Masia Neal, Motyka James D, Westrich Kimberly, Campbell Jon D
Health Capital Group, LLC and Columbia University, New York, NY, USA.
National Pharmaceutical Council, Washington, DC, USA.
Inquiry. 2025 Jan-Dec;62:469580251370317. doi: 10.1177/00469580251370317. Epub 2025 Sep 4.
We tested whether the 340B program impacts Affordable Care Act (ACA) premiums. Data from 2018 to 2022 was used to establish a baseline for silver benchmark premiums and other key measures, including: the number of active 340B sites per 10,000 people in a county (Hospital Site Density, or HSD), ACA benchmark plan premiums for every county, and measures likely to influence insurance premiums including per capita income, unemployment, and hospital market power. We used a multivariate fixed effects regression that included state and year effects, the explanatory variables, and the county-level HSD for each year. The impact of 340B on ACA premiums was illustrated using 2022 data. We estimate that a 1-unit change in 340B HSD was associated with a 1.1% (95% CI 0.73-1.15) change in the benchmark ACA premium. In 2022, the mean county 340B HSD was 1.63, and the mean Silver Benchmark Plan monthly premium was $500. After adjusting for per capita income, hospital concentration index, and other factors, the mean 340B HSD accounted for 1.8% (95% CI: 1.3-2.1) of the average Silver Benchmark Plan monthly premium, or $8.90 (95% CI $6.50-$10.25) per month, implying a cost in additional subsidies of over $106 per year per subsidized ACA enrollee. The results support that the 340B program is associated with a financially meaningful component of ACA premiums.
我们测试了340B计划是否会影响《平价医疗法案》（ACA）的保费。利用2018年至2022年的数据建立了银色基准保费及其他关键指标的基线，这些指标包括：每10000人中活跃的340B机构数量（医院机构密度，即HSD）、每个县的ACA基准计划保费，以及可能影响保险保费的指标，包括人均收入、失业率和医院市场势力。我们使用了一个多元固定效应回归模型，该模型包括州和年份效应、解释变量以及每年的县级HSD。利用2022年的数据说明了340B对ACA保费的影响。我们估计，340B HSD每变化1个单位，与基准ACA保费变化1.1%（95%置信区间0.73 - 1.15）相关。2022年，各县340B HSD的平均值为1.63，银色基准计划的月均保费为500美元。在调整了人均收入、医院集中度指数和其他因素后，340B HSD的平均值占银色基准计划月均保费的1.8%（95%置信区间：1.3 - 2.1），即每月8.90美元（95%置信区间6.50 - 10.25美元），这意味着每个获得补贴的ACA参保人每年额外补贴成本超过106美元。结果支持340B计划与ACA保费中具有财务意义的组成部分相关。
