Hall Mark A, McCue Michael J, Palazzolo Jennifer R
1 Wake Forest University, Winston-Salem, NC, USA.
2 Virginia Commonwealth University, Richmond, VA, USA.
Med Care Res Rev. 2018 Jun;75(3):384-393. doi: 10.1177/1077558717697013. Epub 2017 Mar 6.
Many insurers incurred financial losses in individual markets for health insurance during 2014, the first year of Affordable Care Act mandated changes. This analysis looks at key financial ratios of insurers to compare profitability in 2014 and 2013, identify factors driving financial performance, and contrast the financial performance of health insurers operating in state-run exchanges versus the federal exchange. Overall, the median loss of sampled insurers was -3.9%, no greater than their loss in 2013. Reduced administrative costs offset increases in medical losses. Insurers performed better in states with state-run exchanges than insurers in states using the federal exchange in 2014. Medical loss ratios are the underlying driver more than administrative costs in the difference in performance between states with federal versus state-run exchanges. Policy makers looking to improve the financial performance of the individual market should focus on features that differentiate the markets associated with state-run versus federal exchanges.
在《平价医疗法案》规定的变革实施的第一年，即2014年，许多保险公司在个人医疗保险市场遭受了财务损失。本分析着眼于保险公司的关键财务比率，以比较2014年和2013年的盈利能力，确定推动财务表现的因素，并对比在州立交易所运营的健康保险公司与联邦交易所运营的健康保险公司的财务表现。总体而言，抽样保险公司的中位数损失为-3.9%，不高于2013年的损失。行政成本的降低抵消了医疗损失的增加。2014年，在有州立交易所的州，保险公司的表现优于使用联邦交易所的州的保险公司。在联邦交易所与州立交易所所在州的表现差异中，医疗损失率比行政成本更是根本驱动因素。希望改善个人市场财务表现的政策制定者应关注区分州立交易所与联邦交易所相关市场的特征。
