Health Aff (Millwood). 2013 Sep;32(9):1531-7. doi: 10.1377/hlthaff.2013.0522.
The Affordable Care Act will expand insurance coverage to more than twenty-five million Americans, partly through subsidized private insurance available from newly created health insurance exchanges for people with incomes of 133-400 percent of the federal poverty level. The act will alter the financial incentive structure for employers and influence their decisions on whether or not to offer their employees coverage. These decisions, in turn, will affect federal outlays and revenues through several mechanisms. We model the sensitivity of federal costs for the insurance exchange coverage provision of the Affordable Care Act using the nationally representative Medical Expenditure Panel Survey data set. We assess revenues and subsidy outlays for premiums and cost sharing for individuals purchasing private insurance through exchanges. Our findings show that changing theoretical premium contribution levels by just $100 could induce 2.25 million individuals to transition to exchanges and increase federal outlays by $6.7 billion. Policy makers and analysts should pay especially careful attention to participation rates as the act's implementation continues.
平价医疗法案将为超过 2500 万美国人扩大保险范围，部分通过为收入在联邦贫困线 133-400%之间的人设立的新医疗保险交易所提供补贴私人保险来实现。该法案将改变雇主的经济激励结构，并影响他们是否为员工提供保险的决定。这些决定反过来将通过多种机制影响联邦支出和收入。我们使用具有全国代表性的医疗支出面板调查数据集来模拟平价医疗法案中保险交易所保险范围规定的联邦成本的敏感性。我们评估了通过交易所购买私人保险的个人的保费和费用分担的收入和补贴支出。我们的研究结果表明，仅将理论保费贡献水平提高 100 美元，就可能促使 225 万人转向交易所，并使联邦支出增加 67 亿美元。随着该法案的实施继续，政策制定者和分析人士应特别注意参与率。
