Insurance Coverage Mandates for Preventive Care: The Market for Contraceptives

Laws that mandate contraceptive coverage by private health insurance plans are common at the state level, and the Affordable Care Act (ACA) also recently mandated coverage at the national level. Little empirical work has examined the potential impact of these laws on women’s contraceptive utilization. I perform both 1) a short-term analysis of the impact of the ACA\u27s mandate using available data, and 2) an examination of 29 state-level contraception coverage mandates passed between 1999 and 2010 that could shed light upon the long-term utilization impacts of the national mandate. For these analyses, I use two datasets: the first a 50-state survey with an extensive set of individual-level covariates, and the second a proprietary claims dataset with detailed information on contraceptive utilization and out-of-pocket spending. I find suggestive evidence that the state mandates resulted in increased insurance coverage of some methods of contraceptives, but find no resulting changes in overall utilization or the type of method chosen. I find that the ACA mandate has caused large decreases in out-of-pocket spending on contraceptives, but I detect only very small changes in utilization in response, implying that demand for contraceptives among privately insured women is fairly price-insensitive. My results suggest that mandating insurance coverage of contraceptives is unlikely to result in immediate or large changes in patterns of contraceptive use in the U.S

ED, Heal Thyself

Emergency department (ED) wait times have continued to worsen despite receiving considerable attention for more than 2 decades and despite the availability of a variety of methods to restructure care in a more streamlined fashion. This article offers an economic framework that abstracts away from the details of operations research to understand the fundamental disincentives to improving wait times. Hospitals that reduce wait times are financially penalized if they must provide more uncompensated care as a result. Pending changes under the Patient Protection and Affordable Care Act are considered. We find that the likely effect of the Patient Protection and Affordable Care Act\u27s insurance expansion is to reduce this penalty for improving ED wait times. Consequently, mandating adoption of solutions to ED crowding may be unnecessary and counterproductive. If the insurance expansion is insufficient to fully solve the problem, the hospital value-based purchasing initiative should adopt wait times as a goal in its next iteration

King vs. Burwell Through the Lens of Economics

Now that Supreme Court arguments over the Affordable Care Act (ACA) are over, and the health insurance status of millions of Americans awaits a June decision, lets take a look at some of the economics of what a ruling for the plaintiff could mean

Understanding the Individual Mandate\u27s SCOTUS Pivot Points

One of the most controversial elements of the recent health reform legislation embodied in the Patient Protection and Affordable Care Act (ACA) has been the individual mandate. The mandate works as a conditional tax: by 2016, when the tax is fully phased in, individuals who do not purchase insurance coverage will pay about $60 per month. Exemptions are provided for those for whom the cheapest insurance plan would be unaffordable

State-Based Marketplaces Spent Heavily to Help Enroll Consumers

The Affordable Care Act required that consumers have access to in-person or on-call assistance to understand their choices and navigate the complexities of the new health insurance marketplaces. One consequence of each state\u27s decision about whether to run its own marketplace is an extreme variation in the time-limited funding available for consumer assistance programs. This Data Brief looks at the types of assistance available and the level of funding for each state in the first year of marketplace operations

Health Insurance Marketplace Enrollment Rates by Type of Exchange

Because the ACA gave them choices in how to implement insurance coverage, health reform looks different state to state. This Data Brief examines a number of choices related to the establishment and running of the new health insurance marketplaces, and their potential impact on enrollment rates to date. We use existing data sources as well as a new database developed by researchers at the University of Pennsylvania that documents and codes state-level variation in the political setting, institutional structures, and operational decisions likely to affect outcomes on the marketplaces

Final Enrollment Rates Show Federally run Marketplaces Make up Lost Ground at end of Enrollment

This new data brief updates our interim March 2014 findings with enrollment rates at the close of the Affordable Care Act\u27s first open enrollment period. It focuses on enrollment rates by state and type of marketplace, and assesses changes in enrollment rates in the final six weeks. The final enrollment figures reveal that the federally facilitated marketplaces and some of the troubled state-based ones made up some ground in the last four to six weeks of the open enrollment period

How Did Rural Residents Fare on the Health Insurance Marketplaces?

How are rural areas faring with the Affordable Care Act? Has the law fostered competition among plans or have one or two insurers dominated? This Data Brief examines 2014 premiums and finds that residents of rural counties, as a whole, did not face higher premiums than residents of urban counties. However, states with largely rural populations do face fewer choices and higher premiums. These are the states to watch as new issuers enter the marketplaces and 2015 premiums are filed