Barker Abigail R, McBride Timothy D, Kemper Leah M, Mueller Keith
Rural Policy Brief. 2014 May 1(2014 5):1-5.
Key Findings. (1) State-level decisions in implementing the Patient Protection and Affordable Care Act of 2010 (ACA) have led to significant state variation in the design of Health Insurance Marketplace (HIM) rating areas. In some designs, rural counties are grouped together, while in others, rural and urban counties have been deliberately mixed. (2) Urban counties have, on average, approximately one more firm participating in the marketplaces, representing about 11 more plan offerings, than rural counties have. (3) The highest-valued "platinum" plan types are less likely to be available in rural areas. Thus, the overall mix of plan types should be factored into the reporting of average premiums. (4) Levels of competition are likely to have a greater impact on the decisions of firms considering whether to operate in higher-cost areas or not, as those firms must determine how they can pass such costs on to consumers, conditional on the market share they are likely to control.
（1）各州在实施2010年《患者保护与平价医疗法案》（ACA）时所做的决策，导致了健康保险市场（HIM）评级区域设计在各州之间存在显著差异。在某些设计中，农村县被归为一组，而在其他设计中，农村县和城市县被有意混合在一起。（2）平均而言，城市县参与市场的公司比农村县多约一家，这意味着城市县的计划产品比农村县多约11种。（3）价值最高的“白金”计划类型在农村地区更难获得。因此，在报告平均保费时应考虑计划类型的总体组合。（4）竞争水平可能对考虑是否在高成本地区运营的公司决策产生更大影响，因为这些公司必须确定如何在可能控制的市场份额条件下将此类成本转嫁给消费者。
