Providers Paid Substantially Less By Marketplace Nongroup Insurers Than By Employer Small-Group Plans, 2021.

Numerous studies show that employer plans pay providers significantly more than Medicare, but less is known about prices in nongroup plans sold both on and off the Marketplaces established by the Affordable Care Act (ACA), where narrow networks and low-cost insurers are more prevalent. We estimated prices for three market segments (Marketplace nongroup, off-Marketplace nongroup, and employer small group) and three types of services (professional, outpatient hospital, and inpatient hospital) relative to a Medicare benchmark. We used 2021 claims data covering virtually all enrollment in ACA risk-adjusted plans.

How price and quantity factors drive spending in nongroup and employer health plans.

Objectives: To describe how spending in private, nongroup health insurance plans compared to spending in employer plans and to attribute those spending differences to components related to provider prices and quantity of care.

Data Sources: The 2016 commercial claims and enrollment data of three large, national insurers from the Health Care Cost Institute.

Study Design: We compared per member per month spending across three employer and three nongroup market segments, including on-exchange, off-exchange, and short-term plans, to average commercial spending.

American primary care physicians' decisions to leave their practice: evidence from the 2009 commonwealth fund survey of primary care doctors.

The status of the primary care workforce is a major health policy concern. It is affected not only by the specialty choices of young physicians but also by decisions of physicians to leave their practices. This study examines factors that may contribute to such decisions.

Massachusetts health reforms: uninsurance remains low, self-reported health status improves as state prepares to tackle costs.

The Massachusetts health reform initiative enacted into law in 2006 continued to fare well in 2010, with uninsurance rates remaining quite low and employer-sponsored insurance still strong. Access to health care also remained strong, and first-time reductions in emergency department visits and hospital inpatient stays suggested improvements in the effectiveness of health care delivery in the state. There were also improvements in self-reported health status.

Coverage, access, and affordability under health reform: learning from the Massachusetts model.

While the impacts of the Affordable Care Act will vary across the states given their different circumstances, Massachusetts' 2006 reform initiative, the template for national reform, provides a preview of the potential gains in insurance coverage, access to and use of care, and health care affordability for the rest of the nation. Under reform, uninsurance in Massachusetts dropped by more than 50%, due, in part, to an increase in employer-sponsored coverage. Gains in health care access and affordability were widespread, including a 28% decline in unmet need for doctor care and a 38% decline in high out-of-pocket costs.

The impacts of state health reform initiatives on adults in New York and Massachusetts.

Objective: To analyze the effects of health reform efforts in two large states--New York and Massachusetts.

Data Sources/study Setting: National Health Interview Survey (NHIS) data from 1999 to 2008.

Study Design: We take advantage of the "natural experiments" that occurred in New York and Massachusetts to compare health insurance coverage and health care access and use for adults before and after the implementation of the health policy changes.

Sustaining health reform in a recession: an update on Massachusetts as of fall 2009.

With the passage of national health reform legislation modeled on Massachusetts' 2006 reform initiative, the Bay State continues to provide important lessons for the nation. Most recently, Massachusetts has shown that although it is difficult, sustaining the gains of health reform in a severe recession is possible. The state's uninsurance rate, 4.

Massachusetts health reform: employer coverage from employees' perspective.

The national health reform debate continues to draw on Massachusetts' 2006 reform initiative, with a focus on sustaining employer-sponsored insurance. This study provides an update on employers' responses under health reform in fall 2008, using data from surveys of working-age adults. Results show that concerns about employers' dropping coverage or scaling back benefits under health reform have not been realized.

Another Look at the Impacts of Health Reform in Massachusetts: Evidence Using New Data and a Stronger Model.

In April 2006, Massachusetts enacted a comprehensive health care reform bill that seeks to move the state to near universal insurance coverage. The bill included expanded eligibility for public coverage, subsidized insurance, market reforms, requirements for employers, and, most controversial, an individual mandate. A study of the early impacts of the state's initiative found evidence of a substantial drop in uninsurance--from 13 to 7 percent for nonelderly adults (Long 2008).

Trends in Medicaid physician fees, 2003-2008.

Medicaid physician fees increased 15.1 percent, on average, between 2003 and 2008. This was below the general rate of inflation, resulting in a reduction in real fees.