Cathy Schoen (
Sara R. Collins is vice president for affordable health insurance at the Commonwealth Fund, in New York City.
Health Aff (Millwood). 2017 Dec;36(12):2185-2194. doi: 10.1377/hlthaff.2017.0858.
The five largest US commercial health insurance companies together enroll 125 million members, or 43 percent of the country's insured population. Over the past decade these insurers have become increasingly dependent for growth and profitability on public programs, according to an analysis of corporate reports. In 2016 Medicare and Medicaid accounted for nearly 60 percent of the companies' health care revenues and 20 percent of their comprehensive plan membership. Although headlines have focused on losses in the state Marketplaces created by the Affordable Care Act (ACA), the Marketplaces represent only a small fraction of insurers' members. Overall, the five largest insurers have remained profitable since passage of the ACA as a result of profits in other market segments. Notably, companies with significant Medicare or Medicaid enrollment have continued to insure beneficiaries in states where the insurers do not participate in Marketplaces. Given the insurers' dependence on public programs, there is potential to improve access if federal or state governments, or both, required insurers that participate in Medicare or Medicaid to also participate in the Marketplaces in the same geographic area. Such requirements could ensure more viable and less volatile insurance, benefiting people insured within each market as well as those who cycle on and off public and private insurance.
美国最大的五家商业健康保险公司共承保了 1.25 亿名成员，占美国参保人口的 43%。根据对企业报告的分析，在过去十年中，这些保险公司的增长和盈利能力越来越依赖公共项目。2016 年，医疗保险和医疗补助计划占这些公司医疗保健收入的近 60%，占其综合计划成员的 20%。尽管头条新闻一直关注平价医疗法案（ACA）创建的州市场的亏损，但这些市场仅占保险公司成员的一小部分。总体而言，自 ACA 通过以来，由于其他市场领域的利润，这五家最大的保险公司一直保持盈利。值得注意的是，在保险公司不参与市场的州，那些有大量医疗保险或医疗补助计划的公司继续为受益人提供保险。鉴于保险公司对公共项目的依赖，如果联邦或州政府（或两者）要求参与医疗保险或医疗补助计划的保险公司也在同一地理区域参与市场，那么就有可能改善获得保险的机会。这些要求可以确保更可行和更稳定的保险，使每个市场内的参保人员以及那些在公共和私人保险之间转换的人员受益。
