Premium tax credits in the American Rescue Plan and off-marketplace enrollees.

Objectives: The 2021 American Rescue Plan Act (ARPA) increased the availability and magnitude of premium tax credits (PTCs) for consumers purchasing individual marketplace plans in 2021-2022. Millions currently purchase PTC-ineligible plans off of the marketplace. We estimate the proportion of off-marketplace enrollees who would be eligible for the expanded PTCs under ARPA, calculate PTC amounts for eligible enrollees, and examine factors influencing plan choice that could inform outreach efforts.

Growth In ACA-Compliant Marketplace Enrollment And Spending Risk Changes During The COVID-19 Pandemic.

In 2020 the COVID-19 pandemic caused millions to lose their jobs and, consequently, their employer-sponsored health insurance. Enacted in 2010, the Affordable Care Act (ACA) created safeguards for such events by expanding Medicaid coverage and establishing Marketplaces through which people could purchase health insurance. Using a novel national data set with information on ACA-compliant individual insurance plans, we found large increases in Marketplace enrollment in 2020 compared with 2019 but with varying percentage increases and spending risk implications across states.

Sorting Out the Health Risk in California's State-Based Marketplace.

Objective: To characterize the health risk of enrollees in California's state-based insurance marketplace (Covered California) by metal tier, region, month of enrollment, and plan.

Data Source/study Setting: 2014 Open-enrollment data from Covered California linked with 2012 hospitalization and emergency department (ED) visit records from statewide all-payer administrative databases.

Data Collection/extraction Methods: Chronic Illness and Disability Payment System (CDPS) health risk scores derived from an individual's age and sex from the enrollment file and the diagnoses captured in the hospitalization and ED records.

Increase the Use of "Bundled" Payment Approaches.

This article explores how increased use of bundled payment approaches would affect health system performance along seven dimensions. Bundled payment approaches have the potential to reduce spending, consumer financial risk, and waste. Evidence is mixed regarding how these approaches would affect health.

Bending the curve through health reform implementation.

In September 2009, we released a set of concrete, feasible steps that could achieve the goal of significantly slowing spending growth while improving the quality of care. We stand by these recommendations, but they need to be updated in light of the new Patient Protection and Affordable Care Act (ACA). Reducing healthcare spending growth remains an urgent and unresolved issue, especially as the ACA expands insurance coverage to 32 million more Americans.

Building regulatory and operational flexibility into accountable care organizations and 'shared savings'.

The Affordable Care Act created accountable care organizations (ACOs), which will be a new part of Medicare as of January 2012, together with a "shared savings program" that will modify how these organizations will be paid to care for patients. Accountable care organizations have the potential to lower costs, improve the quality of care, facilitate delivery system reform, and promote innovation in health care. The federal government is set to create rules to regulate these organizations and has broad discretion to allow them to pursue a variety of approaches.

Fixing flaws in Medicare drug coverage that prompt insurers to avoid low-income patients.

Since 2006 numerous insurers have stopped serving the low-income segment of the Medicare Part D program, forcing millions of beneficiaries to change prescription drug plans. Using data from participating plans, we found that Medicare payments do not sufficiently reimburse insurers for the relatively high medication use among this population, creating perverse incentives for plans to avoid this part of the Part D market. Plans can accomplish this by increasing their premiums for all beneficiaries to an amount above regional benchmarks.

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

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.

The Accountable Care Organization (ACO) model: building blocks for success.

The Accountable Care Organization (ACO) model has received significant attention among policymakers and leaders in the healthcare community in the context of the ongoing debate over health reform, not only because of the unsustainable path on which the country now finds itself but also because it directly focuses on what must be a key goal of the healthcare system: higher value. The model offers a promising approach for achieving this goal. This article provides an overview of the ACO model and its role in the current policy context, highlights the key elements that will be common to all ACOs, and provides details of several challenges that may arise throughout the implementation process, including a host of technical, legal, and operational challenges.

Toward a 21st-century health care system: recommendations for health care reform.

The coverage, cost, and quality problems of the U.S. health care system are evident.

Fostering accountable health care: moving forward in medicare.

To succeed, health care reform must slow spending growth while improving quality. We propose a new approach to help achieve more integrated and efficient care by fostering local organizational accountability for quality and costs through performance measurement and "shared savings" payment reform. The approach is practical and feasible: it is voluntary for providers, builds on current referral patterns, requires no change in benefits or lock-in for beneficiaries, and offers the possibility of sustained provider incomes even as total costs are constrained.

Distributing $800 billion: an early assessment of Medicare Part D risk adjustment.

The viability and stability of the Medicare Part D prescription drug program depend on accurate risk-adjusted payments. The current approach, prescription drug hierarchical condition categories (RxHCCs), uses diagnosis and demographic information to predict future drug costs. We evaluated the performance of multiple approaches for predicting 2006 Part D drug costs and plan liability.

Variation in use of medical care services: higher risk or higher consumption?

The issue of variation in use of medical care is important in Florida and in other regions of the country. It is difficult to disaggregate the effects of differences in health risk of Medicare beneficiaries from physicians' practice patterns and patients' preferences for care. New risk-adjustment methods used by the Centers for Medicare and Medicaid Services may provide some insights, but they also raise similar questions about the influence of practice patterns on variation.

Early experience with employee choice of consumer-directed health plans and satisfaction with enrollment.

Objective: To assess the initial impact of offering consumer-defined health plan (CDHP) options on employees.

Data Sources/study Setting: A mail survey of 4,680 employees in the corporate offices of Humana Inc. in June 2001.