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The CBO's Crystal Ball: How Well Did It Forecast the Effects of the Affordable Care Act? 国会预算办公室的水晶球:它对平价医疗法案影响的预测有多好?
LDI issue brief Pub Date : 2015-12-01 DOI: 10.15868/socialsector.25056
S. Glied, Anupama Arora, C. Solís-Román
{"title":"The CBO's Crystal Ball: How Well Did It Forecast the Effects of the Affordable Care Act?","authors":"S. Glied, Anupama Arora, C. Solís-Román","doi":"10.15868/socialsector.25056","DOIUrl":"https://doi.org/10.15868/socialsector.25056","url":null,"abstract":"The Congressional Budget Office (CBO), a nonpartisan agency of Congress, made official projections of the Affordable Care Act's impact on insurance coverage rates and the costs of providing subsidies to consumers purchasing health plans in the insurance marketplaces. This analysis finds that the CBO overestimated marketplace enrollment by 30 percent and marketplace costs by 28 percent, while it underestimated Medicaid enrollment by about 14 percent. Nonetheless, the CBO's projections were closer to realized experience than were those of many other prominent forecasters. Moreover, had the CBO correctly anticipated income levels and health care prices in 2014, its estimate of marketplace enrollment would have been within 18 percent of actual experience. Given the likelihood of additional reforms to national health policy in future years, it is reassuring that, despite the many unforeseen factors surrounding the law's rollout and participation in its reforms, the CBO's forecast was reasonably accurate.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"15 1","pages":"1-13"},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84934124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 7
Evaluating the Impact of Health Insurance Industry Consolidation: Learning from Experience. 评估健康保险业整合的影响:从经验中学习。
LDI issue brief Pub Date : 2015-11-01 DOI: 10.15868/SOCIALSECTOR.25054
Leemore S. Dafny
{"title":"Evaluating the Impact of Health Insurance Industry Consolidation: Learning from Experience.","authors":"Leemore S. Dafny","doi":"10.15868/SOCIALSECTOR.25054","DOIUrl":"https://doi.org/10.15868/SOCIALSECTOR.25054","url":null,"abstract":"Research shows consolidation in the private health insurance industry leads to premium increases, even though insurers with larger local market shares generally obtain lower prices from health care providers. Additional research is needed to understand how to protect against harms and unlock benefits from scale. Data on enrollment, premiums, and costs of commercial health insurance--by insurer, plan, customer segment, and local market--would help us understand whether, when, and for whom consolidation is harmful or beneficial. Such transparency is common where there is a strong public interest and substantial public regulation, both of which characterize this vital sector.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"491 1","pages":"1-11"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80276524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 36
How High is America's Health Care Cost Burden? Findings from the Commonwealth Fund Health Care Affordability Tracking Survey, July-August 2015. 美国的医疗保健成本负担有多高?2015年7月至8月，联邦基金卫生保健可负担性跟踪调查结果。
LDI issue brief Pub Date : 2015-11-01 DOI: 10.15868/socialsector.25053
S. Collins, Munira Z. Gunja, M. Doty, Sophie Buetel
{"title":"How High is America's Health Care Cost Burden? Findings from the Commonwealth Fund Health Care Affordability Tracking Survey, July-August 2015.","authors":"S. Collins, Munira Z. Gunja, M. Doty, Sophie Buetel","doi":"10.15868/socialsector.25053","DOIUrl":"https://doi.org/10.15868/socialsector.25053","url":null,"abstract":"One-quarter of privately insured working-age adults have high health care cost burdens relative to their incomes in 2015, according to the Commonwealth Fund Health Care Affordability Index, a comprehensive measure of consumer health care costs. This figure, which is based on a nationally representative sample of people with private insurance who are mainly covered by employer plans, is statistically unchanged from 2014. When looking specifically at adults with low incomes, more than half have high cost burdens. In addition, when privately insured adults were asked how they rated their affordability, greater shares reported their premiums and deductible costs were difficult or impossible to afford than the Index would suggest. Health plan deductibles and copayments had negative effects on many people's willingness to get needed health care or fill prescriptions. In addition, many consumers are confused about which services are free to them and which count toward their deductible.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"28 1","pages":"1-15"},"PeriodicalIF":0.0,"publicationDate":"2015-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82607833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 19
Models of Care for High-Need, High-Cost Patients: An Evidence Synthesis. 高需求、高成本患者的护理模式:证据综合。
LDI issue brief Pub Date : 2015-10-29 DOI: 10.15868/socialsector.25052
D. McCarthy, Jamie Ryan, S. Klein
{"title":"Models of Care for High-Need, High-Cost Patients: An Evidence Synthesis.","authors":"D. McCarthy, Jamie Ryan, S. Klein","doi":"10.15868/socialsector.25052","DOIUrl":"https://doi.org/10.15868/socialsector.25052","url":null,"abstract":"This brief analyzes experts' reviews of evidence about care models designed to improve outcomes and reduce costs for patients with complex needs. It finds that successful models have several common attributes: targeting patients likely to benefit from the intervention; comprehensively assessing patients' risks and needs; relying on evidence-based care planning and patient monitoring; promoting patient and family engagement in self-care; coordinating care and communication among patients and providers; facilitating transitions from the hospital and referrals to community resources; and providing appropriate care in accordance with patients' preferences. Overall, the evidence of impact is modest and few of these models have been widely adopted in practice because of barriers, such as a lack of supportive financial incentives under fee-for-service reimbursement arrangements. Overcoming these challenges will be essential to achieving a higher-performing health care system for this patient population.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"34 1","pages":"1-19"},"PeriodicalIF":0.0,"publicationDate":"2015-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84822992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 114
U.S. health care from a global perspective: spending, use of services, prices, and health in 13 countries. 全球视角下的美国医疗保健:13个国家的支出、服务使用、价格和健康。
LDI issue brief Pub Date : 2015-10-01 DOI: 10.15868/socialsector.25051
D. Squires, Chloe Anderson
{"title":"U.S. health care from a global perspective: spending, use of services, prices, and health in 13 countries.","authors":"D. Squires, Chloe Anderson","doi":"10.15868/socialsector.25051","DOIUrl":"https://doi.org/10.15868/socialsector.25051","url":null,"abstract":"This analysis draws upon data from the Organization for Economic Cooperation and Development and other cross-national analyses to compare health care spending, supply, utilization, prices, and health outcomes across 13 high-income countries: Australia, Canada, Denmark, France, Germany, Japan, Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. These data predate the major insurance provisions of the Affordable Care Act. In 2013, the U.S. spent far more on health care than these other countries. Higher spending appeared to be largely driven by greater use of medical technology and higher health care prices, rather than more frequent doctor visits or hospital admissions. In contrast, U.S. spending on social services made up a relatively small share of the economy relative to other countries. Despite spending more on health care, Americans had poor health outcomes, including shorter life expectancy and greater prevalence of chronic conditions.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"47 1","pages":"1-15"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85689740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 237
How Strong Is the Primary Care Safety Net? Assessing the Ability of Federally Qualified Health Centers to Serve as Patient-Centered Medical Homes. 初级保健安全网有多强?评估联邦合格医疗中心作为以病人为中心的医疗之家的能力。
LDI issue brief Pub Date : 2015-09-03 DOI: 10.15868/socialsector.25047
Jamie Ryan, P. Riley, M. Abrams, Robert S. Nocon
{"title":"How Strong Is the Primary Care Safety Net? Assessing the Ability of Federally Qualified Health Centers to Serve as Patient-Centered Medical Homes.","authors":"Jamie Ryan, P. Riley, M. Abrams, Robert S. Nocon","doi":"10.15868/socialsector.25047","DOIUrl":"https://doi.org/10.15868/socialsector.25047","url":null,"abstract":"By expanding access to affordable insurance coverage for millions of Americans, the Affordable Care Act will likely increase demand for the services provided by federally qualified health centers (FQHCs), which provide an important source of care in low-income communities. A pair of Commonwealth Fund surveys asked health center leaders about their ability to function as medical homes. Survey findings show that between 2009 and 2013, the percentage of centers exhibiting medium or high levels of medical home capability almost doubled, from 32 percent to 62 percent. The greatest improvement was reported in patient tracking and care management. Despite this increased capability, health centers reported diminished ability to coordinate care with providers outside of the practice, particularly specialists. Ongoing federal funding and technical support for medical home transformation will be needed to ensure that FQHCs can fulfill their mission of providing high-quality, comprehensive care to low-income and minority populations.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"21 1","pages":"1-13"},"PeriodicalIF":0.0,"publicationDate":"2015-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79527960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 11
Are Marketplace Plans Affordable? Consumer Perspectives from the Commonwealth Fund Affordable Care Act Tracking Survey, March-May 2015. 市场计划是否负担得起?2015年3月至5月联邦基金平价医疗法案跟踪调查的消费者观点。
LDI issue brief Pub Date : 2015-09-01 DOI: 10.15868/socialsector.25049
S. Collins, Munira Z. Gunja, P. Rasmussen, M. Doty, S. Beutel
{"title":"Are Marketplace Plans Affordable? Consumer Perspectives from the Commonwealth Fund Affordable Care Act Tracking Survey, March-May 2015.","authors":"S. Collins, Munira Z. Gunja, P. Rasmussen, M. Doty, S. Beutel","doi":"10.15868/socialsector.25049","DOIUrl":"https://doi.org/10.15868/socialsector.25049","url":null,"abstract":"Most employers who provide health insurance to employees subsidize their premiums and provide a comprehensive benefit package. Before the Affordable Care Act, people who lacked health insurance through a job and purchased it on their own paid the full cost of their plans, which often came with skimpy benefit packages and high deductibles. Findings from the Commonwealth Fund Affordable Care Act Tracking Survey, March--May 2015, indicate that the law's tax credits have made premium costs in health plans sold through the marketplaces roughly comparable to employer plans, at least for people with low and moderate incomes. At higher incomes, the phase-out of the subsidies means that adults in marketplace plans have higher premium costs than those in employer plans. Overall, larger shares of adults in marketplace plans reported deductibles of $1,000 or more, compared with those in employer plans, though these differences were narrower among low-and moderate-income adults.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"110 1","pages":"1-13"},"PeriodicalIF":0.0,"publicationDate":"2015-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79806229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
The Experiences of State-Run Insurance Marketplaces That Use HealthCare.gov. 使用HealthCare.gov的国营保险市场的经验。
LDI issue brief Pub Date : 2015-09-01 DOI: 10.15868/socialsector.25048
Justin Giovannelli, Kevin W Lucia
{"title":"The Experiences of State-Run Insurance Marketplaces That Use HealthCare.gov.","authors":"Justin Giovannelli, Kevin W Lucia","doi":"10.15868/socialsector.25048","DOIUrl":"https://doi.org/10.15868/socialsector.25048","url":null,"abstract":"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.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"120 1","pages":"1-11"},"PeriodicalIF":0.0,"publicationDate":"2015-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82517967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
To Enroll or Not to Enroll? Why Many Americans Have Gained Insurance Under the Affordable Care Act While Others Have Not. Findings from the Commonwealth Fund Affordable Care Act Tracking Survey, March-May 2015. 报名还是不报名?为什么许多美国人在平价医疗法案下获得了保险，而其他人却没有。联邦基金平价医疗法案跟踪调查结果，2015年3月至5月。
LDI issue brief Pub Date : 2015-09-01 DOI: 10.15868/socialsector.25050
S. Collins, Munira Z. Gunja, M. Doty, S. Beutel
{"title":"To Enroll or Not to Enroll? Why Many Americans Have Gained Insurance Under the Affordable Care Act While Others Have Not. Findings from the Commonwealth Fund Affordable Care Act Tracking Survey, March-May 2015.","authors":"S. Collins, Munira Z. Gunja, M. Doty, S. Beutel","doi":"10.15868/socialsector.25050","DOIUrl":"https://doi.org/10.15868/socialsector.25050","url":null,"abstract":"According to the most recent Commonwealth Fund Affordable Care Act Tracking Survey, March-May 2015, an estimated 25 million adults remain uninsured. To achieve the Affordable Care Act's goal of near-universal coverage, policymakers must understand why some people are enrolling in the law's marketplace plans or in Medicaid coverage and why others are not. This analysis of the survey finds that affordability--whether real or perceived--is playing a significant role in adults' choice of marketplace plans and the decision whether to enroll at all. People who have gained coverage report significantly more positive experiences shopping for health plans than do those who did not enroll. Getting personal assistance--from telephone hotlines, navigators, and insurance brokers, among other sources--appears to make a critical difference in whether people gain health insurance","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"89 ","pages":"1-13"},"PeriodicalIF":0.0,"publicationDate":"2015-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73035398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 11
Competition Among Medicare's Private Health Plans: Does It Really Exist? 医疗保险私人健康计划之间的竞争:真的存在吗?
LDI issue brief Pub Date : 2015-08-25 DOI: 10.15868/socialsector.25046
B. Biles, Giselle Casillas, S. Guterman
{"title":"Competition Among Medicare's Private Health Plans: Does It Really Exist?","authors":"B. Biles, Giselle Casillas, S. Guterman","doi":"10.15868/socialsector.25046","DOIUrl":"https://doi.org/10.15868/socialsector.25046","url":null,"abstract":"Competition among private Medicare Advantage (MA) plans is seen by some as leading to lower premiums and expanded benefits. But how much competition exists in MA markets? Using a standard measure of market competition, our analysis finds that 97 percent of markets in U.S. counties are highly concentrated and therefore lacking in significant MA plan competition. Competition is considerably lower in rural counties than in urban ones. Even among the 100 counties with the greatest numbers of Medicare beneficiaries, 81 percent do not have competitive MA markets. Market power is concentrated among three nationwide insurance organizations in nearly two-thirds of those 100 counties.","PeriodicalId":85087,"journal":{"name":"LDI issue brief","volume":"8 1","pages":"1-14"},"PeriodicalIF":0.0,"publicationDate":"2015-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82525124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
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