Jessica Van Parys (
Health Aff (Millwood). 2018 Aug;37(8):1243-1251. doi: 10.1377/hlthaff.2018.0054.
Premiums have increased rapidly in the two most recent years of the health insurance Marketplaces, with notable variation across state rating areas. Some experts have speculated that these increases are due to greater enrollment among sicker patients, the expiration of market stabilization policies, or the federal government's discontinuation of funding for cost-sharing subsidies. However, these factors do not explain why some rating areas have experienced rapid premium growth, while others have experienced more modest increases. I used a comprehensive database of information about premiums and market characteristics for rating areas in states with federally facilitated Marketplaces to demonstrate that higher premiums are associated with local health insurance monopolies. In 2018, Marketplace premiums were 50 percent ($180) higher, on average, in rating areas with monopolist insurers, compared to those with more than two insurers. This was driven by large premium increases for the monopolist insurers' lowest-cost plans. Understanding how insurer competition has affected enrollment, costs, and quality will help guide future individual-market reforms.
在医疗保险市场的最近两年中，保费迅速上涨，各州的评级区域之间存在显著差异。一些专家推测，这些增长是由于病情较重的患者参保人数增加，市场稳定政策到期，或联邦政府停止为费用分担补贴提供资金。然而，这些因素并不能解释为什么一些评级区域的保费增长迅速，而其他区域的增长较为温和。我使用了一个关于联邦管理市场各州评级区域保费和市场特征的综合数据库来证明，较高的保费与当地医疗保险垄断有关。2018 年，在有垄断保险公司的评级区域，市场保费平均比有两家以上保险公司的评级区域高出 50%（180 美元）。这是由垄断保险公司的最低成本计划保费大幅上涨驱动的。了解保险公司竞争如何影响参保人数、成本和质量，将有助于指导未来的个人市场改革。
