Participation, Pricing, and Enrollment in a Health Insurance "Public Option": Evidence From Washington State's Cascade Care Program.
Participation, Pricing, and Enrollment in a Health Insurance "Public Option": Evidence From Washington State's Cascade Care Program.
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健康保险“公共选择”的参与、定价和注册：来自华盛顿州级联护理计划的证据。
DOI：
10.1111/1468-0009.12546
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Anderson,GerardF
中科院分区：
文献类型：
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作者：
Sen,AditiP;Singh,Yashaswini;Meiselbach,MarkK;Eisenberg,MatthewD;Anderson,GerardF
政策要点政策制定者考虑引入健康保险“公共选择”以降低医疗支出并减少未投保人数，可以借鉴华盛顿州，该州于2021年通过其州交易所提供了全国第一个公共选择（“Cascade Care”）。本文研究了华盛顿公共选择中的保险公司参与，定价和注册。在提供公共选择的19个县中，有9个县的公共选择是保费最低的标准银计划。这些保险公司的自愿参与以及供应商参与意愿的不确定性可能阻碍了公共选择的第一年更大的保费减免和注册。考虑引入医疗保险“公共选择”的ContextState和联邦政策制定者可以向华盛顿州学习，该州建立了全国第一个公共选择，覆盖范围从2021年1月开始。公共选择计划自愿提供的私人保险公司通过华盛顿健康福利交换，并受到国家规定的计划设计和支付requirements.MethodsWe使用的计划数据从华盛顿健康福利交换，连接到数据从美国人口普查局，美国医院协会和InterStudy。我们比较了公共选择和非公共选择计划的地理可用性和保费以及注册情况，以及公共选择可用的县和公共选择是最低保费计划的县的特征。五家保险公司提供了公共期权计划，其中包括一家新进入该州的公司和一家新进入交易所的公司。虽然公共选择的可用性在交易所规模较大、竞争力较强的县更为常见，但公共选择计划在规模较小、竞争力较弱的县的保费最低。在第一年，1%的参保人选择了公共选项，部分原因是大多数返回参保人在其2020 plannes.ConclusionsPublic选项计划的自动重新注册提供了一个低保费的选择，否则有更少的负担得起的计划，但保险公司和供应商的自愿参与，以及随之而来的参与不确定性阻碍了广泛和大幅降低保费。各州应考虑将保险公司和供应商的公共选择参与与其他州计划联系起来，并使用决策支持工具来促进积极注册。联邦政策制定者可以在考虑建立国家公共选择的同时支持各州的努力。
Policy PointsPolicymakers considering introduction of a health insurance “public option” to lower health spending and reduce the number of uninsured can learn from Washington State, which offered the nation's first public option (“Cascade Care”) through its state exchange in 2021.This article examines insurer participation, pricing, and enrollment in the Washington public option. The public option was the lowest‐premium standard silver plan in 9 of the 19 counties in which it was offered.Cascade Care is available solely through private insurers. Voluntary participation of these insurers and uncertainty about the willingness of providers to participate may have hindered greater premium reductions and enrollment in the public option's first year.ContextState and federal policymakers considering introduction of a health insurance “public option” can learn from Washington State, which established the nation's first public option, with coverage beginning in January 2021. Public option plans were offered voluntarily by private insurers through the Washington Health Benefit Exchange and were subject to state‐mandated plan design and payment requirements.MethodsWe used plan data from the Washington Health Benefit Exchange, linked to data from the US Census Bureau, the American Hospital Association, and InterStudy. We compared geographic availability and premiums of, and enrollment in, public option and non–public option plans, as well as characteristics of counties where the public option was available and counties where the public option was the lowest‐premium plan.FindingsAt least one public option plan was available in 19 of 39 counties and was the lowest‐premium option in 9 of the 19 counties where it was available. Five insurers offered public option plans, including one new entrant to the state and one new entrant to the Exchange. While public option availability was more common in counties where the Exchange was bigger and more competitive, public option plans had the lowest premium in smaller, less competitive counties. In the first year, 1% of enrollees selected the public option, in part due to automatic reenrollment of the majority of returning enrollees in their 2020 plan.ConclusionsPublic option plans offered a low‐premium choice in counties that otherwise had fewer affordable plans, but voluntary participation of insurers and providers and accompanying uncertainty about participation hindered widespread and substantial premium reductions. States should consider tying public option participation by insurers and providers to other state programs and using decision support tools to promote active enrollment. Federal policymakers can support state efforts while considering establishment of a national public option.