Health Affairs’ October Issue: Insurance, The ACA, Care In India & More
Bethesda, MD - The October issue of Health Affairs, a variety issue, includes several reports detailing aspects of the implementation of the Affordable Care Act (ACA) at a time when the latest census data shows the smallest-ever share of the US population without health insurance. The issue also features a cluster of articles about the quality of health care in India.
Marketplace premiums lower with narrower physician networks.
The introduction of health insurance Marketplaces under the Affordable Care Act (ACA) has been linked to the growth of restricted provider networks. While researchers have identified a correlation between narrower hospital networks and lower consumer costs, the association between breadth of physician networks and plan pricing has not been established. In the first study to explore that connection, Daniel Polsky of the University of Pennsylvania and coauthors examined data on 2014 silver plans in all US health insurance exchanges and found that the premiums of plans with a small network were 6.7 percent lower than premiums for otherwise equivalent plans with a large network. According to the authors, in markets with average-price plans, this translates to annual savings of $212–339 per person for an individual plan (depending on the consumer’s age) and up to $692 for a young family of four. Since the cost of health insurance premiums remains the main reason many Americans remain uninsured, the authors conclude that the use of narrow networks, with lower premium prices, could hold the key to reducing the number of uninsured people.
Another ACA-related study in the issue:
Wide variation in state oversight of freestanding emergency departments.
Freestanding emergency departments (EDs), introduced in the 1970s, are proliferating, with 400 being operated in thirty-two states as of December 2015. Some are hospital-affiliated, while others are independent. Texas and Ohio have the greatest numbers of freestanding EDs (see map below). Catherine Gutierrez of Harvard Medical School and coauthors evaluated state regulations of freestanding EDs and found that twenty-one states had policies for freestanding EDs, either incorporated into hospital regulations or listed independently. According to the authors, twenty-nine states had no regulations, with New York and Washington regulating freestanding EDs on a case-by-case basis, and California indirectly barring them in its hospital regulations. The authors conclude that consistent state regulation of freestanding EDs is needed so patients can better understand the EDs’ capabilities and costs, enabling patients to choose the most appropriate site for emergency care.