The Effects of Political Versus Actuarial Uncertainty on Insurance Market Stability

REFERENCES

1. ↵
   1. Aaron, Henry J.,
   2. Matthew Fiedler,
   3. Paul B. Ginsburg,
   4. Loren Adler, and
   5. Alice M. Rivlinet

   . 2017. “Turmoil in the Individual Insurance Market—Where It Came From and How to Fix It.” New England Journal of Medicine 377: 314–15.

   OpenUrl
2. ↵
   1. Abelson, Reed

   . 2018. “Obamacare Is Proving Hard to Kill.” New York Times, July 3. Accessed January 29, 2020. https://www.nytimes.com/2018/07/03/health/obamacare-insurance-rates.html.
3. ↵
   1. Abraham, Jean Marie

   . 2020. “Individual Market Volatility and Vulnerability, 2015 to 2019.” RSF: The Russell Sage Foundation Journal of the Social Sciences 6(2): 206–22. DOI: 10.7758/RSF.2020.6.2.10.

   OpenUrlCrossRef
4. 1. American Academy of Actuaries

   . 2017. “Comments on Executive Order to Departments of Labor, Treasury, and Health and Human Services.” Letter from Shari Westerfield, Vice President, American Academy of Actuaries, to Alexander Acosta, Department of Labor, Eric D. Hargan, Department of Health and Human Services, and Steven Mnuchin, Treasury Department. Accessed January 29, 2020. https://www.actuary.org/sites/default/files/files/publications/Executive_Order_Academy_Comments_110717.pdf.
5. ↵
   1. Anthem

   . 2017a. “Statement on Individual Market Participation in Ohio.” Press Release, June 6. Anthem Insurance Companies. Accessed January 29, 2020. https://www.anthem.com/press/ohio/anthem-statement-on-individual-market-participation-in-ohio.
6. ↵
   1. Anthem

   . 2017b. “Re: HHS Notice of Benefit and Payment Parameters for 2019; Proposed Rule.” Letter from Anthony Mader, Vice President, Public Policy, Anthem, Inc., to Eric Hargan, Acting Secretary, U.S. Department of Health and Human Services, November 22. Anthem Insurance Companies. Accessed January 29, 2020. https://s3.amazonaws.com/assets.fiercemarkets.net/public/004-Healthcare/external_Q42017/Anthem_comments.pdf.
7. ↵
   1. Appleby, Julie

   . 2018. “Despite Changes That Undermined ACA Enrollment, Marketplaces ‘Remarkably Stable’.” Kaiser Health News, February 7, 2018. Accessed January 29, 2020. https://khn.org/news/despite-changes-that-undermined-aca-enrollment-marketplaces-remarkably-stable.
8. ↵
   1. Barry-Jester, Anna Maria

   . 2017. “The Obamacare Marketplaces Aren’t in a Death Spiral: But They Are in Real Trouble.” FiveThirtyEight, May 19. Accessed January 29, 2020. https://fivethirtyeight.com/features/the-obamacare-marketplaces-arent-in-a-death-spiral.
9. ↵
   1. Blue Cross and Blue Shield of North Carolina (BCBS-NC)

   . 2017. “Actuarial Memorandum: 2018 Individual ACA Single-Risk-Pool Rate Filing.” August 3. Accessed January 29, 2020. https://ratereview.healthcare.gov/files/718681_11512_01012018_IND_RedactedAM.pdf.
10. 1. Blue Cross Blue Shield of Tennessee (BCBS-TN)

    . 2017. Letter from J. D. Hickey, President and CEO, to Commissioner Julie McPeak, Tennessee Department of Commerce and Insurance. May 9, 2017. Accessed January 29, 2020. https://cdn1.vox-cdn.com/uploads/chorus_asset/file/8487845/JDH_Letter_CommMcPeak_FV.0.pdf.
11. ↵
    1. Brookings Institution

    . 2018. “What’s Ahead for the Individual Health Insurance Market.” Proceedings, Washington, D.C., March 6. Accessed January 29, 2020. https://www.brookings.edu/wp-content/uploads/2018/03/es_20180306_health_market_transcript.pdf.
12. ↵
    1. Cabral, Marika,
    2. Michael Geruso, and
    3. Neale Mahoney

    . 2017. “Do Larger Health Insurance Subsidies Benefit Patients or Producers? Evidence from Medicare Advantage.” NBER working paper no. 20470. Cambridge, Mass.: National Bureau of Economic Research. Accessed January 29, 2020. http://www.nber.org/papers/w20470.
13. ↵
    1. Center for Budget and Policy Priorities (CBPP)

    . 2017. “Sabotage and Uncertainty Jeopardizing ACA Marketplaces, Insurers and Regulators Confirm.” Washington, D.C.: CBPP. Accessed January 29, 2020. https://www.cbpp.org/sites/default/files/atoms/files/5-12-17quotes.pdf.
14. ↵
    1. Center for Consumer Information & Insurance Oversight (CCIIO)

    . 2020. “Section 1332: State Innovation Waivers.” Last modified January 10, 2020. Washington: Centers for Medicare and Medicaid Services. Accessed January 29, 2020. https://www.cms.gov/CCIIO/Programs-and-Initiatives/State-Innovation-Waivers/Section_1332_state_Innovation_Waivers-.html.
15. ↵
    1. Centers for Medicare and Medicaid Services (CMS)

    . 2017. “Health Insurance Marketplaces 2017 Open Enrollment Period Final Enrollment Report: November 1, 2016–January 31, 2017.” Newsroom Fact Sheet, March 15. Washington: U.S. Department of Health and Human Services. Accessed January 29, 2020. https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-03-15.html.
16. ↵
    1. Centers for Medicare and Medicaid Services (CMS)

    . 2018. “Early 2018 Effectuated Enrollment Snapshot.” Trends Report, July 2. Washington: U.S. Department of Health and Human Services. Accessed January 29, 2020. https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/Downloads/2018-07-02-Trends-Report-1.pdf.
17. ↵
    1. Centers for Medicare and Medicaid Services (CMS)

    . 2019. “Health Insurance Exchanges 2019 Open Enrollment Report.” Newsroom Fact Sheet, March 25. Washington: U.S. Department of Health and Human Services. https://www.cms.gov/newsroom/fact-sheets/health-insurance-exchanges-2019-open-enrollment-report.
18. ↵
    1. Congressional Budget Office (CBO)

    . 2018. “Federal Subsidies for Health Insurance Coverage for People Under Age 65: 2018 to 2028.” CBO report no. 53826. Washington: Government Printing Office. https://www.cbo.gov/system/files/115th-congress-2017-2018/reports/53826-healthinsurancecoverage.pdf.
19. ↵
    1. Corlette, Sabrina and
    2. Jack Hoadley

    . 2016. “Strategies to Stabilize the Affordable Care Act Marketplaces: Lessons from Medicare.” Washington, D.C.: Georgetown University Health Policy Institute, Center on Health Insurance Reforms. Accessed January 29, 2020. https://www.rwjf.org/en/library/research/2016/08/strategies-to-stabilize-the-affordable-care-act-marketplaces.html.
20. ↵
    1. Covered California

    . 2018. “Individual Insurance Markets: Enrollment Changes in 2018 and Potential Policies That Could Lower Premiums and Stabilize the Markets in 2019.” Sacramento: Covered California. Accessed January 29, 2020. http://hbex.coveredca.com/data-research/library/CoveredCA_2018_Individual_Market_Enrollment_4-25-18.pdf.
21. ↵
    1. Cox, Cynthia,
    2. Larry Levitt, and
    3. Gary Claxton

    . 2017. “Insurer Financial Performance in the Early Years of the Affordable Care Act.” Data Note, April. San Francisco: Kaiser Family Foundation. Accessed January 29, 2020. https://www.kff.org/health-reform/issue-brief/insurer-financial-performance-in-the-early-years-of-the-affordable-care-act.
22. ↵
    1. Cox, Cynthia,
    2. Ashley Semanskee, and
    3. Larry Levitt

    . 2018. “Individual Insurance Market Performance in 2017.” Issue Brief, May. San Francisco: Kaiser Family Foundation. Accessed January 29, 2020. http://files.kff.org/attachment/Issue-Brief-Individual-Insurance-Market-Performance-in-2017.
23. ↵
    1. Cunningham, Paige Winfield

    . 2018. “Leading Obamacare Insurer Says Things Are ‘Materially Worse’ Under Trump Administration.” Washington Post, May 1.
24. ↵
    1. Demko, Paul

    . 2017. “How Iowa Became an Obamacare Horror Story.” Politico, October 23. Accessed January 29, 2020. https://www.politico.com/magazine/story/2017/10/23/iowa-obamacare-aca-markets-215736.
25. ↵
    1. Ely, Kathleen,
    2. William J. Thompson,
    3. Thomas D. Murawski,
    4. Sean Hilton,
    5. Donna Wix, and
    6. David Williams

    . 2018. “Section 1332 State Innovation Waiver Actuarial Analyses and Certification and Economic Analyses.” Maine Guaranteed Access Reinsurance Association Client Report, March 20. Windsor, Conn.: Milliman. Accessed January 29, 2020. https://www.maine.gov/pfr/insurance/mgara/exhibit_a_milliman_modeling_final.pdf.
26. ↵
    1. Fiedler, Mathew

    . 2017. “Taking Stock of Insurer Financial Performance in the Individual Health Insurance Market Through 2017.” Washington, D.C.: Brookings Institution. Accessed January 29, 2020. https://www.brookings.edu/research/taking-stock-of-insurer-financial-performance-in-the-individual-health-insurance-market-through-2017.
27. ↵
    1. Fletcher, Holly

    . 2017. “Tennessee’s Insurance Chief Seeks Elusive Answers in Washington.” The Tennessean, May 12. Accessed January 29, 2020. https://www.tennessean.com/story/money/industries/health-care/2017/05/12/tennessees-insurance-chief-seeks-elusive-answers-washington/315186001.
28. ↵
    1. Fritchen, Beth, and
    2. Kurt Giesa

    . 2018. “The Affordable Care Act’s Stabilization.” Oliver Wyman, June 20. Accessed January 29, 2020. http://health.oliverwyman.com/transform-care/2018/06/aca_survey.html.
29. ↵
    1. Gaba, Charles

    . 2018a. “2018 Rate Hikes.” ACASignups. Accessed January 29, 2020. http://acasignups.net/2018-rate-hikes.
30. ↵
    1. Gaba, Charles

    . 2018b. “How Much More Are YOU Paying This Year Due to #ACA Sabotage?” ACASignups, April 11. Accessed January 29, 2020. http://acasignups.net/18/04/11/updated-exclusive-how-much-more-are-you-paying-year-due-aca-sabotage.
31. ↵
    1. Giovannelli, Justin, and
    2. Emily Curran

    . 2018. “How Did State-Run Health Insurance Marketplaces Fare in 2017?” Issue Brief, March. New York: Commonwealth Fund. Accessed January 29, 2020. http://www.commonwealthfund.org/publications/issue-briefs/2018/mar/how-did-state-run-marketplaces-fare-in-2017.
32. ↵
    1. Gnau, Thomas

    . 2017. “Premier Health Plan to Exit ACA Exchange.” Dayton Daily News, June 29, 2017.
33. ↵
    1. Haislmaier, Edmund F

    . 2018. “Obamacare Health Insurance Exchanges: Competition and Choice Continue to Shrink.” Washington, D.C.: Heritage Foundation.
34. ↵
    1. Hall, Mark A

    . 1995. Reforming Private Health Insurance. Washington, D.C.: AEI Press.
35. ↵
    1. Hall, Mark A., and
    2. Michael J. McCue

    . 2016. “How Has the Affordable Care Act Affected Health Insurers’ Financial Performance?” New York: Commonwealth Fund.
36. 1. Hall, Mark A

    . 2018. “Health Insurance Markets Perform Better in States That Run Their Own Marketplaces.” New York: Commonwealth Fund.
37. ↵
    1. Jost, Timothy

    . 2017a. “Shoring Up the Health Insurance Marketplaces: Learning from Medicare’s Prescription Drug Program.” To the Point (Commonwealth Fund blog), April 7. Accessed January 29, 2020. https://www.commonwealthfund.org/blog/2017/shoring-health-insurance-marketplaces-learning-medicares-prescription-drug-program.
38. ↵
    1. Jost, Timothy

    . 2017b. “CMS Checklist for State 1332 Waivers Focuses on High-Risk Pools, Reinsurance.” Following the ACA (Health Affairs blog), May 12. http://healthaffairs.org/blog/2017/05/12/cms-checklist-for-state-1332-waivers-focuses-on-high-risk-pools-reinsurance.
39. 1. Kaiser Family Foundation

    . 2020. “State Health Facts.” Accessed January 19, 2020. https://www.kff.org/statedata/.
40. ↵
    1. Laszewski, Robert

    . 2017. “Is Part of the Health-Insurance Market Entering a Death Spiral?” National Review, August 3. Accessed January 28, 2020. https://www.nationalreview.com/2017/08/obamacare-death-spiral-exchange-enrollment-down-29-percent.
41. ↵
    1. Lee, Peter V.,
    2. Vishaal Pegany,
    3. James Scullary, and
    4. Colleen Stevens

    . 2017. Marketing Matters: Lessons from California to Promote Stability and Lower Costs in National and State Individual Insurance Markets. Sacramento: Covered California. Accessed January 29, 2020. http://hbex.coveredca.com/data-research/library/CoveredCA_Marketing_Matters_9-17.pdf.
42. ↵
    1. Lerman, Amy E.,
    2. Meredith L. Sadin, and
    3. Samuel Trachtman

    . 2017. “Policy Uptake as Political Behavior: Evidence from the Affordable Care Act.” American Political Science Review 111(4): 755–70. DOI: 10.1017/S0003055417000272.

    OpenUrlCrossRef
43. ↵
    1. Liu, Jodi, and
    2. Christine Eibner

    . 2018. “Expanding Individual Market Enrollment Without the Individual Mandate: Options to Bring More People into the Market.” New York: Commonwealth Fund.
44. ↵
    1. Lucia, Kevin,
    2. Jack Hoadley,
    3. Sabrina Corlette,
    4. Dania Palanker, and
    5. Olivia Hopp

    . 2017. “Stepping into the Breach: How States and Insurers Worked Together to Prevent Bare Counties for 2018.” Washington, D.C.: Urban Institute. Accessed January 29, 2020. https://www.urban.org/sites/default/files/publication/94571/2001591_bare_county_brief_1.pdf.
45. ↵
    1. Mathews, Anna Wilde

    . 2018. “Insurers to Expand Presence in Affordable Care Act Marketplaces Despite Uncertainty.” Wall Street Journal, June 21.
46. ↵
    1. Monheit, Alan, and
    2. Joel Cantor

    . 2004. State Health Insurance Market Reform. Philadelphia, Pa.: Routledge Press.
47. ↵
    1. Norris, Louise

    . 2016. “Beware Obamacare’s ‘Subsidy Cliff.’” Healthinsurance.org, October 17. Accessed January 29, 2020. https://www.healthinsurance.org/obamacare/beware-obamacares-subsidy-cliff.
48. ↵
    1. Ogilvy

    . 2018. “Health Care Press Coverage 2017 Enrollment Period vs. 2018 Enrollment.” Sacramento: Covered California. Accessed January 29, 2020. http://board.coveredca.com/meetings/2018/01-18/Ogilvy-Enrollment_Coverage_Measurement-Final-01-18-18.pdf.
49. ↵
    1. Pauly, Mark, and
    2. Bradley Herring

    . 1999. Pooling Health Insurance Risks. Washington, D.C.: AEI Press.
50. ↵
    1. Ramm, Michaela

    . 2018. “Wellmark to Return to Iowa Exchange, Sell ACA-Compliant Plans.” The Gazette, February 8. Accessed January 29, 2020. http://www.thegazette.com/subject/news/health/wellmark-to-return-to-iowa-exchange-sell-aca-compliant-plans-20180208.
51. ↵
    1. S&P Global

    . 2018. “Are U.S. Health Insurers Finally Getting to Stable Ground in the ACA Individual Market?” January 2018. Accessed January 29, 2020. https://www.capitaliq.com/CIQDotNet/CreditResearch/RenderArticle.aspx?articleId=1977710&SctArtId=446012&from=CM&nsl_code=LIME&sourceObjectId=10392499.
52. ↵
    1. Semanskee, Ashley,
    2. Cynthia Cox,
    3. Gary Claxton, M. Long, and
    4. Rabah Kamal

    . 2017. “Insurer Participation on ACA Marketplaces, 2014–2018.” Data Note, November 10. San Francisco: Kaiser Family Foundation.
53. ↵
    1. Semanskee, Ashley,
    2. Cynthia Cox, and
    3. Larry Levitt

    . 2018. “Changes in Enrollment in the Individual Health Insurance Market.” Data Note, July. San Francisco: Kaiser Family Foundation. http://files.kff.org/attachment/Data-Note-Changes-in-Enrollment-in-the-Individual-Health-Insurance-Market.
54. ↵
    1. Trachtman, Samuel

    . 2018. “Polarization, Participation, and Policy Performance: The Case of ACA Marketplaces.” Unpublished paper, University of California. DOI: 10.2139/ssrn.3081991.
55. ↵
    1. U.S. Congress

    . 2017. “A Manufactured Crisis: Trump Administration and Republican Sabotage of the Health Care System.” Democratic Staff Report, June 2017. Washington: Government Printing Office. Accessed January 29, 2020. https://energycommerce.house.gov/sites/democrats.energycommerce.house.gov/files/documents/A%20Manufactured%20Crisis%20-%20Trump%20Administration%20and%20Republican%20Sabotage%20of%20the%20Health%20Care%20System_FINAL.pdf.
56. ↵
    1. U.S. Department of Health and Human Services (HHS)

    . 2017. “Health Plan Choice and Premiums in the 2018 Federal Health Insurance Exchange.” ASPE issue brief, October 30. Washington: Government Printing Office. Accessed January 29, 2020. https://aspe.hhs.gov/system/files/pdf/258456/Landscape_Master2018_1.pdf.
57. ↵
    1. Weinberg, Micah, and
    2. Leif Haase

    . 2017. “Improving Individual Health Insurance Markets.” San Francisco: Bay Area Council Economic Institute. Accessed January 29, 2020. http://www.bayareaeconomy.org/files/pdf/ImprovingHealthInsMarketsBACEI102717.pdf.
58. ↵
    1. White House

    . 2018. “The Profitability of Health Insurance Companies.” Washington: Council of Economic Advisers. Accessed January 29, 2020. https://www.whitehouse.gov/wp-content/uploads/2018/03/The-Profitability-of-Health-Insurance-Companies.pdf.