Association for Public Policy Analysis & Management

This presentation will present results from both data analysis and field research on the strengths and weaknesses of the health insurance market under the Affordable Care Act (ACA) and on strategies to stabilize and strengthen this market. While the Affordable Care Act’s reforms of the individual and small group insurance markets worked well for the first two years, market conditions began to worsen substantially in the individual market in 2016 and 2017, prompting some states to consider or implement a range of market stabilization strategies, such as retrospective reinsurance, prospective reinsurance, and high-risk pools. Also, the Trump Administration’s changes to various administrative policies, such as those regarding association health plans and short-term policies, threaten to further weaken or destabilize both the individual and the small group market.

My presentation will draw from two separate studies of market conditions, one quantitative and the other qualitative. The quantitative study is based on analyses of insurance market and financial data from CMS. The qualitative study is based on a series of case studies in 10 states that represent a range of geographic, market, socio-economic, and public policy characteristics as well as market stabilization strategies of particular interest. Topics covered will include:

1. Why has the small group marketnot struggled to the same extent as the individual market?
2. Will more liberal use of “association health plans” weaken the small group market substantially?
3. For the individual market, why have states that operate their own exchangeshad better market conditions than states the default to the federal exchange?
4. Did shortened open enrollmentor reduced advertising have any apparent effects in 2017?
5. What steps did states take to cover bare counties(with no ACA insurers)?
6. What effect is repeal of the individual mandateexpected to have?
7. What are the expected impacts of new federal rules that are less restrictive of non-complying short term plans;
8. What effect is uncertainty over the ACA’s futureand over current administrative policy more generally having on market stability?