Medical Industry Leadership Institute, University of Minnesota, Carlson School of Management, Department of Finance, Minneapolis, MN 55455, USA.
Health Serv Res. 2013 Apr;48(2 Pt 2):826-49. doi: 10.1111/1475-6773.12036. Epub 2013 Feb 10.
To predict take-up of private health insurance and Medicaid following the U.S. Supreme Court decision upholding the Affordable Care Act (ACA).
Data came from three large employers and a sampling of premiums from ehealthinsurance.com. We supplemented the employer data with information on state Medicaid eligibility and costs from the Kaiser Family Foundation. National predictions were based on the MEPS Household Component.
We estimated a conditional logit model of health plan choice in the large group market. Using the coefficients from the choice model, we predicted take-up in the group and individual health insurance markets. Following ACA implementation, we added choices to the individual market corresponding to plans that will be available in state and federal exchanges. Depending on eligibility for premium subsidies, we reduced the out-of-pocket premiums for those choices. We simulated several possible patterns for states opting out of the Medicaid expansion, as allowed by the Supreme Court.
The ACA will increase coverage substantially in the private insurance market and Medicaid. HSAs will remain desirable in both the individual and employer markets.
If states opt out of the Medicaid expansion, this could increase the federal cost of health reform, while reducing the number of newly covered lives.
预测美国最高法院维持平价医疗法案（ACA）后私人医疗保险和医疗补助（Medicaid）的参保率。
数据来自三家大型雇主和 ehealthinsurance.com 的保费抽样。我们利用 Kaiser Family Foundation 提供的关于州医疗补助资格和费用的信息，补充了雇主数据。全国预测基于 MEPS 家庭组成部分。
我们在大型团体市场中估计了健康计划选择的条件逻辑模型。利用选择模型的系数，我们预测了团体和个人医疗保险市场的参保率。ACA 实施后，我们在个人市场中增加了符合州和联邦交易所提供的计划的选择。根据获得保费补贴的资格，我们降低了这些选择的自付保费。我们模拟了最高法院允许的几种州退出医疗补助扩大范围的模式。
ACA 将大幅增加私人保险市场和医疗补助的参保率。在个人和雇主市场中，HSA 仍将受到欢迎。
如果各州选择不扩大医疗补助范围，这可能会增加医改的联邦成本，同时减少新覆盖的参保人数。
