Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, MA.
Department of Medicine, Harvard Medical School, Boston, MA.
Health Serv Res. 2018 Oct;53(5):3750-3769. doi: 10.1111/1475-6773.12868. Epub 2018 May 17.
The Affordable Care Act (ACA) introduced reforms to mitigate adverse selection into and within the individual insurance market. We examined the traits and predicted medical spending of enrollees in California post-ACA.
Survey of 2,103 enrollees in individual market plans, on- and off-exchange, in 2014.
We compared actual versus potential participants using data from the 2014 California Health Interview Survey on respondents who were individually insured or uninsured. We predicted annual medical spending for each group using age, sex, self-rated health, body mass index, smoking status, and income.
Average predicted spending was similar for actual ($3,377, 95 percent CI [$3,280-$3,474]) and potential participants ($3,257 [$3,060-$3,454]); however, some vulnerable subgroups were underrepresented. On- versus off-exchange enrollees differed in sociodemographic and health traits with modest differences in spending ($3,448 [$3,330-$3,565] vs. $3,175 [$3,012-$3,338]).
We did not find evidence of selection into the overall insurance pool in 2014; however, differences by exchange status reflect the importance of including off-exchange enrollees in analyses and the pool for risk adjustment. California's post-ACA individual market has been a relative success, highlighting the importance of state policies and outreach efforts to encourage participation in the market.
平价医疗法案（ACA）引入了改革措施，以减轻个人医疗保险市场中的逆向选择。我们研究了加利福尼亚州 ACA 后的参保者的特征和预测医疗支出。
2014 年对个人市场计划（包括交易所和非交易所）的 2103 名参保者的调查。
我们使用 2014 年加利福尼亚健康访谈调查中关于个人参保或未参保者的数据，比较了实际参与者和潜在参与者。我们使用年龄、性别、自我评估健康状况、体重指数、吸烟状况和收入，预测了每个群体的年度医疗支出。
实际参与者（$3377，95%置信区间[$3280-$3474]）和潜在参与者（$3257 [$3060-$3454]）的平均预测支出相似；然而，一些弱势群体的代表性不足。交易所内和交易所外的参保者在社会人口统计学和健康特征方面存在差异，支出差异较小（$3448 [$3330-$3565] 与 $3175 [$3012-$3338]）。
我们没有发现 2014 年整体保险池中存在选择的证据；然而，交易所状况的差异反映了将交易所外的参保者纳入分析和风险调整池的重要性。加利福尼亚州 ACA 后的个人市场相对成功，突出了州政策和外展努力对于鼓励市场参与的重要性。
