Tuesday, December 29, 2015

Marketplace watch: ACA year in review

As an amateur student of U.S. healthcare, I'm always conscious that I'm talking to (and reading) people who know far, far more than I do.  And I wish I knew how to locate and talk to more marketplace and Medicaid enrollees about their experiences. Perhaps that can be my resolution for 2016.

That said, by carefully reading sources I've come to trust (and studies they recommend), and burrowing into a few preoccupations (CSR, anyone?), I do think I've managed to bring a few important points to light or into focus in the past year. Chief among them may be the extent to which enrollees who should have been Medicaid-eligible propped up the private plan marketplace in states that refused the Medicaid expansion; the extent to which the uninsured were concentrated in low income bands where ACA offerings have been most effective; the various ways in which subsidy-eligible uninsured people may have got the impression they were ineligbile for aid; the extent to which news coverage and even sophisticated research misses the effects of Cost Sharing Reduction; and the extent to which exchange design affects CSR takeup.

A lot of my 'discoveries' are surely obvious to those who closely study healthcare or work at implementing the ACA. But it may not be obvious to them that the points need highlighting. Below are a few of those highlights from 2015. Thanks for reading!

Dollars to donut holes, Ambetter undercuts the competition (11/20)
     Cut-rate insurers with roots in Medicaid managed care are driving down benchmark premiums in some major markets

The counter-Upshot: Obamacare is quite as egalitarian as it seems (11/20)
     Most of America's uninsured have incomes below 250% of the Federal Poverty Level

Supporting the biggest decision for ACA marketplace shoppers (11/3)
     That would be whether to access or forgo Cost Sharing Reduction subsidies

Surprise! Where silver plans are cheaper, more people buy them (10/24)
     Californians are very price sensitive. Bonus: a 2-county case study.

"Are Marketplace plans affordable?" (9/28)
     Most, yes. But too many aren't. Some sidelights on a Commonwealth Fund survey.

A quibble with Avalere over CSR takeup (8/28)
    Don't cross the CSR czar

Underinsured and deep in debt: Which cracks did this family fall through?  (8/4)
     I was right about this: I'm told that the children in question are now in CHIP. Hooray!

My call on King v. Burwell  (6/25)
     That reason prevailed wasn't entirely surprising

Underinsurance: What's offsetting the rise in deductibles? (5/27)
     Something is.

Scrap the ACA's awkward dual subsidy system? (4/24)
     Richard Mayhew and I have batted around ways to give ACA shoppers more viable low-cost choices

A reduced ACA spending projection that no one should celebrate (3/12)
   Spending on Cost Sharing Reduction is coming in under budget. That's a shame.

Love in the time of ObamaCare (2/12)
    A valentine for the ACA

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