Through Section 1332 of the Affordable Care Act (ACA), states may apply for innovation waivers to alter key ACA requirements in the individual and small group insurance markets. States can use the flexibility granted by 1332 waiver authority to shore up fragile insurance markets, address unique state insurance market issues, or experiment with alternative models of providing coverage to state residents. With Congressional efforts to repeal and replace the ACA on hold, attention will likely turn to 1332 waivers as states explore ways to address access and affordability issues in their individual and small group markets.
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.
Subsidizing Health Insurance for Low-Income Adults: Evidence from
Massachusetts. Amy Finkelstein, Nathaniel Hendren, Mark Shepard∗
Abstract: How much are low-income individuals willing to pay for health insurance, and what are the implications for insurance markets? Using administrative data from Massachusetts’ subsidized insurance exchange, we exploit discontinuities in the subsidy schedule to estimate willingness to pay and costs of insurance among low-income adults. As subsidies decline, insurance take-up falls rapidly, dropping about 25% for each $40 increase in monthly enrollee premiums. Marginal enrollees tend to be lower-cost, consistent with adverse selection into insurance. But across the entire distribution we can observe – approximately the bottom 70% of the willingness to pay distribution – enrollee willingness to pay is three to four times below own expected medical costs. As a result, we estimate that take-up will be highly incomplete even with generous subsidies: if enrollee premiums were 25% of insurers’ average costs, at most half of potential enrollees would buy insurance, and even premiums subsidized down to 10% of average costs would still leave at least 20% uninsured. We briefly consider explanations for this finding – which suggests an important role for uncompensated care for the uninsured – and explore normative implications for insurance subsidies for low-income individuals.
Nevada’s Republican governor vetoed a bill late Friday that would have created the nation’s first “Medicaid for all” insurance offering, a plan that drew widespread attention as states brace for changes in the federal Affordable Care Act.
The bill would have allowed any state resident to buy into Medicaid, the federal-state program for people with low incomes or disabilities. The idea, which its Democratic sponsor said would have created a guaranteed health coverage option that was affordable, has drawn the interest of other liberal-leaning states as congress works to repeal major portions of the Affordable Care Act, including the law’s Medicaid expansion.
Governor Charlie Baker of Massachusetts has proposed a tax of $2,000 per worker on businesses which do not offer health coverage to employees who become dependent on Medicaid.
The first state in the nation to require residents to carry health insurance is grappling with escalating Medicaid rolls, but a fix floated by Massachusetts’ Republican governor is drawing pushback from employers.
Gov. Charlie Baker will propose in his annual budget on Wednesday a $2,000 penalty per worker on businesses that don’t shoulder enough of the health-insurance cost. The governor is aiming to solve what he sees as a flaw in the national health law: Medicaid ends up being more appealing to low-income workers than insurance offered by employers, raising the costs for the state.
Our simulations show that a primary driver of long-term fiscal challenges for the state and local government sector continues to be the growth in health-related costs. Specifically, state and local Medicaid expenditures and the cost of health care compensation for state and local government employees and retirees generally grow at a rate that exceeds GDP.7 The model’s simulations suggest that the sector’s health-related costs will be about 4.1 percent of GDP in 2016 and 6.3 percent of GDP in 2065. From 2016 through 2065, Medicaid expenditures are expected to increase on average by 0.5 percentage points more than GDP—referred to as excess cost growth. Other health related receipts and expenditures, including health care compensation for state and local government employees and retirees, are expected to increase on average by 0.9 percentage points more than GDP each year from 2016 to 2023, and then begin to decline, reaching 0.7 percentage points in 2065.