Department of Health Management and Policy, University of Iowa, Iowa City, Iowa, USA.
Department of Economics, University of Iowa, Iowa City, Iowa, USA.
Health Serv Res. 2023 Oct;58(5):1077-1088. doi: 10.1111/1475-6773.14205. Epub 2023 Jul 24.
The aim of the study was to estimate the effect of the state-based reinsurance programs through the section 1332 State Innovation Waivers on health insurance marketplace premiums and insurer participation.
2015 to 2022 Robert Wood Johnson Foundation Health Insurance Exchange Compare Datasets.
An event study difference-in-differences (DD) model separately for each year of implementation and a synthetic control method (SCM) are used to estimate year-by-year effects following program implementation.
DATA COLLECTION/EXTRACTION METHODS: Not applicable.
Reinsurance programs were associated with a decline in premiums in the first year of implementation by 10%-13%, 5%-19%, and 11%-17% for bronze, silver, and gold plans (p < 0.05). There is a trend of sustained declines especially for states that implemented their programs in 2019 and 2020. The SCM analyses suggest some effect heterogeneity across states but also premium declines across most states. There is no evidence that reinsurance programs affected insurer participation.
State-based reinsurance programs have the potential to improve the affordability of health insurance coverage. However, reinsurance programs do not appear to have had an effect on insurer participation, highlighting the need for policy makers to consider complementary strategies to encourage insurer participation.
本研究旨在评估基于州的再保险计划（通过第 1332 条州创新豁免）对医疗保险市场保费和保险公司参与度的影响。
2015 年至 2022 年罗伯特伍德约翰逊基金会医疗保险交易所比较数据集。
使用事件研究差分（DD）模型（针对实施的每一年分别使用）和综合控制方法（SCM），分别估计计划实施后逐年的影响。
数据收集/提取方法：不适用。
再保险计划与实施第一年的保费下降相关，青铜、银和金计划分别下降了 10%-13%、5%-19%和 11%-17%（p<0.05）。对于 2019 年和 2020 年实施计划的州，存在持续下降的趋势。SCM 分析表明各州之间存在一定的效应异质性，但大多数州的保费也有所下降。没有证据表明再保险计划影响了保险公司的参与度。
基于州的再保险计划有可能提高医疗保险覆盖的负担能力。然而，再保险计划似乎对保险公司的参与度没有影响，这凸显了政策制定者需要考虑补充策略来鼓励保险公司的参与。
