Study Results from Vanderbilt University Medical Center Broaden Understanding of Health and Medicine (Plan Selection, Enrollee Risk, and Health Spending on the Patient Protection and Affordable Care Act Individual Marketplaces, 2019): Health and Medicine

2023 APR 18 (NewsRx) -- By a News Reporter-Staff News Editor at Health Policy and Law Daily -- Current study results on agriculture have been published. According to news reporting out of Nashville, Tennessee, by NewsRx editors, research stated, “Importance: The Patient Protection and Affordable Care Act (ACA) individual marketplaces are a source of insurance for millions of residents in the US. However, the association between enrollee risk, health spending, and metal tier selection remains unclear.”

Our news reporters obtained a quote from the research from Vanderbilt University Medical Center: “To describe individual marketplace enrollees’ metal tier selections by risk score and assess enrollees’ health spending by metal tier, risk score, and spending type. Design, Setting, and Participants: This retrospective, cross-sectional study analyzed claims data from the Wakely Consulting Group ACA database, a deidentified claims database built on data voluntarily submitted by insurers. Enrollees with continuous, full-year enrollment in on-exchange or off-exchange ACA-qualified health plans during the 2019 contract year were included. Data analysis was conducted from March 2021 to January 2023. Main Outcomes and Measures: Enrollment totals, total spending, and out-of-pocket cost were calculated, stratified by metal tier and the Department of Health and Human Services (HHS) Hierarchical Condition Category (HCC) risk score for 2019. Enrollment and claims data were obtained for 1 317 707 enrollees (53.5% female; mean [SD] age, 46.35 [13.43] years) across all census areas, age groups, and sexes. Of these, 34.6% were on plans with cost-sharing reductions (CSRs), 75.5% did not have an assigned HCC, and 84.0% submitted at least 1 claim. Compared with enrollees in bronze plans (17.2%), enrollees were more likely to be classified in the top HHS-HCC risk quartile if they selected platinum (42.0%), gold (34.4%), or silver (29.7%) plans. The highest share of enrollees with $0 total spending was noted with the catastrophic (26.4%) and bronze (22.7%) plans, while gold plans had the lowest share (8.1%). Median total spending was lower among bronze plan enrollees ($593; IQR, $28-$2100) vs platinum ($4111; IQR, $992-$15 821) or gold ($2675; IQR, $728-$9070).”

According to the news editors, the research concluded: “Within the top risk score decile, CSR enrollees had less average total spending than any other metal tier by more than 10%. Conclusions and Relevance: In this cross-sectional study of the ACA individual marketplace, enrollees who selected plans with higher actuarial value also had greater mean HHS-HCC risk scores and health spending. The findings suggest these differences may be associated with variation in benefit generosity by metal tier, enrollee’s perceptions of future health needs, or other barriers to care access.”

For more information on this research see: Plan Selection, Enrollee Risk, and Health Spending on the Patient Protection and Affordable Care Act Individual Marketplaces, 2019. JAMA Network Open, 2023,6(3). (JAMA Network Open - https://jamanetwork.com/journals/jamanetworkopen). The publisher for JAMA Network Open is American Medical Association (AMA).

A free version of this journal article is available at https://doi.org/10.1001/jamanetworkopen.2023.4529.

Our news journalists report that more information may be obtained by contacting Graham Treasure, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States. Additional authors for this research include David M. Anderson, Lauren Hatcher, Alexandra E. Makhoul, Darren Johnson, Jenna Stefan, Kevin N. Griffith.

(Our reports deliver fact-based news of research and discoveries from around the world.)