基于人头、低成本、县级的公共医疗保险选择与加利福尼亚平价医疗法案保费增长之间的关联。

Association Between a Capitated, Low-cost, County-Based Public Health Insurance Option and Affordable Care Act Premium Growth in California.

机构信息

School of Public Health, University of California, Berkeley, California.

Goldman School of Public Policy, University of California, Berkeley, California.

出版信息

JAMA Health Forum. 2023 Apr 7;4(4):e230488. doi: 10.1001/jamahealthforum.2023.0488.

DOI:10.1001/jamahealthforum.2023.0488

PMID:37083824

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10122165/

Abstract

IMPORTANCE

Empirical evidence is needed on how a capitated, risk-based county plan performs as a viable public option in the Affordable Care Act (ACA) Marketplace in California.

OBJECTIVE

To estimate whether LA Care-a capitated, county-based public option and California's largest public insurer-was associated with health insurance premium growth in the Los Angeles (LA) regions of Covered California (CC), the ACA exchange in California.

DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation used ACA silver plan premium data within the 19 CC regions. Difference-in-differences and event study models used data on plan-level premiums from Health Insurance Exchange Compare for years 2014 to 2022 to estimate the association between LA Care and ACA premium growth in LA.

EXPOSURES

The intervention was LA Care becoming the lowest-cost health plan on the ACA exchange in 2018. The treatment group included the East and West LA regions, and the control group included the remaining 17 CC regions.

MAIN OUTCOMES AND MEASURES

The main outcome variable was annual premium growth of plans on CC from 2014 to 2022.

RESULTS

Using 504 plan-level observations for 2014 to 2022, ACA premium growth in LA declined by 4.8% after LA Care became the lowest-cost health plan on the exchange in 2018 (coefficient estimate, -0.048; SE, 0.022; 95% CI, -0.093 to -0.002). Savings due to lower premium growth from 2019 to 2022 were calculated to be $345 million, with approximately 70% of the savings ($242 million) going to the federal government.

CONCLUSIONS AND RELEVANCE

In this economic evaluation, LA Care was associated with lower premium growth of other health insurance plans in the LA regions of CC, with the majority of savings going to the federal government. California could have captured these savings if it had applied for and received a State Innovation Waiver under section 1332 of the ACA. LA Care may be a viable public option with the potential to be expanded across California through the state's 16 other county-based health plans.

摘要

重要性

需要有实证证据来证明，在加利福尼亚州平价医疗法案（ACA）市场中，基于人头、风险的县级计划作为可行的公共选择方案表现如何。

目的

评估加利福尼亚州最大的公共保险公司 LA Care（基于人头、县级的公共选择方案）是否与加利福尼亚州洛杉矶（LA）地区的ACA 交易所 Covered California（CC）的健康保险保费增长有关。

设计、设置和参与者：本经济评估使用了 ACA 银计划保费数据，涵盖了 CC 的 19 个地区。差异-差异和事件研究模型使用了 2014 年至 2022 年健康保险交易所比较计划层面保费的数据，以估计 LA Care 与 LA 的 ACA 保费增长之间的关联。

暴露因素

干预措施是 LA Care 于 2018 年成为 ACA 交易所中成本最低的健康计划。实验组包括东区和西区，对照组包括其余的 17 个 CC 地区。

主要结果和措施

主要结果变量是 2014 年至 2022 年 CC 上计划的年度保费增长。

结果

使用 2014 年至 2022 年的 504 个计划层面观察结果，自 2018 年 LA Care 成为交易所中成本最低的健康计划以来，LA 的 ACA 保费增长下降了 4.8%（系数估计值，-0.048；SE，0.022；95%CI，-0.093 至 -0.002）。从 2019 年到 2022 年，由于保费增长较低而节省的费用计算为 3.45 亿美元，其中约 70%（2.42 亿美元）流向联邦政府。

结论和相关性

在这项经济评估中，LA Care 与 CC 的 LA 地区其他健康保险计划的保费增长较低有关，大部分节省流向了联邦政府。如果加利福尼亚州根据 ACA 的第 1332 节申请并获得州创新豁免，它本可以获得这些节省。LA Care 可能是一种可行的公共选择方案，有可能通过该州的其他 16 个县级健康计划在加利福尼亚州全面推广。