Fulton Brent D, Hollingshead Ann, Karaca-Mandic Pinar, Scheffler Richard M
University of California, Berkeley, Berkeley, USA
University of California, Berkeley, Berkeley, USA.
Inquiry. 2015 Sep 21;52. doi: 10.1177/0046958015604164. Print 2015.
The Affordable Care Act (ACA) included financial and regulatory incentives and goals for states to bolster their health insurance rate review programs, increase their anticipated loss ratio requirements, expand Medicaid, and establish state-based exchanges. We grouped states by political party control and compared their reactions across these policy goals. To identify changes in states' rate review programs and anticipated loss ratio requirements in the individual and small group markets since the ACA's enactment, we conducted legal research and contacted each state's insurance regulator. We linked rate review program changes to the Centers for Medicare and Medicaid Services' (CMS) criteria for an effective rate review program. We found, of states that did not meet CMS's criteria when the ACA was enacted, most made changes to meet those criteria, including Republican-controlled states, which generally oppose the ACA. This finding is likely the result of the relatively low administrative burden associated with reviewing health insurance rates and the fact that doing so prevents federal intervention in rate review. However, Republican-controlled states were less likely than non-Republican-controlled states to increase their anticipated loss ratio requirements to align with the federal retrospective medical loss ratio requirement, expand Medicaid, and establish state-based exchanges, because of their general opposition to the ACA. We conclude that federal incentives for states to strengthen their health insurance rate review programs were more effective than the incentives for states to adopt other insurance-related policy goals of the ACA.
《平价医疗法案》（ACA）包含了财政和监管方面的激励措施及目标，促使各州加强其健康保险费率审查计划、提高预期损失率要求、扩大医疗补助计划，并建立基于州的医保交易所。我们按政党控制情况对各州进行了分组，并比较了它们在这些政策目标上的反应。为确定自《平价医疗法案》颁布以来各州在个人和小团体市场的费率审查计划及预期损失率要求的变化，我们进行了法律研究并联系了每个州的保险监管机构。我们将费率审查计划的变化与医疗保险和医疗补助服务中心（CMS）关于有效费率审查计划的标准联系起来。我们发现，在《平价医疗法案》颁布时不符合CMS标准的州中，大多数州都进行了改变以符合这些标准，包括通常反对《平价医疗法案》的共和党控制的州。这一发现可能是由于审查健康保险费率的行政负担相对较低，以及这样做可防止联邦政府干预费率审查。然而，由于共和党控制的州普遍反对《平价医疗法案》，它们比非共和党控制的州更不太可能提高其预期损失率要求以符合联邦追溯医疗损失率要求、扩大医疗补助计划并建立基于州的医保交易所。我们得出结论，联邦政府对各州加强其健康保险费率审查计划的激励措施比对各州采纳《平价医疗法案》其他与保险相关政策目标的激励措施更有效。
