Data Briefs
Since 1967, Penn's Leonard Davis Institute of Health Economics (LDI) has been the leading university institute dedicated to data-driven, policy-focused research that improves our nation’s health and health care. LDI’s Data Briefs provide timely data analysis to inform key issues related to health care coverage, delivery, access, and disparities. For more information, please contact Penn LDI (pennldi-info@wharton.upenn.edu).
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Publication Final Enrollment Rates Show Federally run Marketplaces Make up Lost Ground at end of Enrollment(2014-05-29) Polsky, Daniel; Weiner, Janet; Colameco, Christopher; Becker, Nora VerlaineThis new data brief updates our interim March 2014 findings with enrollment rates at the close of the Affordable Care Act's first open enrollment period. It focuses on enrollment rates by state and type of marketplace, and assesses changes in enrollment rates in the final six weeks. The final enrollment figures reveal that the federally facilitated marketplaces and some of the troubled state-based ones made up some ground in the last four to six weeks of the open enrollment period.Publication Health Insurance Rates and Rate Review(2014-06-27) Harrington, Scott E; Weiner, JanetHealth insurers participating in the new Marketplaces are filing rates for 2015 during the next few months. A few states have already released data on proposed rates. There is substantial economic, policy, and political interest in the magnitude of proposed rate changes. This brief provides background for understanding the economic drivers of proposed rates, state and federal rate review authority, the effects of rate changes on Marketplace enrollees and federal spending on premium credits, and the economic and political dynamics of the rate review and approval process.Publication The Skinny on Narrow Networks in Health Insurance Marketplace Plans(2015-06-23) Polsky, Daniel; Weiner, JanetThe Affordable Care Act (ACA) has prompted health plans to increase their use of “narrow networks” of providers as a cost containment strategy. The Leonard Davis Institute of Health Economics (LDI) has assembled the first integrated dataset of physician networks for the plans offered on the ACA marketplace. This data brief uses this new resource to describe the breadth of the physician networks in plans sold on the state and federal marketplaces. The percent of physician networks that were classified as small or x-small came to 41% overall, 55% for HMO networks, and 25% for PPO networks.Publication Window Shopping on Healthcare.gov and the State-Based Marketplaces: More Consumer Support Needed(2014-12-17) Baker, Tom; Beatty, Adrienne; Nirenburg, Gabbie; Weiner, JanetThis data brief examines the window-shopping experience that consumers encountered on each health insurance marketplace website during the first two weeks of the Affordable Care Act's second open enrollment period. The marketplaces have made some progress toward adopting the recommended "Top 5 Rules for Decision Support." Shoppers found plenty of sorting and filtering options, but insufficient information about providers and little true decision support. Although there is still a long way to go, there are grounds for optimism about further progress for the next open enrollment period.Publication How Nursing Affects Medicare’s Outcome-Based Hospital Payments(2015-11-12) Yakusheva, Olga; Weiner, Janet; Lindrooth, Richard C; Pauly, Mark V; Spetz, JoanneImproving value is one of the central aims of recent and ongoing health care reform. In our last LDI/INQRI Brief, we reviewed the evidence of the role of nurses in increasing the value of health care. In this companion brief, we dig deeper into the three reimbursement strategies that Medicare uses to align hospital financial incentives with quality of care, and we calculate the potential effects of nursing-sensitive quality indicators on hospital payments.Publication Health Insurance Marketplace Enrollment Rates by Type of Exchange(2014-03-28) Polsky, Daniel; Weiner, Janet; Colameco, Christopher; Becker, Nora VerlaineBecause the ACA gave them choices in how to implement insurance coverage, health reform looks different state to state. This Data Brief examines a number of choices related to the establishment and running of the new health insurance marketplaces, and their potential impact on enrollment rates to date. We use existing data sources as well as a new database developed by researchers at the University of Pennsylvania that documents and codes state-level variation in the political setting, institutional structures, and operational decisions likely to affect outcomes on the marketplaces.Publication How Did Rural Residents Fare on the Health Insurance Marketplaces?(2014-08-29) Polsky, Daniel; Weiner, Janet; Nathenson, Robert A; Becker, Nora Verlaine; Kanneganti, MounikaHow are rural areas faring with the Affordable Care Act? Has the law fostered competition among plans or have one or two insurers dominated? This Data Brief examines 2014 premiums and finds that residents of rural counties, as a whole, did not face higher premiums than residents of urban counties. However, states with largely rural populations do face fewer choices and higher premiums. These are the states to watch as new issuers enter the marketplaces and 2015 premiums are filed.Publication Essential Health Benefits: 50-State Variations on a Theme(2014-10-22) Weiner, Janet; Colameco, ChristopherAll qualified health plans under the Affordable Care Act must cover a package of essential health benefits (EHBs) equal in scope to a typical employer plan. The law laid out 10 general categories of services that EHBs must cover, but did not itemize those services. Each state is allowed to identify an existing plan as a benchmark for these EHBs. The result of this policy is that EHBs vary from state to state, often because of a legacy of different state-mandated benefits (such as treatments for autism, infertility, or temporomandibular joint disorders). This Data Brief analyzes state variation in coverage and limits for these non-uniform benefits.Publication The Financial Condition and Performance of CO-OP Plans(2015-02-10) Harrington, Scott EThe liquidation of CoOportunity Health, one of 23 non-profit health insurers created by the Affordable Care Act (ACA) has heightened concerns about the financial condition of the other CO-OP plans. This brief summarizes key data from CO-OPs’ third quarter 2014 National Association of Insurance Commissioners (NAIC) financial reports to state insurance regulators. We review CO-OP funding, enrollment, underwriting results, and rates. The data indicate that CO-OPs varied widely in terms of enrollment, pricing, and underwriting results. Many CO-OPs, including those with relatively high 2014 premium rates, had very little enrollment; others gained substantial enrollment, generally in conjunction with relatively low rates. That CO-OPs would face formidable actuarial, operational and financial challenges, with a significant likelihood that some would not become financially viable, has been recognized from the program’s initial planning stages. CoOportunity Health’s insolvency highlights those challenges and the potential consequences of rapid growth in conjunction with unfavorable claims experience, despite protection provided by the risk adjustment, reinsurance, and risk corridor programs. The experience highlights the need for close monitoring and oversight of CO-OP pricing and enrollment growth going forward.Publication Trends in Physician Networks in the Marketplace in 2016(2016-12-06) Polsky, Daniel; Zhang, Yuehan; Weiner, Janet; Yasaitis, Laura CIn this brief, we describe the breadth of physician provider networks offered on the health insurance marketplaces in 2016, and present differences by plan type, physician specialty, and state. We also compare networks in 2016 to those in 2014. We find little change in overall prevalence of narrow networks, but we find important geographic shifts and a trend towards x-small networks among plans with narrow networks. We discuss the policy implications of our findings for consumers, regulators, and health plans.