ACA and Private Insurance Markets
The private health insurance market is the central innovation of health care financing in the United States. Although the Affordable Care Act (ACA) has altered this market, its evolution through innovations in design has opportunities for new public policy initiatives. This panel will present three papers examining changes in private insurance. The first paper contrasts private Medicare Advantage with Fee-for-Service and how each manages diabetic patients differently. It is the first paper to make this comparison using the Health Care Cost Institute’s 10 million lives of Medicare Advantage data from three private insurers. The second paper looks at the tax exemption for employer-sponsored premiums with a fresh approach. The authors combine a microeconomic simulation of health plan choice with dynamic macroeconomic programming. They find that complete elimination of the ESI tax exclusion and transfer to a lower marginal tax rate will give an economic boost to the economy. This boost will more than offset the loss of the exclusion and will create an economic surplus capable of paying for other health policy innovations. The third paper examines the impact of relaxing the regulations that define qualified health plans in ACA health insurance exchanges. The authors identify pre-ACA designs in 2013 and then use a micro-simulation model estimate the impact if non-qualified pre-ACA plans were allowed to be sold in insurance exchanges after 2016. They find ACA regulations have a negative impact on the full potential of the private insurance market that will result in nearly 7% more uninsured by 2018.