Regional Disease Incidence in Pricing Private Health Insurance Premiums: - A Study of Florida Health Insurance Marketplace under the Affordable Care Act.
Regional Disease Incidence in Pricing Private Health Insurance Premiums: - A Study of Florida Health Insurance Marketplace under the Affordable Care Act Yuxian Du,
1 B.S. ;
Michael A. Morrisey,
1 Ph.D ;
Robert L. Ohsfeldt,
1 Ph.D. ;
Daikwon Han,
2 Ph.D.
& Alan Dabney,
3 Ph.D.
1. Health Policy and Management; 2. Epidemiology and Biostatistics; 3. Statistics – Texas A&M University, College Station, TX 77843
RESULTS Number of Silver Plans & Issuers in Florida (2014-2018) 14
2000
15
12
11
1500
10
8 1000 1576 500
6 1399
1147
1125
1069
0
0 2014 2015 2016 2017 2018 Number of Silver Plans Number of Issuers
Statistical Models
Multivariate Regression and Fixed Effects Results
RESEARCH OBJECTIVES • The dynamics of private health plans and insurers • Identify potential factors impacting the premiums
DATA & METHODS Data Sources • Health Insurance Premiums: CMS Marketplace Public Use File • Regional Information
5
Number of Issuers
The Affordable Care Act (ACA) • The Affordable Care Act (ACA) provided health insurance for many previously uninsured after effective start March 2010 . • Premiums under ACA allowed to vary by age, location, # of dependents, tobacco use, and plan type (bronze, silver, gold, platinum) • Premium increases and insurer dropout Benchmark plan premium increased 25% (FY2014-16) Number of plans available dropped 32% Why Florida? • Largest state using each county as rating area
Number of Insurers and Silver Plans
Number of Silver Plans
INTRODUCTION
Premium Changes for Age 35 and 55 Individuals (2014-2018)
How much more (or less) you would pay if … Premium Increase from Urban Live in Suburban and rural
$35.25
Live in Small urban and Large Suburban Live in Mid-size Urban -$20.00
$2.64 -$10.86 $0.00
$20.00
• Rural-Urban Continuum Code (RUCC) 2013 report • Disease incidences: CDC maps on cancer and Premium Increase from 2014 (Time Effect) diabetes Purchase in Year 2018 • Other information: Area Health Resource File (AHRF) Purchase in Year 2017 $106.39 Methods
KEY FINDINGS • Average Silver premium increased about 77.6% ($434.59 vs. $771.69) • Insurers dropped out (12 vs. 6, 50%) • Rural-Urban differences (most expensive in suburban and rural) • Age Effect (one year older results in $15.87 higher premium – result not shown) • Premiums increased at an increasing rate from 2014-2018 • Impact of county incidence rates (per 100K) for Cancer (-$0.06) and Diabetes ($0.01) statistically significant but small in magnitude $40.00
IMPLICATIONS
• ACA’s constraints on medical underwriting might have contributed to the premium increase and insurer dropout. • Generalized Linear Multivariate Regression Purchase in Year 2016 $41.67 • Policies that affect premium determination should • Fixed effects model: Age, Year, Disease Incidences, consider incorporating other factors such as local Purchase in Year 2015 $46.45 Urbanity disease incidence, as it might help with premium Why Cancer and Diabetes: $0.00 $100.00 $200.00 $300.00 $400.00 setting and lowering uninsured rate Potential to avoid higher cost enrollees • Insurers participation and premiums increase could Reference Scenario: age 26, In year 2014, live in larger urban area be correlated. Further investigation is necessary. $347.58
