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. 2013 Apr;48(2 Pt 2):826-49.
doi: 10.1111/1475-6773.12036. Epub 2013 Feb 10.

Microsimulation of private health insurance and medicaid take-up following the U.S. Supreme court decision upholding the Affordable Care Act

Stephen T Parente  1 , Roger Feldman
Affiliations

Microsimulation of private health insurance and medicaid take-up following the U.S. Supreme court decision upholding the Affordable Care Act

Stephen T Parente et al. Health Serv Res. 2013 Apr.

Abstract

Objective: To predict take-up of private health insurance and Medicaid following the U.S. Supreme Court decision upholding the Affordable Care Act (ACA).

Data sources: Data came from three large employers and a sampling of premiums from ehealthinsurance.com. We supplemented the employer data with information on state Medicaid eligibility and costs from the Kaiser Family Foundation. National predictions were based on the MEPS Household Component.

Study design: We estimated a conditional logit model of health plan choice in the large group market. Using the coefficients from the choice model, we predicted take-up in the group and individual health insurance markets. Following ACA implementation, we added choices to the individual market corresponding to plans that will be available in state and federal exchanges. Depending on eligibility for premium subsidies, we reduced the out-of-pocket premiums for those choices. We simulated several possible patterns for states opting out of the Medicaid expansion, as allowed by the Supreme Court.

Principal findings: The ACA will increase coverage substantially in the private insurance market and Medicaid. HSAs will remain desirable in both the individual and employer markets.

Conclusions: If states opt out of the Medicaid expansion, this could increase the federal cost of health reform, while reducing the number of newly covered lives.

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Figures

Figure 1
Figure 1
Model of Health Plan Demand and Cost
See this image and copyright information in PMC

References

    1. Families USA. 2012. October, “ObamaCare versus RomneyCare versus RomneyCandidateCare: A National and State-by-State Analysis” [accessed on November 19, 2012]. Available at http://www.familiesusac4.org/2012-health-care-comparison.pdfStuart Altman, Jonathan Gruber, and John McDonough are credited with significant roles in creating the report.
    1. Feldman R, Parente ST, Abraham J, Christianson JB, Taylor R. “Health Savings Accounts: Early Evidence of National Take-up from the 2003 Medicare Modernization Act and Future Policy Proposals”. Health Affairs. 2005;24(6):1582–91. - PubMed
    1. Kaiser Family Foundation. 2012a. Employer Health Benefits 2011 Annual Survey [accessed on November 19, 2012]. Available at http://ehbs.kff.org/pdf/2011/8225.pdf.
    1. Kaiser Family Foundation. Where Are States Today? Medicaid and CHIP Eligibility Levels for Children and Non-Disabled Adults. 2012b. [accessed on November 19, 2012]. Available at http://www.kff.org/medicaid/upload/7993-02.pdf.
    1. Parente ST, Feldman R, Christianson JB. “Employee Choice of Consumer-Driven Health Insurance in a Multiplan, Multiproduct Setting”. Health Services Research. 2004;39(4, Part II):1091–111. - PMC - PubMed

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