Marketplace Plans With Narrow Physician Networks Feature Lower Monthly Premiums Than Plans With Larger Networks

Polsky, Daniel; Cidav, Zuleyha; Swanson, Ashley

doi:10.1377/hlthaff.2016.0693

Cited by 68 publications

(58 citation statements)

References 13 publications

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“…For example, from 2016 to 2017, the percentage of counties with one participating insurer increased from 7.34 percent to 35.85 percent. Unlike previous studies that used cross‐sectional variation across counties to identify the effect of insurer participation on premiums, this more robust approach allows us to control for all time‐invariant county characteristics that could influence our outcomes through the use of county fixed effects. Our identification strategy is similar for state policies in that we relied on within‐county variation in exposure to state policies over time to identify state policy effects.…”

Section: Methodsmentioning

confidence: 99%

“…It also considers how Medicaid expansion decisions and states’ responses to CSR subsidy cuts affected premium levels and spreads. Unlike previous studies, we do not rely on cross‐sectional variation across counties to identify the effect of insurer participation on premiums. Instead, we use within‐county variation in insurer participation over time.…”

Section: Introductionmentioning

confidence: 99%

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Individual market health plan affordability after cost‐sharing reduction subsidy cuts

Drake

Abraham

2019

Health Services Research

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Objective To investigate how changes in insurer participation and composition as well as state policies affect health plan affordability for individual market enrollees. Data Sources 2014‐2019 Qualified Health Plan Landscape Files augmented with supplementary insurer‐level information. Study Design We measured plan affordability for subsidized enrollees using premium spreads, the difference between the benchmark plan and the lowest cost plan, and premium levels for unsubsidized enrollees. We estimated how premium spreads and levels varied with insurer participation, insurer composition, and state policies using log‐linear models for 15 222 county‐years. Principal Findings Increased insurer participation reduces premium levels, which is beneficial for unsubsidized enrollees. However, it also reduces premium spreads, leading to lower plan affordability for subsidized enrollees. States responding to cost‐sharing reduction subsidy payment cuts by increasing only silver plans' premiums increase premium spreads, particularly when premium increases are restricted to on‐Marketplace silver plans. The latter approach also protects unsubsidized, off‐Marketplace enrollees from experiencing premium shocks. Conclusions Insurer participation and insurer composition affect subsidized and unsubsidized enrollees' health plan affordability in different ways. Decisions by state regulators regarding health plan pricing can significantly affect health plan affordability for each enrollee segment.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Individual market health plan affordability after cost‐sharing reduction subsidy cuts

Drake

Abraham

2019

Health Services Research

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“…After implementation of the ACA, the government marketplace created narrow network plans as a cost containing strategy. [38,39] The narrow network plans eliminated providers within the plan making it difficult for the patient to keep their original provider. Keeping their original physician was possible but if the provider was not within the narrow network, patients are now required to pay out-of-network prices.…”

Section: Discussionmentioning

confidence: 99%

Perceptions of the affordable care act by Physician Assistants

Reinhold

Bacon-Baguley

2019

IJH

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Objective: Implementation of the affordable care act (ACA) resulted in an increased number of insured individuals and a shortage of primary care physicians. Physician Assistants (PAs) are poised to address this shortage since the PA profession is grounded in teamwork exemplified by the Accountable Care Organizations supported by the ACA. This study assesses the perception of the ACA by PAs providing healthcare services during implementation of the ACA.Methods: In this repeated cross-sectional study, alumni from a Midwest PA program were surveyed in 2014, 2016 and 2018 on knowledge and perception of the ACA. Questions addressed the ACA impact on the PA profession and on patients’ access to healthcare.Results: During the initial four years of ACA implementation, the following increases in perception were seen: 1) 32% increase in positive outlook of healthcare; 2) 37% increase in positive influence on PA practice; 3) 30% increase in positive impact of practice autonomy; 4) 64% increase in positive impact for patients; and 5) 33% increase in patient access to care. Additionally, the inability to choose a provider increased by 18%.Conclusions: Over the last four years PAs have perceived positive effects pertaining to their practice and regarding the impact on their patients despite an increase in the inability to choose a provider. Inability to choose a provider may in part be due to the rising number of narrow-network plans. The findings of greater autonomy and increased compensation for PAs are contrary to physicians who perceive the ACA to decrease their autonomy and their compensation.

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“…In other words, patients enrolled in a narrow network plan and who have a new cancer diagnosis may find limited referral options for in-network oncologists, and the care they receive at an out-of-network provider or hospital may be subject to balance-billing, and may not be subject to an annual cap on out-of-pocket costs. 36,37 …”

Section: Possible Access Barriers To Cancer Carementioning

confidence: 99%

Effects of Affordable Care Act Marketplaces and Medicaid Eligibility Expansion on Access to Cancer Care

Graves

Swartz

2017

Cancer J

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Purpose To inform oncologists about how repealing the ACA may affect their ability to provide cancer therapies for people with cancer enrolled in ACA health plans, and why proposals to change Medicaid funding may make it even more difficult for Medicaid beneficiaries to access cancer treatments. Methods We examined the regulations and provisions of the ACA related to how health insurance impacts access to diagnostic testing and treatments for people with cancer, including access to clinical trials. Similarly, we examined federal and state rules affecting Medicaid beneficiaries’ access to cancer treatments. Results Repealing various provisions of the ACA will restrict who has access to both current and new cancer treatments. Such changes also will impact oncology research that depends on having heterogeneous people in clinical trials. Discussion Significant changes to the ACA will affect oncology treatment choices of everyone with health insurance – not just the 10 million people newly covered by ACA health plans and the 70 million people with Medicaid coverage.

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Marketplace Plans With Narrow Physician Networks Feature Lower Monthly Premiums Than Plans With Larger Networks

Cited by 68 publications

References 13 publications

Individual market health plan affordability after cost‐sharing reduction subsidy cuts

Individual market health plan affordability after cost‐sharing reduction subsidy cuts

Perceptions of the affordable care act by Physician Assistants

Effects of Affordable Care Act Marketplaces and Medicaid Eligibility Expansion on Access to Cancer Care

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