sex (e.g., older people or women in reproductive ages), results in adverse selection against the public health insurance system. This is due to the lack of risk adjustment of the public health insurance's premium. Hence, Chile's risk selection problem is, at least in part, due to the design of the Chilean public insurance system.

Public health insurance under a nonbenevolent state.

PubMed

Lemieux, Pierre

2008-10-01

This paper explores the consequences of the oft ignored fact that public health insurance must actually be supplied by the state. Depending how the state is modeled, different health insurance outcomes are expected. The benevolent model of the state does not account for many actual features of public health insurance systems. One alternative is to use a standard public choice model, where state action is determined by interaction between self-interested actors. Another alternative--related to a strand in public choice theory--is to model the state as Leviathan. Interestingly, some proponents of public health insurance use an implicit Leviathan model, but not consistently. The Leviathan model of the state explains many features of public health insurance: its uncontrolled growth, its tendency toward monopoly, its capacity to buy trust and loyalty from the common people, its surveillance ability, its controlling nature, and even the persistence of its inefficiencies and waiting lines.

Public insurance is increasingly crucial to American families even as employer-sponsored health insurance coverage ends its steady decline.

PubMed

Gould, Elise

2014-01-01

Americans under age 65 rely on a healthy labor market for almost all facets of economic security. While 2012 marked the first year in more than a decade that the employer-sponsored health insurance (ESI) coverage rate for the under-65 population did not decline, employer-sponsored health insurance continues to fail American families. If the coverage rate had not fallen 10.8 percentage points as it did from 2000 to 2012, as many as 29 million more people under age 65 would have had ESI in 2012. Even with the end of its longstanding decline, ESI coverage rates among men and women, white and non-white, high and low income, white and blue collar, young and old remain far lower than they were in 2000. Over this period, the increase in uninsured Americans was not as steep as the fall in ESI because of increases in public coverage, including Medicaid, the Children's Health Insurance Program, and Medicare. These programs were particularly effective in reducing the share of children uninsured over the 2000s. Additionally, key components in the Patient Protection and Affordable Care Act shielded young adults from further coverage losses.

Immigrants' access to health insurance: no equality without awareness.

PubMed

Dzúrová, Dagmar; Winkler, Petr; Drbohlav, Dušan

2014-07-14

The Czech government has identified commercial health insurance as one of the major problems for migrants' access to health care. Non-EU immigrants are eligible for public health insurance only if they have employee status or permanent residency. The present study examined migrants' access to the public health insurance system in Czechia. A cross-sectional survey of 909 immigrants from Ukraine and Vietnam was conducted in March and May 2013, and binary logistic regression was applied in data analysis. Among immigrants entitled to Czech public health insurance due to permanent residency/asylum, 30% were out of the public health insurance system, and of those entitled by their employment status, 50% were out of the system. Migrants with a poor knowledge of the Czech language are more likely to remain excluded from the system of public health insurance. Instead, they either remain in the commercial health insurance system or they simultaneously pay for both commercial and public health insurance, which is highly disadvantageous. Since there are no reasonable grounds to stay outside the public health insurance, it is concluded that it is lack of awareness that keeps eligible immigrants from entering the system. It is suggested that no equal access to health care exists without sufficient awareness about health care system.

Impact of the 2006 Massachusetts health care insurance reform on neurosurgical procedures and patient insurance status.

PubMed

Villelli, Nicolas W; Das, Rohit; Yan, Hong; Huff, Wei; Zou, Jian; Barbaro, Nicholas M

2017-01-01

OBJECTIVE The Massachusetts health care insurance reform law passed in 2006 has many similarities to the federal Affordable Care Act (ACA). To address concerns that the ACA might negatively impact case volume and reimbursement for physicians, the authors analyzed trends in the number of neurosurgical procedures by type and patient insurance status in Massachusetts before and after the implementation of the state's health care insurance reform. The results can provide insight into the future of neurosurgery in the American health care system. METHODS The authors analyzed data from the Massachusetts State Inpatient Database on patients who underwent neurosurgical procedures in Massachusetts from 2001 through 2012. These data included patients' insurance status (insured or uninsured) and the numbers of procedures performed classified by neurosurgical procedural codes of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Each neurosurgical procedure was grouped into 1 of 4 categories based on ICD-9-CM codes: 1) tumor, 2) other cranial/vascular, 3) shunts, and 4) spine. Comparisons were performed of the numbers of procedures performed and uninsured patients, before and after the implementation of the reform law. Data from the state of New York were used as a control. All data were controlled for population differences. RESULTS After 2008, there were declines in the numbers of uninsured patients who underwent neurosurgical procedures in Massachusetts in all 4 categories. The number of procedures performed for tumor and spine were unchanged, whereas other cranial/vascular procedures increased. Shunt procedures decreased after implementation of the reform law but exhibited a similar trend to the control group. In New York, the number of spine surgeries increased, as did the percentage of procedures performed on uninsured patients. Other cranial/vascular procedures decreased. CONCLUSIONS After the Massachusetts health care

Health insurance and the development of diabetic complications.

PubMed

Flavin, Nina E; Mulla, Zuber D; Bonilla-Navarrete, Aracely; Chedebeau, Fernando; Lopez, Oscar; Tovar, Yara; Meza, Armando

2009-08-01

Lack of health insurance can adversely affect access to medical care which leads to poor disease outcome. Few studies examine the effects of no insurance on the development of diabetes complications. The objective of this study was to determine if there is an association between health insurance status and the outcome of complications among a group of diabetic patients admitted to a teaching hospital on the Texas-Mexico border. A retrospective case-control study was conducted over a one-year period. Multiple imputations were used to address missing values. We examined 82 diabetics who had one or more complications and 83 diabetic controls without complications. A complication was defined as a current skin or soft-tissue infection or a limb amputation. The main exposure was health insurance status, a three-level variable: no health insurance, Medicaid, and other insurance (referent). Logistic regression was used to calculate health insurance odds ratios (OR) adjusted for age, sex, and a history of recent trauma. Patients with no health insurance were twice as likely to have a diabetic complication as patients in the referent category: adjusted OR = 2.22, P = 0.03. An association between Medicaid status and complications was not detected (adjusted OR = 1.16, P = 0.78). Not having health insurance was a risk factor for developing diabetic complications in a group of predominantly Hispanic patients.

Does extending health insurance coverage to the uninsured improve population health outcomes?

PubMed

Thornton, James A; Rice, Jennifer L

2008-01-01

An ongoing debate exists about whether the US should adopt a universal health insurance programme. Much of the debate has focused on programme implementation and cost, with relatively little attention to benefits for social welfare. To estimate the effect on US population health outcomes, measured by mortality, of extending private health insurance to the uninsured, and to obtain a rough estimate of the aggregate economic benefits of extending insurance coverage to the uninsured. We use state-level panel data for all 50 states for the period 1990-2000 to estimate a health insurance augmented, aggregate health production function for the US. An instrumental variables fixed-effects estimator is used to account for confounding variables and reverse causation from health status to insurance coverage. Several observed factors, such as income, education, unemployment, cigarette and alcohol consumption and population demographic characteristics are included to control for potential confounding variables that vary across both states and time. The results indicate a negative relationship between private insurance and mortality, thus suggesting that extending insurance to the uninsured population would result in an improvement in population health outcomes. The estimate of the marginal effect of insurance coverage indicates that a 10% increase in the population-insured rate of a state reduces mortality by 1.69-1.92%. Using data for the year 2003, we calculate that extending private insurance coverage to the entire uninsured population in the US would save over 75 000 lives annually and may yield annual net benefits to the nation in excess of $US400 billion. This analysis suggests that extending health insurance coverage through the private market to the 46 million Americans without health insurance may well produce large social economic benefits for the nation as a whole.

Extending health insurance coverage to the informal sector: Lessons from a private micro health insurance scheme in Lagos, Nigeria.

PubMed

Peterson, Lauren; Comfort, Alison; Hatt, Laurel; van Bastelaer, Thierry

2018-04-15

As a growing number of low- and middle-income countries commit to achieving universal health coverage, one key challenge is how to extend coverage to informal sector workers. Micro health insurance (MHI) provides a potential model to finance health services for this population. This study presents lessons from a pilot study of a mandatory MHI plan offered by a private insurance company and distributed through a microfinance bank to urban, informal sector workers in Lagos, Nigeria. Study methods included a survey of microfinance clients, key informant interviews, and a review of administrative records. Demographic, health care seeking, and willingness-to-pay data suggested that microfinance clients, particularly women, could benefit from a comprehensive MHI plan that improved access to health care and reduced out-of-pocket spending on health services. However, administrative data revealed declining enrollment, and key informant interviews further suggested low use of the health insurance plan. Key implementation challenges, including changes to mandatory enrollment requirements, insufficient client education and marketing, misaligned incentives, and weak back-office systems, undermined enrollment and use of the plan. Mandatory MHI plans, intended to mitigate adverse selection and facilitate private insurers' entry into new markets, present challenges for covering informal sector workers, including when distributed through agents such as a microfinance bank. Properly aligning the incentives of the insurer and the agent are critical to effectively distribute and service insurance. Further, an urban environment presents unique challenges for distributing MHI, addressing client perceptions of health insurance, and meeting their health care needs. Copyright © 2018 John Wiley & Sons, Ltd.

“Aging Out” of Dependent Coverage and the Effects on US Labor Market and Health Insurance Choices

PubMed Central

2015-01-01

Objectives. I examined how labor market and health insurance outcomes were affected by the loss of dependent coverage eligibility under the Patient Protection and Affordable Care Act (ACA). Methods. I used National Health Interview Survey (NHIS) data and regression discontinuity models to measure the percentage-point change in labor market and health insurance outcomes at age 26 years. My sample was restricted to unmarried individuals aged 24 to 28 years and to a period of time before the ACA’s individual mandate (2011–2013). I ran models separately for men and women to determine if there were differences based on gender. Results. Aging out of this provision increased employment among men, employer-sponsored health insurance offers for women, and reports that health insurance coverage was worse than it was 1 year previously (overall and for young women). Uninsured rates did not increase at age 26 years, but there was an increase in the purchase of non–group health coverage, indicating interest in remaining insured after age 26 years. Conclusions. Many young adults will turn to state and federal health insurance marketplaces for information about health coverage. Because young adults (aged 18–29 years) regularly use social media sites, these sites could be used to advertise insurance to individuals reaching their 26th birthdays. PMID:26447916

[Health management in private health insurance].

PubMed

Ziegenhagen, D J; Schilling, M K

2000-09-01

German private health insurance faces new challenges. The classical tools of cost containment are no longer sufficient to keep up with ever increasing expenses for health care, and international competitors with managed care experience from their home markets are on the point of entering business in Germany. Although the American example of managed care is not fully compatible with customer demands and state regulations, some elements of this approach will gradually be introduced. First agreements were signed with networks or individual preferred providers in outpatient care and rehabilitation medicine. Insurance companies become more and more interested in supporting evidence based guidelines and programmes for disease and case management. The pros and cons of various other health management tools are discussed against the specific background of the quite unique German health care system.

[Reimbursement of health apps by the German statutory health insurance].

PubMed

Gregor-Haack, Johanna

2018-03-01

A reimbursement category for "apps" does not exist in German statutory health insurance. Nevertheless different ways for reimbursement of digital health care products or processes exist. This article provides an overview and a description of the most relevant finance and reimbursement categories for apps in German statutory health insurance. The legal qualifications and preconditions of reimbursement in the context of single contracts with one health insurance fund will be discussed as well as collective contracts with national statutory health insurance funds. The benefit of a general outline appeals especially in respect to the numerous new players and products in the health care market. The article will highlight that health apps can challenge existing legal market access and reimbursement criteria and paths. At the same time, these criteria and paths exist. In terms of a learning system, they need to be met and followed.

Housing Instability and Children's Health Insurance Gaps.

PubMed

Carroll, Anne; Corman, Hope; Curtis, Marah A; Noonan, Kelly; Reichman, Nancy E

To assess the extent to which housing instability is associated with gaps in health insurance coverage of preschool-age children. Secondary analysis of data from the Early Childhood Longitudinal Study-Birth Cohort, a nationally representative study of children born in the United States in 2001, was conducted to investigate associations between unstable housing-homelessness, multiple moves, or living with others and not paying rent-and children's subsequent health insurance gaps. Logistic regression was used to adjust for potentially confounding factors. Ten percent of children were unstably housed at age 2, and 11% had a gap in health insurance between ages 2 and 4. Unstably housed children were more likely to have gaps in insurance compared to stably housed children (16% vs 10%). Controlling for potentially confounding factors, the odds of a child insurance gap were significantly higher in unstably housed families than in stably housed families (adjusted odds ratio 1.27; 95% confidence interval 1.01-1.61). The association was similar in alternative model specifications. In a US nationally representative birth cohort, children who were unstably housed at age 2 were at higher risk, compared to their stably housed counterparts, of experiencing health insurance gaps between ages 2 and 4 years. The findings from this study suggest that policy efforts to delink health insurance renewal processes from mailing addresses, and potentially routine screenings for housing instability as well as referrals to appropriate resources by pediatricians, would help unstably housed children maintain health insurance. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

A national and state profile of leading health problems and health care quality for US children: key insurance disparities and across-state variations.

PubMed

Bethell, Christina D; Kogan, Michael D; Strickland, Bonnie B; Schor, Edward L; Robertson, Julie; Newacheck, Paul W

2011-01-01

Parent/consumer-reported data is valuable and necessary for population-based assessment of many key child health and health care quality measures relevant to both the Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009 and the Patient Protection and Affordable Care Act of 2010 (ACA). The aim of this study was to evaluate national and state prevalence of health problems and special health care needs in US children; to estimate health care quality related to adequacy and consistency of insurance coverage, access to specialist, mental health and preventive medical and dental care, developmental screening, and whether children meet criteria for having a medical home, including care coordination and family centeredness; and to assess differences in health and health care quality for children by insurance type, special health care needs status, race/ethnicity, and/or state of residence. National and state level estimates were derived from the 2007 National Survey of Children's Health (N = 91,642; children aged 0-17 years). Variations between children with public versus private sector health insurance, special health care needs, specific conditions, race/ethnicity, and across states were evaluated using multivariate logistic regression and/or standardized statistical tests. An estimated 43% of US children (32 million) currently have at least 1 of 20 chronic health conditions assessed, increasing to 54.1% when overweight, obesity, or being at risk for developmental delays are included; 19.2% (14.2 million) have conditions resulting in a special health care need, a 1.6 point increase since 2003. Compared with privately insured children, the prevalence, complexity, and severity of health problems were systematically greater for the 29.1% of all children who are publicly insured children after adjusting for variations in demographic and socioeconomic factors. Forty-five percent of all children in the United States scored positively on a minimal quality

NATIONAL EMPLOYER HEALTH INSURANCE SURVEY (NEHIS)

EPA Science Inventory

The National Employer Health Insurance Survey (NEHIS) was developed to produce estimates on employer-sponsored health insurance data in the United States. The NEHIS was the first Federal survey to represent all employers in the United States by State and obtain information on all...

Parental employment, family structure, and child's health insurance.

PubMed

Rolett, A; Parker, J D; Heck, K E; Makuc, D M

2001-01-01

To examine the impact of family structure on the relationship between parental employment characteristics and employer-sponsored health insurance coverage among children with employed parents in the United States. National Health Interview Survey data for 1993-1995 was used to estimate proportions of children without employer-sponsored health insurance, by family structure, separately according to maternal and paternal employment characteristics. In addition, relative odds of being without employer-sponsored insurance were estimated, controlling for family structure and child's age, race, and poverty status. Children with 2 employed parents were more likely to have employer-sponsored health insurance coverage than children with 1 employed parent, even among children in 2-parent families. However, among children with employed parents, the percentage with employer-sponsored health insurance coverage varied widely, depending on the hours worked, employment sector, occupation, industry, and firm size. Employer-sponsored health insurance coverage for children is extremely variable, depending on employment characteristics and marital status of the parents.

Do individuals respond to cost-sharing subsidies in their selections of marketplace health insurance plans?

PubMed

DeLeire, Thomas; Chappel, Andre; Finegold, Kenneth; Gee, Emily

2017-12-01

The Affordable Care Act (ACA) provides assistance to low-income consumers through both premium subsidies and cost-sharing reductions (CSRs). Low-income consumers' lack of health insurance literacy or information regarding CSRs may lead them to not take-up CSR benefits for which they are eligible. We use administrative data from 2014 to 2016 on roughly 22 million health insurance plan choices of low-income individuals enrolled in ACA Marketplace coverage to assess whether they behave in a manner consistent with being aware of the availability of CSRs. We take advantage of discontinuous changes in the schedule of CSR benefits to show that consumers are highly sensitive to the value of CSRs when selecting insurance plans and that a very low percentage select dominated plans. These findings suggest that CSR subsidies are salient to consumers and that the program is well designed to account for any lack of health insurance literacy among the low-income population it serves. Copyright © 2017 Elsevier B.V. All rights reserved.

Self-selection and moral hazard in Chilean health insurance.

PubMed

Sapelli, Claudio; Vial, Bernardita

2003-05-01

We study the existence of self-selection and moral hazard in the Chilean health insurance industry. Dependent workers must purchase health insurance either from one public or several private insurance providers. For them, we analyze the relationship between health care services utilization and the choice of either private or public insurance. In the case of independent workers, where there is no mandate, we analyze the relationship between utilization and the decision to voluntarily purchase health insurance. The results show self-selection against insurance companies for independent workers, and against public insurance for dependent workers. Moral hazard is negligible in the case of hospitalization, but for medical visits, it is quantitatively important.

Reciprocating living kidney donor generosity: tax credits, health insurance and an outcomes registry

PubMed Central

Joshi, Shivam; Joshi, Sheela; Kupin, Warren

2016-01-01

Kidney transplantation significantly improves patient survival, and is the most cost effective renal replacement option compared with dialysis therapy. Living kidney donors provide a valuable societal gift, but face many formidable disincentive barriers that include not only short- and long-term health risks, but also concerns regarding financial expenditures and health insurance. Other than governmental coverage for their medical evaluation and surgical expenses, donors are often asked to personally bear a significant financial responsibility due to lost work wages and travel expenses. In order to alleviate this economic burden for donors, we advocate for the consideration of tax credits, lifelong health insurance coverage, and an outcomes registry as societal reciprocity to reward their altruistic act of kidney donation. PMID:26798480

Spousal labor market effects from government health insurance: Evidence from a veterans affairs expansion.

PubMed

Boyle, Melissa A; Lahey, Joanna N

2016-01-01

Measuring the total impact of health insurance receipt on household labor supply is important in an era of increased access to publicly provided and subsidized insurance. Although government expansion of health insurance to older workers leads to direct labor supply reductions for recipients, there may be spillover effects on the labor supply of uncovered spouses. While the most basic model predicts a decrease in overall household work hours, financial incentives such as credit constraints, target income levels, and the need for own health insurance suggest that spousal labor supply might increase. In contrast, complementarities of spousal leisure would predict a decrease in labor supply for both spouses. Utilizing a mid-1990s expansion of health insurance for U.S. veterans, we provide evidence on the effects of public insurance availability on the labor supply of spouses. Using data from the Current Population Survey and Health and Retirement Study, we employ a difference-in-differences strategy to compare the labor market behavior of the wives of older male veterans and non-veterans before and after the VA health benefits expansion. Although husbands' labor supply decreases, wives' labor supply increases, suggesting that financial incentives dominate complementarities of spousal leisure. This effect is strongest for wives with lower education levels and lower levels of household wealth and those who were not previously employed full-time. These findings have implications for government programs such as Medicare and Social Security and the Affordable Care Act. Copyright © 2015 Elsevier B.V. All rights reserved.

Spousal Labor Market Effects from Government Health Insurance: Evidence from a Veterans Affairs Expansion

PubMed Central

Boyle, Melissa A.; Lahey, Joanna N.

2015-01-01

Measuring the total impact of health insurance receipt on household labor supply is important in an era of increased access to publicly-provided and subsidized insurance. Although government expansion of health insurance to older workers leads to direct labor supply reductions for recipients, there may be spillover effects on the labor supply of uncovered spouses. While the most basic model predicts a decrease in overall household work hours, financial incentives such as credit constraints, target income levels, and the need for own health insurance suggest that spousal labor supply might increase. In contrast, complementarities of spousal leisure would predict a decrease in labor supply for both spouses. Utilizing a mid-1990s expansion of health insurance for U.S. veterans, we provide evidence on the effects of public insurance availability on the labor supply of spouses. Using data from the Current Population Survey and Health and Retirement Study, we employ a difference-in-differences strategy to compare the labor market behavior of the wives of older male veterans and non-veterans before and after the VA health benefits expansion. Although husbands’ labor supply decreases, wives’ labor supply increases, suggesting that financial incentives dominate complementarities of spousal leisure. This effect is strongest for wives with lower education levels and lower levels of household wealth and those who were not previously employed full-time. These findings have implications for government programs such as Medicare and Social Security and the Affordable Care Act. JEL codes: H4, I1, J2 PMID:26734757

Supplementary health insurance as a tool for risk-selection in mandatory basic health insurance markets.

PubMed

Paolucci, Francesco; Schut, Erik; Beck, Konstantin; Gress, Stefan; Van de Voorde, Carine; Zmora, Irit

2007-04-01

As the share of supplementary health insurance (SI) in health care finance is likely to grow, SI may become an increasingly attractive tool for risk-selection in basic health insurance (BI). In this paper, we develop a conceptual framework to assess the probability that insurers will use SI for favourable risk-selection in BI. We apply our framework to five countries in which risk-selection via SI is feasible: Belgium, Germany, Israel, the Netherlands, and Switzerland. For each country, we review the available evidence of SI being used as selection device. We find that the probability that SI is and will be used for risk-selection substantially varies across countries. Finally, we discuss several strategies for policy makers to reduce the chance that SI will be used for risk-selection in BI markets.

Relative Affordability of Health Insurance Premiums under CHIP Expansion Programs and the ACA.

PubMed

Gresenz, Carole Roan; Laugesen, Miriam J; Yesus, Ambeshie; Escarce, José J

2011-10-01

Affordability is integral to the success of health care reforms aimed at ensuring universal access to health insurance coverage, and affordability determinations have major policy and practical consequences. This article describes factors that influenced the determination of affordability benchmarks and premium-contribution requirements for Children's Health Insurance Program (CHIP) expansions in three states that sought to universalize access to coverage for youth. It also compares subsidy levels developed in these states to the premium subsidy schedule under the Affordable Care Act (ACA) for health insurance plans purchased through an exchange. We find sizeable variability in premium-contribution requirements for children's coverage as a percentage of family income across the three states and in the progressivity and regressivity of the premium-contribution schedules developed. These findings underscore the ambiguity and subjectivity of affordability standards. Further, our analyses suggest that while the ACA increases the affordability of family coverage for families with incomes below 400 percent of the federal poverty level, the evolution of CHIP over the next five to ten years will continue to have significant implications for low-income families.

Employer-sponsored health insurance coverage continues to decline in a new decade.

PubMed

Gould, Elise

2013-01-01

Most Americans, particularly those under age 65, rely on health insurance offered through the workplace. Given continuing high unemployment, it comes as no surprise that the share of Americans under age 65 covered by employer-sponsored health insurance (ESI) eroded for the 11th year in a row in 2011, falling from 58.6 percent in 2010 to 58.3 percent. The situation started deteriorating long before the Great Recession: the share of Americans under age 65 covered by ESI eroded every year from 2000 to 2011, decreasing by a total of 10.9 percentage points. As many as 29 million more people under age 65 would have had ESI in 2011 if the coverage rate had remained at the 2000 level. The decline in ESI coverage has been accompanied by an overall decline in health insurance coverage. The number of uninsured non-elderly Americans was 47.9 million in 2011--11.7 million higher than in 2000. Increasing public insurance coverage, particularly among children, is the only reason the uninsured rate did not rise one-for-one with losses in ESI. In addition, key components in the Patient Protection and Affordable Care Act took effect in 2010, shielding young adults from further coverage losses.

America's Children: Health Insurance and Access to Care.

ERIC Educational Resources Information Center

Edmunds, Margaret, Ed.; Coye, Molly Joel, Ed.

The National Academy of Sciences Committee on Children, Health Insurance, and Access to Care was assembled to address questions about health insurance for children, evaluating the strengths and limitations of insurance as a means of improving children's health from a variety of approaches and policies. Meeting between March 1997 and January 1998,…

Treatment-seeking behaviour and social health insurance in Africa: the case of Ghana under the National Health Insurance Scheme.

PubMed

Fenny, Ama P; Asante, Felix A; Enemark, Ulrika; Hansen, Kristian S

2014-10-27

Health insurance is attracting more and more attention as a means for improving health care utilization and protecting households against impoverishment from out-of-pocket expenditures. Currently about 52 percent of the resources for financing health care services come from out of pocket sources or user fees in Africa. Therefore, Ghana serves as in interesting case study as it has successfully expanded coverage of the National Health Insurance Scheme (NHIS). The study aims to establish the treatment-seeking behaviour of households in Ghana under the NHI policy. The study relies on household data collected from three districts in Ghana covering the 3 ecological zones namely the coastal, forest and savannah.Out of the 1013 who sought care in the previous 4 weeks, 60% were insured and 71% of them sought care from a formal health facility. The results from the multinomial logit estimations show that health insurance and travel time to health facility are significant determinants of health care demand. Overall, compared to the uninsured, the insured are more likely to choose formal health facilities than informal care including self-medication when ill. We discuss the implications of these results as the concept of the NHIS grows widely in Ghana and serves as a good model for other African countries.

Treatment-Seeking Behaviour and Social Health Insurance in Africa: The Case of Ghana Under the National Health Insurance Scheme

PubMed Central

Fenny, Ama P.; Asante, Felix A.; Enemark, Ulrika; Hansen, Kristian S.

2015-01-01

Health insurance is attracting more and more attention as a means for improving health care utilization and protecting households against impoverishment from out-of-pocket expenditures. Currently about 52 percent of the resources for financing health care services come from out of pocket sources or user fees in Africa. Therefore, Ghana serves as in interesting case study as it has successfully expanded coverage of the National Health Insurance Scheme (NHIS). The study aims to establish the treatment-seeking behaviour of households in Ghana under the NHI policy. The study relies on household data collected from three districts in Ghana covering the 3 ecological zones namely the coastal, forest and savannah. Out of the 1013 who sought care in the previous 4 weeks, 60% were insured and 71% of them sought care from a formal health facility. The results from the multinomial logit estimations show that health insurance and travel time to health facility are significant determinants of health care demand. Overall, compared to the uninsured, the insured are more likely to choose formal health facilities than informal care including self-medication when ill. We discuss the implications of these results as the concept of the NHIS grows widely in Ghana and serves as a good model for other African countries. PMID:25560361

Private health insurance in South Korea: an international comparison.

PubMed

Shin, Jaeun

2012-11-01

The goal of this study is to present the historical and policy background of the expansion of private health insurance in South Korea in the context of the National Health Insurance (NHI) system, and to provide empirical evidence on whether the increased role of private health insurance may counterbalance government financing, social security contributions, out-of-pocket payments, and help stabilize total health care spending. Using OECD Health Data 2011, we used a fixed effects model estimation. In this model, we allow error terms to be serially correlated over time in order to capture the association of private health insurance financing with three other components of health care financing and total health care spending. The descriptive observation of the South Korean health care financing shows that social security contributions are relatively limited in South Korea, implying that high out-of-pocket payments may be alleviated through the enhancement of NHI benefit coverage and an increase in social security contributions. Estimation results confirm that private health insurance financing is unlikely to reduce government spending on health care and social security contributions. We find evidence that out-of-pocket payments may be offset by private health insurance financing, but to a limited degree. Private health insurance financing is found to have a statistically significant positive association with total spending on health care. This indicates that the duplicated coverage effect on service demand may cancel out the potential efficiency gain from market initiatives driven by the active involvement of private health insurance. This study finds little evidence for the benefit of private insurance initiatives in coping with the fiscal challenges of the South Korean NHI program. Further studies on the managerial interplay among public and private insurers and on behavioral responses of providers and patients to a given structure of private-public financing are

National Health Insurance by Regulation: Mandated Employee Benefits,

DTIC Science & Technology

1980-04-01

A0AO95 050 RANW CORP SANTA MONICA CA F/0 S/I1 NATIONAL HEALTH INSURANCE BY REKULATION: MANDATED EMPLOYEE NE-TC(U) APR 80 C E PI4ELPS LICLASSIFIED...31 ! 9 : I NATIONAL HEALTH INSURANCE BY REGULATION: MANDATED EMPLOYEE BENEFITS 1 I. INTRODUCTION Social issues have often been solved...offer a variety of insurance packages to employees , iThis paper was presented at the Conference on "National Health Insurance: Ihat Now, What Later, What

Insurance exchanges under health reform: six design issues for the states.

PubMed

Kingsdale, Jon; Bertko, John

2010-06-01

The Patient Protection and Affordable Care Act depends on new, state-based exchanges to make health insurance readily available to certain segments of the population. One such segment is the lower-income uninsured, who can qualify for subsidized coverage only through an exchange. Other segments are unsubsidized individuals and small employers, who may choose to buy coverage inside or outside of an exchange. Although the law provides some guidance in structuring these new exchanges, it leaves many key decisions to the states. Successfully implementing exchanges will require public-private partnerships, expertise in insurance operations and marketing, and a series of strategic decisions. We review the half-dozen most important design issues.