Health Affairs October Issue: ACA Progress, Health And Social Supports

The October issue of Health Affairs looks at aspects of the Affordable Care Act (ACA) as the United States gears up for the next open enrollment season on the health exchanges. Other studies examine health costs, and the complex interplay between health and social supports.

DataWatch: More Lesbian, Gay, And Bisexual Adults Gained Insurance Under The ACA

Over the past two years, two major policy changes—the implementation of the ACA and the expansion of marriage equality—have affected the ability of lesbian, gay, and bisexual (LGB) adults to gain health insurance coverage and access health care. Laura Skopec and Sharon Long of the Urban Institute used data from the Health Reform Monitoring Survey (HRMS), comparing results before and after the ACA took effect for those respondents who identified themselves as "gay," "lesbian," or "bisexual."

The authors found that between the summer of 2013 and the winter of 2014–15, significant gains in insurance coverage were made by LGB adults (78.2 percent versus 88.9 percent) as well as the likelihood of having a usual source of care. However, they did not discern statistically significant changes in access and affordability of care for LGB adults during this time, although difficulties obtaining and affording care appear to have declined across all the measures. While gaps in access and affordability between LGB and non-LGB adults remained in 2014–15, the authors predict that the national legalization of same-sex marriage and continuing access to health insurance will eventually expand coverage options for LGB adults.

Lessons On Risk Selection From European Health Exchanges

As US consumers become more familiar with navigating health exchanges, Wynand van de Ven of the Netherland's Erasmus University Rotterdam and coauthors looked back at the 20-year experience of several European countries and focused on how these countries dealt with risk selection.

The study points out errors made by several European legislators and details strategies taken to reduce risk selection, especially through quality skimping, as well as some of the trade-offs made. To prevent risk selection that threatens access to quality care for underpriced high-cost patients, the authors recommend that US policymakers allow insurers more flexibility in setting premium rates and replace the current premium band on age with a generic premium band. They concluded that policymakers need to understand the complexities of regulating competitive health insurance markets.

Other ACA-related studies in the issue:

• Out-Of-Pocket Prescription Costs Under A Typical Silver Plan Are Twice As High As They Are In The Average Employer Plan by Kenneth Thorpe of Emory University and coauthors.

• California's Early ACA Expansion Increased Coverage And Reduced Out-Of-Pocket Spending For The State's Low-Income Population by Ezra Golberstein of the University of Minnesota and coauthors.

How Job Conditions Affect US Life Expectancy

While life expectancy gaps in the United States among whites, blacks, and Hispanics are well-documented, some of the reasons for them are not. Joel Goh of Harvard Business School and coauthors from Stanford University looked at one of these neglected factors: how people with different levels of education select jobs with different degrees of exposure to workplace attributes that may contribute to poor health.

Using General Social Security data from 2002–10 to estimate differential exposures to workplace conditions, the authors found that 10–38 percent of the difference in life expectancy across demographic groups can be explained by the different job conditions their members experience. They concluded that many of the difficulties faced in some workplaces—long hours, lack of health insurance, and job insecurity—can be at least partially addressed through policy interventions.

Studies pertaining to health costs:

• Less Physician Practice Competition Is Associated With Higher Prices Paid For Common Procedures by Daniel Austin and Laurence Baker, both of Stanford University.

• Price Increases Were Much Lower In Ambulatory Surgery Centers Than Hospital Outpatient Departments In 2007–12 by Kathleen Carey of Boston University.

from Health Affairs Blog http://ift.tt/1MUDwZ5