(Why) Did the Health Insurance Marketplaces Fail?

Titelangaben

Rollwage, Antonia:
(Why) Did the Health Insurance Marketplaces Fail?
In: Schmid, Andreas ; Singh, Simone (Hrsg.): Crossing Borders - Innovation in the U.S. Health Care System. - Bayreuth : P.C.O. , 2017 . - S. 49-65 . - (Schriften zur Gesundheitsökonomie ; 84 )
ISBN 978-3-941678-63-7

Volltext

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Abstract

In 2010, the ACA was signed into law and required states to establish and operate health insurance marketplaces for individuals without access to governmental payment programs or employer sponsored health insurance. Currently, the media is flooded with increasing premiums and health insurance companies leaving the marketplace. This paper aims to analyze the performance of the marketplace in terms of (1) enrollment, (2) risk pooling, (3) navigation, (4) financial performance and (5) affordability. The analysis showed initial technological problems inhibited a smooth launch of the marketplaces and led to skewed risk pools. Enrollment numbers are mediocre, reaching only 20 percent of the market's target population. Individuals lacking health literacy face a challenging market environment, leading to a significant number of enrollees who do not know their exact insurance plan coverage and cost-sharing requirements. In the first two years, the financial per-formance of the insurance market was poor, but as more data on enrollees was ob-tained and used for premium calculations the performance of insurance companies slowly started to improve. Despite the positive trend, insurers decided to leave the marketplace. However, to offer profitability and maintain insurer participation, a continuing stabilization of the market is needed. Individuals and families, especially, report trouble in affording care, financial insecurities, and postponement of care. The establishment of the marketplaces helped to increase insurance coverage, but also introduced new challenges hindering the marketplace to reach its full potential. Interventions are needed for the marketplace to become more successful.