Fung Vicki, Liang Catherine Y, Donelan Karen, Peitzman Cassandra G K, Dow William H, Zaslavsky Alan M, Fireman Bruce, Derose Stephen F, Chernew Michael E, Newhouse Joseph P, Hsu John
Vicki Fung (
Catherine Y. Liang is a research assistant at the Mongan Institute Health Policy Center, Massachusetts General Hospital.
Health Aff (Millwood). 2017 Jan 1;36(1):21-31. doi: 10.1377/hlthaff.2016.0472.
The Affordable Care Act includes financial assistance that reduces both premiums and cost-sharing amounts for lower-income Americans, to increase the affordability of health insurance coverage and care. To receive both types of assistance, enrollees must purchase a qualified health plan through a public insurance exchange, and those eligible for the cost-sharing reduction must purchase a silver-tier plan. We estimate that 31 percent of individual-market enrollees in California who were likely eligible for financial assistance purchased plans that were not silver tier or that were not sold on the state's exchange and thus missed opportunities to receive premium or cost-sharing assistance or both. Lower-income enrollees who chose plans not eligible for subsidies had two to three times higher odds of reporting difficulty paying premiums and out-of-pocket expenses during the year, compared to those who chose eligible plans. Regardless of how the structure of the individual market evolves in the coming years, efforts are likely needed to steer lower-income enrollees away from financially suboptimal plan choices.
《平价医疗法案》提供了经济援助，以降低低收入美国人的保险费和费用分担金额，从而提高医疗保险覆盖范围和医疗服务的可承受性。要获得这两种援助，参保人必须通过公共保险交易所购买符合条件的健康保险计划，而符合费用分担减免条件的人必须购买白银级计划。我们估计，加利福尼亚州个人保险市场中可能有资格获得经济援助的参保人中有31%购买了非白银级计划或未在该州交易所出售的计划，因此错失了获得保费或费用分担援助或两者的机会。与选择符合条件计划的参保人相比，选择不符合补贴条件计划的低收入参保人在当年报告支付保费和自付费用困难的几率高出两到三倍。无论未来几年个人保险市场的结构如何演变，都可能需要做出努力，引导低收入参保人避免做出在经济上并非最优的计划选择。
