An additional 24 million people had individually purchased guaranteed-renewable coverage (HIPAA required all non-short-term individual market plans to be guaranteed renewable). Such plans protected enrollees from premium spikes if they developed expensive conditions, were more secure than employer plans for patients with expensive conditions, and faced incentives to make plans attractive to the sick as well as not to renege on their commitments to the sick. Hundreds of millions of Americans once had the freedom to enroll in guaranteed-renewable plans but lost that choice when Obamacare outlawed them. A study by McKinsey and Company for the Department of Health and Human Services shows provider networks in individual-market plans have narrowed significantly since 2013, when the breadth of networks reflected actual consumer preferences.
This EBRI Notes article examines the percentage of employers offering health insurance from 2008–2016 to better understand how health insurance offer rates may have been affected by the Patient Protection and Affordable Care Act of 2010 (ACA), the Great Recession of 2007–2009, and the subsequent economic recovery. The data come from the Medical Expenditure Panel Survey–Insurance Component (MEPS-IC).
Many employers were expected to drop workplace health insurance with the introduction of the ACA. Since 2008, the percentage of coverage-offering employers with 1,000 or more employees has been consistently near or above 99 percent—it reached 99.8 percent in 2016—but smaller firms have shown a steady, though not precipitous, decline in offer rates. For the smallest employers studied, those with fewer than 10 employees, the offer rate declined from 22.7 percent in 2015 to 21.7 percent in 2016.
But over the last year, perhaps with the strengthening economy and lower unemployment rates, there is evidence of what may be a rebound in employment-based coverage offer rates among firms with 10-999 employees. More specifically, from 2015-2016:
For employers with 10–24 employees, those offering health benefits increased from 48.9 percent to 49.4 percent.
For employers with 25–99 employees, those offering health benefits increased from 73.5 percent to 74.6 percent.
For employers with 100-999 employees, those offering health benefits increased from 95.1 percent to 96.3 percent. For these employers, this trend actually began a year earlier, when the offer rate increased from 92.5 percent in 2014 to 95.1 percent in 2015.
This paper discusses the context for the recent rebound and suggests factors that may influence future trends.
Insurance churn “is a long-standing problem in the U.S. health care system,” said Benjamin Sommers, a physician and health economist at Harvard’s Chan School of Public Health.
“But there’s a concern that with the ACA you’ve added a whole new layer.” Insurance turnover is especially frequent among lower-income families and those with irregular work.
This study contributes to the literature on supply-side adjustments to insurance expansions by examining the effect of the Affordable Care Act (ACA) on ambulance response times. Exploiting temporal and geographic variation in the implementation of the ACA as well as pre-treatment differences in uninsured rates, we estimate that the expansions of private and Medicaid coverage under the ACA combined to slow ambulance response times by an average of 19%. We conclude that, through extending coverage to individuals who, in its absence, would not have availed themselves of emergency medical services, the ACA added strain to emergency response systems.
As of November 25, 2017, the open enrollment period for 2018 individual market coverage is more than 57% complete. To date, 2.8M individuals have signed up for coverage through HealthCare.gov, compared to more than 7M people during the prior two years’ enrollment seasons.
Thousands of North Carolina residents have been exempt from the Affordable Care Act and got to keep their old health insurance, paying significantly less for their coverage than those insured under the ACA.
But that’s about to come to an end for 50,000 customers of Blue Cross and Blue Shield of North Carolina. In 2018, they will have to switch to ACA plans, in some cases paying twice as much or more for health insurance.
The number of people with individual health-insurance coverage is shrinking. Despite $146 billion in federal subsidies to low-income households and well-capitalized insurers, 2.6 million fewer people had individual policies in March 2017 than in March 2016, a drop of nearly 15 percent.