Dataset Information

Adverse Selection into and within the Individual Health Insurance Market in California in 2014.

ABSTRACT: OBJECTIVE:The Affordable Care Act (ACA) introduced reforms to mitigate adverse selection into and within the individual insurance market. We examined the traits and predicted medical spending of enrollees in California post-ACA. DATA SOURCES:Survey of 2,103 enrollees in individual market plans, on- and off-exchange, in 2014. STUDY DESIGN:We compared actual versus potential participants using data from the 2014 California Health Interview Survey on respondents who were individually insured or uninsured. We predicted annual medical spending for each group using age, sex, self-rated health, body mass index, smoking status, and income. PRINCIPAL FINDINGS:Average predicted spending was similar for actual ($3,377, 95 percent CI [$3,280-$3,474]) and potential participants ($3,257 [$3,060-$3,454]); however, some vulnerable subgroups were underrepresented. On- versus off-exchange enrollees differed in sociodemographic and health traits with modest differences in spending ($3,448 [$3,330-$3,565] vs. $3,175 [$3,012-$3,338]). CONCLUSIONS:We did not find evidence of selection into the overall insurance pool in 2014; however, differences by exchange status reflect the importance of including off-exchange enrollees in analyses and the pool for risk adjustment. California's post-ACA individual market has been a relative success, highlighting the importance of state policies and outreach efforts to encourage participation in the market.

SUBMITTER: Fung V

PROVIDER: S-EPMC6153153 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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Adverse Selection into and within the Individual Health Insurance Market in California in 2014.

Fung Vicki V Peitzman Cassandra G K CGK Shi Julie J Liang Catherine Y CY Dow William H WH Zaslavsky Alan M AM Fireman Bruce H BH Derose Stephen F SF Chernew Michael E ME Newhouse Joseph P JP Hsu John J

Health services research 20180517 5

<h4>Objective</h4>The Affordable Care Act (ACA) introduced reforms to mitigate adverse selection into and within the individual insurance market. We examined the traits and predicted medical spending of enrollees in California post-ACA.<h4>Data sources</h4>Survey of 2,103 enrollees in individual market plans, on- and off-exchange, in 2014.<h4>Study design</h4>We compared actual versus potential participants using data from the 2014 California Health Interview Survey on respondents who were indiv ...[more]

PMID: 29774534

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Project description:ImportanceThere have been substantial improvements in the early detection, treatment, and survival from cancer in the United States, but it is not clear to what extent patients with different types of health insurance have benefitted from these advancements.ObjectiveTo examine trends in cancer survival by health insurance status from January 1997 to December 2014.Design, setting, and participantsCalifornia Cancer Registry (a statewide cancer surveillance system) data were used to estimate population-based survival by health insurance status in 3 calendar periods: January 1997 to December 2002, January 2003 to December 2008, and January 2009 to December 2014 with follow-up through 2014. Overall, 1 149 891 patients diagnosed with breast, prostate, colorectal, or lung cancer, or melanoma in California were included in the study.Main outcomes and measuresFive-year all-cause and cancer-specific survival probabilities by insurance category and calendar period for each cancer site and sex; hazard ratios (HRs) and 95% CIs for each insurance category (none, Medicare, other public) compared with private insurance in each calendar period.ResultsAccording to data from 1 149 891 patients diagnosed with breast, prostate, colorectal, or lung cancer, or melanoma gathered from the California Cancer Registry, improvements in survival were almost exclusively limited to patients with private or Medicare insurance. For patients with other public or no insurance, survival was largely unchanged or declined. Relative to privately insured patients, cancer-specific mortality was higher in uninsured patients for all cancers except prostate, and disparities were largest from 2009 to 2014 for breast (HR, 1.72; 95% CI, 1.45-2.03), lung (men: HR, 1.18; 95% CI, 1.06-1.31 and women: HR, 1.32; 95% CI, 1.15-1.50), and colorectal cancer (women: HR, 1.30; 95% CI, 1.05-1.62). Mortality was also higher for patients with other public insurance for all cancers except lung, and disparities were largest from 2009 to 2014 for breast (HR, 1.25; 95% CI, 1.17-1.34), prostate (HR, 1.17; 95% CI, 1.04-1.31), and colorectal cancer (men: HR, 1.16; 95% CI, 1.08-1.23 and women: HR, 1.11; 95% CI, 1.03-1.20).Conclusions and relevanceAfter accounting for patient and clinical characteristics, survival disparities for men with prostate cancer and women with lung or colorectal cancer increased significantly over time, reflecting a lack of improvement in survival for patients with other public or no insurance. To mitigate these growing disparities, all patients with cancer need access to health insurance that covers all the necessary elements of health care, from prevention and early detection to timely treatment according to clinical guidelines.

Dataset Information

Adverse Selection into and within the Individual Health Insurance Market in California in 2014.

Publications

Adverse Selection into and within the Individual Health Insurance Market in California in 2014.

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