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Changes in Coverage in the Individual and Group Health Insurance Markets and the Effect of Health Status
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Author(s): Bradley Herring, Xue Song and Mark Pauly |
Organization(s): Johns Hopkins University |
Although the vast majority of privately insured people in the U.S. obtain their coverage in the employment-based group market, about 17 million people under age 65 were insured in the individual health insurance market in 2006. About 47 million people, or 16% of the total U.S. population, were without health insurance coverage in 2006. Researchers know relatively little about how the group and individual markets actually function for those with chronic health conditions, and much of what we know is based on point-in-time analyses of insurance coverage. However, insurance coverage is actually very dynamic due to changes in employment and because eligibility for public programs typically depends on income and other criteria. This paper provides an in-depth look at the impact of health status on changes in coverage in these insurance markets using data from the Medical Expenditure Panel Survey. We also use these data to examine the effect of health status on changes in premiums in the individual insurance market. [38 PDF pages] |
Published: April, 2008 |
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Employer Provided Health Insurance:
(Report)
What can be Learned from the 5500 Data? |
Author(s): Anja Drecressin, Tomeka Hill, Julia Lane |
Organization(s): Census Bureau, LEHD, and Department of Labor, EBSA, OPR |
This report provides a technical assessment of the utility of data from the Pension and Welfare Benefits Administration, specifically the form 5500 data, to examine the receipt of employer provided health care when merged with data from the Census Bureau's Longitudinal Employer Household Dynamics data program. The report finds that while the data are not well-suited to examine the proportion of workers receiving health care or the proportion of firms offering health care, they can contribute significantly to our understanding of the types of firms that offer health plans, as well as how offers and cost-sharing changes over time within specific firms. |
Published: January, 2006 |
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Research Brief
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Executive Summary
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Evaluation of Parity in the Federal Employees Health Benefits (FEHB) Program: Final Report
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Author(s): Parity Eavluation Research Team |
Organization(s): Northrop Grumman Information Technology, Harvard Medical School, RAND Corporation, University of Maryland-Baltimore, Westat |
The evaluation of the 2001 OPM policy of parity for mental health and substance abuse (MH/SA) health care insurance benefits in the FEHB Program was conducted primarily to assess the impact of this policy on utilization and cost. Would increases be within reasonable limits or would the increase to utilization and cost render MH/SA parity unaffordable? Would implementation of MH/SA parity have an effect on the quality of MH/SA care? Analysis of claims data from 1999-2002 for nine FEHB plans, which cover over 3.2 million lives, showed that both utilization and cost increased after parity. However, when compared to a matched set of claims drawn from the Medstat Group MarketScan® Benefit Plan Design database, the increase in FEHB plans was not statistically significantly different from the Medstat plans that were not included in the parity policy. The increase could not be attributed to the parity policy. Further analysis of the FEHB claims on the impact of the parity policy on quality of care, found that there was no negative impact on quality when looking at care in comparison to published professional standards. [258 PDF pages] |
Published: December, 2004 |
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Impact of Access Regulation on Health Insurance Market Structure
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Author(s): Deborah J. Chollet, Adele M. Kirk, Kosali Ilayperuma Simon |
Organization(s): Mathematica Policy Research, University of California at Los Angeles, and Michigan State University |
This paper considers the impact of regulation on the supply side of health insurance markets, in both the group and individual insurance markets. Our analysis contributes to the existing literature in several ways: (1) we examine the supply side of the market, whereas other studies to date have tested only the demand-side effects regulation; (2) we test for the impact of various market regulations separately, whereas other studies have tested the impact of "bundles" of reforms taken together; and (3) we consider the degree of reforms limiting insurers' prices and exclusions for preexisting conditions, differentiating both between narrower and broader rate bands and between shorter and longer exclusion periods. |
Published: October, 2000 |
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Consumer Protection in Private Insurance:
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State Implementation and Enforcement Experience |
Author(s): Stephanie Lewis, J.D., M.H.S.A. Karen Pollitz, M.P.P. |
Organization(s): Institute for Health Care Research and Policy, Georgetown University |
This report examines state implementation of the following consumer protections specifically for the most seriously and chronically ill patients: access to emergency services, network adequacy, continuity of care, standing referral, and access to out-of-network specialists. The report discusses the experience of four states: Colorado, Maryland, Minnesota, and New York. |
Published: October, 2000 |
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Nonresident Fathers: To What Extent Do They Have Access to Employment-Based Health Care Coverage?
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Author(s): Laura Wheaton |
Organization(s): Urban Institute |
As part of the Child Support Performance and Incentive Act of 1998, Congress established a medical child support working group to identify barriers to medical support enforcement and to recommend ways to address them. This report is an effort to provide greater background on one such barrier — the lack of access by many nonresident parents to employment-based health care coverage. The report develops a national estimate of the extent to which nonresident fathers have access to employment-based health care coverage, and considers the potential for increasing the number of children covered through a nonresident father's employment-based health care plan. |
Published: June, 2000 |
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21 Million Children's Health: Our Shared Responsibility.
(Report)
The Medical Child Support Working Group's Report |
Author(s): U.S. Department of Health and Human Services, Department of Labor |
Organization(s): Medical Child Support Working Group |
In the Child Support Performance and Incentive Act of 1998, Congress directed the establishment of the Medical Support Working Group by the Secretaries of HHS and Labor. The charge of the Working Group was to identify the impediments to the effective enforcement of medical child support and recommend solutions to those impediments. The Working Group's 76 recommendations are presented in this report to Congress. |
Published: June, 2000 |
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Consumer Protection in Private Health Insurance:
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The Role of Consumer Complaints |
Author(s): Sharon Willcox |
This study provides background lessons for federal regulators who may be required to implement federal patient protection legislation by focusing on consumer complaints about private health insurance in a sample of selected states and major employers. Specifically, the study seeks to identify the agencies responsible for health insurance complaints and the availability of complaints data, to review the status of complaints "report cards" and to analyze complaints data as a tool in understanding the implementation of patient protections. |
Published: June, 2000 |
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Assessing the Economics of EMR Adoption and Successful Implementation in Physician Small Practice Settings
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Author(s): Steven Lutzky, John Corea and Lisa Alecxih |
Organization(s): Lewin Group |
The primary purpose of this research is to inform employers' (including the Federal Government's) decision about how to structure and market a long-term care insurance offering to employees. This final report provides information about current and best practices in the employer group long-term care insurance market that can inform federal policymakers and employers in deciding how to construct a group long-term care insurance offering. Current practices were collected from a random and select sample of employers and best practices were compiled from the select sample (similar to government agencies, innovative, or successful in enrollment) of employers. The random sample survey generated a response rate of 58%, which is in line with response rates achieved with other employer surveys. The total sample included 93 employers. |
Published: May, 2000 |
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Effects of Trigger Events in Children's Health Insurance Coverage
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Author(s): John L. Czajka and Cara Olsen |
Organization(s): Mathematica Policy Research |
This report examines the role of "trigger events" -- primarily changes in the family economic situation or family composition -- in bringing about these changes in health insurance coverage. In short, we ask whether there are other changes in the family that may explain the occurrence of these changes in coverage or their timing. We examine a broad spectrum of changes in coverage rather than focusing on a small set of transitions to understand how particular changes fit into the big picture of health insurance dynamics. We focus on trigger events rather than personal characteristics that may predispose children to greater or lesser probabilities of change because of their potential to explain both the volatility of health insurance coverage for a segment of the population and the trends in aggregate coverage as well. The trigger events that we examine include changes in parents' employment status, jobs, and hours worked; changes in AFDC recipiency; large swings in family income; and changes in family headship and family size. A notable exclusion from the events that we examine is change in the availability and costs to employees of family coverage offered by employers. |
Published: April, 2000 |
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