RAND Corporation.
J Health Polit Policy Law. 2011 Oct;36(5):859-77. doi: 10.1215/03616878-1407658. Epub 2011 Jul 22.
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.
可负担性是医疗改革成功的关键，旨在确保全民获得医疗保险覆盖，而可负担性的确定对政策和实践都有重大影响。本文描述了三个州在扩大儿童健康保险计划（CHIP）以普及青年保险覆盖范围时，影响可负担性基准和保费缴纳要求确定的因素。还比较了这些州制定的补贴水平与平价医疗法案（ACA）下通过交易所购买的医疗保险计划的保费补贴计划。我们发现，三个州的儿童保险保费缴纳要求在家庭收入中所占比例存在相当大的差异，制定的保费缴纳计划在累进性和倒退性方面也存在差异。这些发现强调了可负担性标准的模糊性和主观性。此外，我们的分析表明，尽管平价医疗法案提高了收入低于联邦贫困线 400%的家庭的家庭保险的可负担性，但未来五到十年 CHIP 的发展将继续对低收入家庭产生重大影响。
