Eibner Christine, Girosi Federico, Price Carter C, McGlynn Elizabeth A
Rand Health Q. 2011 Sep 1;1(3):16. eCollection 2011 Fall.
The Patient Protection and Affordable Care Act (PPACA), signed into law by President Barack Obama on March 23, 2010, will introduce new health insurance options for many Americans. While PPACA will alter the health insurance options available to many people, one of the goals of the law is to enable Americans to keep the coverage they currently have if they choose to do so. In an effort to ensure that current coverage options do not change, PPACA exempts existing health insurance plans from certain regulations, a policy known as "grandfathering." Newly offered plans, including plans available through state health insurance exchanges, are not eligible for grandfathering. This paper uses the Comprehensive Assessment of Reform Efforts (COMPARE) microsimulation model to analyze the effects that grandfathering in the small group market will have on outcomes, including the percentage of small firms (with 100 or fewer workers) offering coverage, premium prices in the grandfathered market and in the exchanges, the total number of people enrolled in health insurance coverage, and the number of people enrolled in exchange-based health insurance plans. Results suggest that, while grandfathering may lead to slightly higher exchange premiums, grandfathering is also associated with higher employer-sponsored insurance enrollment and lower government spending. Therefore, grandfathering may be an effective policy if the goal is to maximize the number of people enrolled in employment-based coverage.
2010年3月23日，巴拉克·奥巴马总统签署成为法律的《患者保护与平价医疗法案》（PPACA）将为许多美国人引入新的医疗保险选择。虽然PPACA会改变许多人可获得的医疗保险选择，但该法律的目标之一是让美国人能够在愿意的情况下保留他们目前拥有的保险。为确保现有保险选择不变，PPACA将现有医疗保险计划豁免于某些规定，这一政策被称为“沿用”。新提供的计划，包括通过州医疗保险交易所提供的计划，无资格沿用。本文使用改革努力综合评估（COMPARE）微观模拟模型，来分析小团体市场中的沿用对各项结果的影响，包括提供保险的小公司（员工人数为100人或更少）的比例、沿用市场和交易所中的保费价格、参加医疗保险的总人数，以及参加基于交易所的医疗保险计划的人数。结果表明，虽然沿用可能导致交易所保费略有上涨，但沿用也与更高的雇主赞助保险参保率和更低的政府支出相关。因此，如果目标是使参加基于就业的保险的人数最大化，沿用可能是一项有效的政策。
