Krinn Kelly, Karaca-Mandic Pinar, Blewett Lynn A
Kelly Krinn is a recent graduate of the master of public policy program at the Humphrey School of Public Affairs, University of Minnesota, in Minneapolis.
Pinar Karaca-Mandic (
Health Aff (Millwood). 2015 Jan;34(1):161-9. doi: 10.1377/hlthaff.2014.0627. Epub 2014 Dec 17.
The state-based and federally facilitated health insurance Marketplaces, or exchanges, enrolled more than eight million people during the first open enrollment period, which ended March 31, 2014. There is significant variation in how states have designed and implemented their Marketplaces. We examined how premiums varied with states' involvement in the Marketplaces through governance, plan management authority, and strategy during the first year that the exchanges have been open. State-based Marketplaces using "clearinghouse" plan management models had significantly lower adjusted average premiums for all plans within each metal level compared to state-based Marketplaces using "active purchaser" models and the federally facilitated and partnership Marketplaces. Clearinghouse management models are those in which all health plans that meet published criteria are accepted. Active purchaser models are those in which states negotiate premiums, provider networks, number of plans, and benefits. Our baseline estimates provide valuable benchmarks for evaluating future performance of states' involvement in governance, plan management, and regulatory authority of the insurance Marketplaces.
基于州和由联邦政府推动的医疗保险市场，即保险交易所，在2014年3月31日结束的首个开放注册期内，有超过800万人参保。各州在设计和实施其保险市场方面存在显著差异。我们研究了在保险交易所开放的第一年里，保费如何随各州通过治理、计划管理权限和战略对保险市场的参与程度而变化。与采用“主动购买者”模式的州立保险市场以及联邦政府推动的保险市场和合作保险市场相比，采用“票据交换所”计划管理模式的州立保险市场在每个金属等级内所有计划的调整后平均保费显著更低。票据交换所管理模式是指接受所有符合公布标准的健康保险计划的模式。主动购买者模式是指各州就保费、供应商网络、计划数量和福利进行谈判的模式。我们的基线估计为评估各州在保险市场治理、计划管理和监管权限方面的参与程度的未来表现提供了有价值的基准。
