David M. Anderson (
Ezra Golberstein, University of Minnesota, Minneapolis, Minnesota.
Health Aff (Millwood). 2024 Mar;43(3):398-407. doi: 10.1377/hlthaff.2023.00971.
Sixteen states have used Section 1332 waivers to implement reinsurance programs that aim to reduce premiums and increase enrollment in the Affordable Care Act's health insurance Marketplaces. Although reinsurance programs have successfully reduced premiums for unsubsidized enrollees, little is known about how reinsurance affects Marketplace premiums, minimum cost of coverage, and enrollment for the large majority of Marketplace enrollees who receive premium subsidies. Using a difference-in-differences analysis of matched counties straddling Georgia's borders to examine Georgia's 2022 implementation of its reinsurance program, we found that reinsurance increased the minimum cost of enrolling in subsidized Marketplace coverage by approximately 30 percent and decreased enrollment by roughly a third for Marketplace enrollees with incomes of 251-400 percent of the federal poverty level. Marketplace reinsurance programs may have the unintended consequences of increasing the minimum cost of subsidized coverage and reducing enrollment. These outcomes are especially relevant in the present policy context of enhanced subsidies, which have substantially reduced the number of unsubsidized enrollees who would benefit most from reinsurance.
十六个州已使用第 1332 条豁免条款来实施再保险计划，旨在降低保费并增加平价医疗法案医疗保险市场的参保人数。尽管再保险计划成功降低了未参保者的保费，但对于再保险如何影响医疗保险市场保费、最低保障费用以及大多数享受保费补贴的医疗保险市场参保者的参保人数知之甚少。我们使用佐治亚州边境两侧匹配县的差异分析来研究佐治亚州 2022 年实施的再保险计划，发现再保险将享受补贴的医疗保险市场参保的最低保障费用增加了大约 30%，并使收入在联邦贫困线的 251%-400%之间的医疗保险市场参保者的参保人数减少了大约三分之一。医疗保险市场再保险计划可能会产生意想不到的后果，即增加补贴性保险的最低保障费用并减少参保人数。在目前增强补贴的政策背景下，这些结果尤其重要，因为补贴大幅减少了最受益于再保险的无补贴参保人数。
