By Megan Collado, AcademyHealth
Amid coverage of Olympic feats and the presidential election, two questions have grabbed health policy headlines as summer concludes: 1) Will the ACA marketplaces remain competitive? and 2) Will health insurance be affordable? In particular, decisions by major US health insurance companies, like Aetna, to leave the health insurance marketplaces established under the Affordable Care Act (ACA) signal concerns about whether there will be sufficient competition to promote affordable plans for consumers. Reports of premium increases have raised questions about affordability, although for many, these increases may be offset by marketplace subsidies.
To answer these and other related questions, the Robert Wood Johnson Foundation created the Policy-Relevant Insurance Studies (PRIS) program in 2015. This program, managed by AcademyHealth, seeks to fund quick turnaround, empirical research studies that examine highly policy-relevant questions related to health insurance markets. The 2015 PRIS grantees examined a diverse array of topics, including: Medicaid expansion and the effect on personal finances, self-insurance in the small group market, the ACA’s risk adjustment mechanism, and the ACA smoking penalties.
The second round of funding under this program was announced in early 2016, and seven grants were recently awarded. Many of the grantees will address the pressing questions around competition and affordability on the ACA marketplaces.
For example, Christine Buttorff at RAND Corporation will examine the potential consequences of the current ACA tax credit structure and the implications of changes in the benchmark plan on consumers’ ability to afford continuous coverage.
Maria Polyakova at Stanford University will consider affordability of marketplace plans from another important angle—risk protection. She will assess the extent to which financial risk protection from out-of-pocket spending varies across marketplace plans and develop methods to convey the level of risk protection provided by plans to the public.
Other 2016 PRIS grantees are examining issues related to competition and stability in the marketplaces. Stan Dorn at the Urban Institute will address risk selection during special enrollment periods to identify whether current risk adjustment mechanisms adequately adjust for higher-risk enrollees. David Howard at Emory University will assess the impact of provider-led plans on competition and explore whether these plans have lower premiums than plans marketed by traditional insurers.
At AcademyHealth, we believe that policies that affect health and the performance of the health system should be informed by the best and most relevant evidence. To that end, we are working with all of the PRIS grantees to ensure their findings reach policymakers and other decision makers working on these issues. We bring grantees to Washington, D.C., to brief staff at relevant agencies, and we prepare syntheses of published research to highlight key findings and implications for policy.
With the 2017 open enrollment period on the horizon, health insurance affordability remains a critical concern for the remaining uninsured, and the competitiveness of the marketplaces goes hand-in-hand with the availability of high-value, affordable insurance products. The 2016 PRIS grantees are poised to contribute important evidence to further our understanding of competition and affordability on the ACA marketplaces. Stay tuned.
Megan Collado, M.P.H., is a senior manager at AcademyHealth, where she co-directs and supports a number of Robert Wood Johnson Foundation grantmaking programs and is the Project Director of an AHRQ-sponsored conference grant that convenes policy audiences to discuss the evidence and future research needs related to health care costs, financing, organization and markets.