Gabel Jon R, Whitmore Heidi, Stromberg Sam, Green Matthew
Health Care Evaluation Department, NORC, University of Chicago, Chicago, Illinois.
Issue Brief (Commonw Fund). 2018 Nov 1;2018:1-13.
In 2017, health insurance marketplaces in some states were thriving, while those in other states were struggling. What explains these differences?
Identify factors that explain differences in issuers’ participation levels in state insurance marketplaces.
Analysis of the Robert Wood Johnson Foundation’s HIX Compare dataset, and the National Association of Insurance Commissioners’ 2010 Supplemental Health Care Exhibit Report.
State policies and insurance regulations were key factors affecting the number of issuers participating in the marketplaces in 2017. Marketplaces run by states had more issuers than states that rely on the federally facilitated marketplace. States with fewer than four issuers tended to have policies in place that could have been destabilizing--for example, permitting the sale of plans not compliant with the Affordable Care Act’s requirements regarding essential health benefits or guaranteed issue. Consumers in states that did not take steps to enforce these insurance market reforms still benefited from their protections, however; they were just enforced at the federal level. States with more issuers were also more likely to have expanded Medicaid. States with fewer issuers tended to be rural and have smaller populations, more concentrated hospital markets, and lower physician-to-population ratios.
2017年，一些州的医疗保险市场蓬勃发展，而其他州的市场却举步维艰。如何解释这些差异？
确定能够解释各州保险市场中保险公司参与程度差异的因素。
分析罗伯特·伍德·约翰逊基金会的医保交易所比较数据集，以及美国保险监督官协会2010年的补充医疗保健展览报告。
州政策和保险法规是影响2017年参与市场的保险公司数量的关键因素。由各州运营的医保交易所有比依赖联邦政府协助的医保交易所更多的保险公司。保险公司数量少于四家的州往往制定了可能破坏稳定的政策——例如，允许销售不符合《平价医疗法案》关于基本健康福利或保证承保要求的保险计划。然而，未采取措施执行这些保险市场改革的州的消费者仍然受益于这些保护措施；这些措施只是在联邦层面得到执行。保险公司数量较多的州也更有可能扩大了医疗补助计划。保险公司数量较少的州往往是农村地区，人口较少，医院市场更为集中，医生与人口的比例较低。
