Johns Hopkins Bloomberg School of Public Health.
Milbank Q. 2022 Mar;100(1):190-217. doi: 10.1111/1468-0009.12546. Epub 2021 Nov 23.
Policy Points Policymakers considering introduction of a health insurance "public option" to lower health spending and reduce the number of uninsured can learn from Washington State, which offered the nation's first public option ("Cascade Care") through its state exchange in 2021. This article examines insurer participation, pricing, and enrollment in the Washington public option. The public option was the lowest-premium standard silver plan in 9 of the 19 counties in which it was offered. Cascade Care is available solely through private insurers. Voluntary participation of these insurers and uncertainty about the willingness of providers to participate may have hindered greater premium reductions and enrollment in the public option's first year.
State and federal policymakers considering introduction of a health insurance "public option" can learn from Washington State, which established the nation's first public option, with coverage beginning in January 2021. Public option plans were offered voluntarily by private insurers through the Washington Health Benefit Exchange and were subject to state-mandated plan design and payment requirements.
We used plan data from the Washington Health Benefit Exchange, linked to data from the US Census Bureau, the American Hospital Association, and InterStudy. We compared geographic availability and premiums of, and enrollment in, public option and non-public option plans, as well as characteristics of counties where the public option was available and counties where the public option was the lowest-premium plan.
At least one public option plan was available in 19 of 39 counties and was the lowest-premium option in 9 of the 19 counties where it was available. Five insurers offered public option plans, including one new entrant to the state and one new entrant to the Exchange. While public option availability was more common in counties where the Exchange was bigger and more competitive, public option plans had the lowest premium in smaller, less competitive counties. In the first year, 1% of enrollees selected the public option, in part due to automatic reenrollment of the majority of returning enrollees in their 2020 plan.
Public option plans offered a low-premium choice in counties that otherwise had fewer affordable plans, but voluntary participation of insurers and providers and accompanying uncertainty about participation hindered widespread and substantial premium reductions. States should consider tying public option participation by insurers and providers to other state programs and using decision support tools to promote active enrollment. Federal policymakers can support state efforts while considering establishment of a national public option.
政策要点 考虑引入医疗保险“公共选择”以降低医疗支出和减少未参保人数的政策制定者，可以从华盛顿州吸取经验，该州在 2021 年通过其州内交易所提供了全国首个公共选择（“瀑布护理”）。本文研究了保险公司的参与、定价和在华盛顿公共选择中的参保情况。在提供公共选择的 19 个县中的 9 个县，公共选择是保费最低的标准银计划。瀑布护理仅通过私人保险公司提供。这些保险公司的自愿参与以及提供者参与的意愿不确定，可能阻碍了公共选择第一年保费的更大降幅和参保人数的增加。
考虑引入医疗保险“公共选择”的州和联邦政策制定者可以从华盛顿州吸取经验，该州建立了全国首个公共选择，自 2021 年 1 月开始提供保险。公共选择计划由私人保险公司通过华盛顿健康福利交易所自愿提供，并受州规定的计划设计和支付要求的约束。
我们使用了华盛顿健康福利交易所的数据，并与美国人口普查局、美国医院协会和 InterStudy 的数据相链接。我们比较了公共选择和非公共选择计划的地理可获得性、保费和参保情况，以及提供公共选择的县和公共选择是保费最低计划的县的特征。
在 39 个县中的 19 个县至少提供了一个公共选择计划，在这 19 个提供公共选择计划的县中，有 9 个县是保费最低的选择。五家保险公司提供了公共选择计划，其中包括一家新进入该州和一家新进入交易所的公司。虽然公共选择的可用性在交易所更大、竞争更激烈的县更为常见，但公共选择计划在较小、竞争较弱的县的保费最低。在第一年，有 1%的参保人选择了公共选择，部分原因是 2020 年参保人的大多数自动续保。
在其他地方选择较少的负担得起的计划的县，公共选择计划提供了一个保费较低的选择，但保险公司和提供者的自愿参与以及随之而来的参与不确定性阻碍了广泛而实质性的保费降低。各州应考虑将保险公司和提供者的公共选择参与与其他州的计划挂钩，并使用决策支持工具来促进积极参保。联邦政策制定者可以在考虑建立全国性公共选择的同时，支持州政府的努力。
