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Health Exchange Analysis

Health Exchange Analysis. Market Analysis of Plan Designs, Prices, and Enrollment.

The HSI Network’s health insurance economic simulation model analyzes public and private insurance data to:

  • Simulate individual and employer insurance choices based on healthcare policy and market conditions.
  • Estimate enrollment in private health insurance plans, Medicaid, and the uninsured.
  • Offers budgetary impact analysis for states and the federal government.
  • Gives premium estimates by insurance plan type.

Recent Projects:

Microsimulation of Private Health Insurance and Medicaid Take-Up Following the U.S. Supreme Court Decision Upholding the Affordable Care Act
Publication: Health Services Research Journal

OBJECTIVE: To predict take-up of private health insurance and Medicaid following the U.S. Supreme Court decision upholding the Affordable Care Act (ACA). DATA SOURCE: Data came from three large employers and a sampling of premiums from We supplemented the employer data with information on state Medicaid eligibility and costs from the Kaiser Family Foundation. National predictions were based on the MEPS Household Component. STUDY DESIGN: We estimated a conditional logit model of health plan choice in the large group market. Using the coefficients from the choice model, we predicted take-up in the group and individual health insurance markets. Following ACA implementation, we added choices to the individual market corresponding to plans that will be available in state and federal exchanges. Depending on eligibility for premium subsidies, we reduced the out-of-pocket premiums for those choices. We simulated several possible patterns for states opting out of the Medicaid expansion, as allowed by the Supreme Court. PRINCIPAL FINDINGS: The ACA will increase coverage substantially in the private insurance market and Medicaid. HSAs will remain desirable in both the individual and employer markets. CONCLUSIONS: If states opt out of the Medicaid expansion, this could increase the federal cost of health reform, while reducing the number of newly covered lives.

Competitive Bidding for Health Insurance Contracts: Lessons from the Online HMO Auctions
Publication: International Journal of Health Care Finance and Economics

In this paper, we assess an endeavor by several Fortune 500 companies to reduce healthcare procurement costs for their employees by having HMOs compete in open electronic auctions. Although the auctions were successful in generating significant cost savings for the companies in the first year, i.e., 1999, they failed to replicate the success and were eventually discontinued after two more years. Over the past decade since the failed auction experiment, effective utilization of information technologies have led to significant advances in the design of complex electronic markets. Using this knowledge, and data from the auctions, we point out several shortcomings of the auction design that, we believe, led to the discontinuation of the market after three years. Based on our analysis, we propose several actionable recommendations that policy makers can use to design a sustainable electronic market for procuring health insurance.

Health Savings Accounts: Early Estimates of National Take-Up
Publication: Health Affairs

The 2003 Medicare Prescription Drug, Improvement, and Modernization Act (MMA) approved tax-advantaged health savings accounts (HSAs) for certain high-deductible health insurance plans. We predict that MMA could lead to approximately 3.2 million HSA contracts among Americans ages 19–64 who are not students, not enrolled in public health insurance plans, and not eligible for group coverage as a dependent. We simulate the effect of several additional tax subsidies for HSAs. We predict that the Bush administration’s refundable tax-credit proposal would double HSA take-up and reduce the number of uninsured people by 2.9 million, at an annual cost of $8.1 billion.