Andreyeva Elena, Marthey Daniel, Haeder Simon F, Ukert Benjamin
Department of Health Policy and Management, Texas A&M University, 212 Adriance Lab Rd, College Station, TX 77845. Email:
Am J Manag Care. 2025 Jun 1;31(6):e147-e152. doi: 10.37765/ajmc.2025.89751.
To evaluate the association between Texas Affordable Care Act rating area change and health plan enrollment, plan selection, and premiums from 2022 to 2024 for urban and rural counties.
Texas integrated a rating area consisting of all 177 rural counties into nearby metropolitan rating areas in 2023. We analyzed this policy using enrollment data from the Marketplace Open Enrollment County-Level Public Use Files from 2022-2024.
We calculated the growth in enrollment across rural and urban counties and estimated linear regression models to understand whether enrollment grew faster in rural counties than in urban counties after the policy change.
Total marketplace plan enrollment increased by 80% (95% CI, 70%-90%) in urban counties and 76% (95% CI, 68%-84%) in rural counties. Urban and rural counties experienced the largest growth among enrollees aged 35 to 44 years (urban: 107%; 95% CI, 94%-119%; rural: 103%; 95% CI, 95%-112%) and enrollees with incomes between 100% and 150% of the federal poverty level (urban: 124%; 95% CI, 106%-142%; rural: 116%; 95% CI, 106%-127%). The share of counties reporting gold plan enrollment increased in urban and rural counties from 70% to 95% and 51% to 93%, respectively. Rating area changes were not associated with differential enrollment changes across rural and urban counties.
We found similar growth rates in enrollment for rural and urban counties. Marketplace enrollees were more likely to choose a gold plan, suggesting that they shifted away from less-expensive bronze plans.
评估《德克萨斯州平价医疗法案》评级区域变化与2022年至2024年城乡县的医保计划参保情况、计划选择及保费之间的关联。
2023年，德克萨斯州将由全部177个农村县组成的一个评级区域整合到附近的大都市评级区域。我们利用2022 - 2024年市场公开注册县级公共使用文件中的参保数据对这一政策进行了分析。
我们计算了城乡县的参保增长情况，并估计了线性回归模型，以了解政策变化后农村县的参保增长是否快于城市县。
城市县的市场计划总参保人数增加了80%（95%置信区间，70% - 90%），农村县增加了76%（95%置信区间，68% - 84%）。城乡县中，年龄在35至44岁的参保者增长幅度最大（城市：107%；95%置信区间，94% - 119%；农村：103%；95%置信区间，95% - 112%），以及收入在联邦贫困线100%至150%之间的参保者增长幅度最大（城市：124%；95%置信区间，106% - 142%；农村：116%；95%置信区间，106% - 127%）。报告参保金计划的县的比例在城市县从70%增至95%，在农村县从51%增至93%。评级区域变化与城乡县参保变化差异无关。
我们发现城乡县的参保增长率相似。市场参保者更有可能选择金计划，这表明他们不再选择费用较低的青铜计划。
