While the Affordable Care Act (ACA) put health insurance coverage within reach of most Americans, it does leave some groups without affordable options, according to a paper by researchers from the University of Tennessee Health Science Center (UTHSC) that was published by the prestigious Annals of Internal Medicine.
Ilana Graetz, PhD, assistant professor in the Department of Preventive Medicine at UTHSC, is the lead author of the paper titled, “The U.S. Health Insurance Marketplace: Are Premiums Truly Affordable?” It is one of a series of papers being produced by members of the UTHSC Department of Preventive Medicine examining aspects of the Affordable Care Act.
Co-authors of the paper are: Cameron Kaplan, PhD, assistant professor in the Department of Preventive Medicine at UTHSC; Erin Kaplan, PhD, assistant professor in the Department of Economics at Rhodes College; Teresa Waters, PhD, chair of the Department of Preventive Medicine at UTHSC; and Jim Bailey, MD, MPH, professor in the Department of Medicine at UTHSC.Annals of Internal Medicine is one of the most highly cited academic medical journals in the world.
The ACA, signed into law in 2010, mandates that most individuals have health insurance or pay a penalty. Those with incomes up to 400 percent of the federal poverty level qualify for a federal subsidy to make coverage more affordable. But if the lowest-cost plan available is greater than 8 percent of income, individuals are exempt from paying the penalty.
The researchers gathered data on premiums for all health plans offered on the state and federal health care marketplaces, and calculated the after-subsidy premiums for the lowest-cost (bronze) plan for every county in the United States. Variations in cost by age, income and geographic location were considered.
“Results indicated that — although marketplace subsidies ensure affordable health insurance for most persons in the United States – many individuals with incomes just above the subsidy threshold will lack affordable coverage and will be exempt from the federal mandate,” the paper said.
The researchers also found that because of the way the subsidies are calculated, young people with low incomes often pay as much or more than older individuals for bronze plans. “If substantial numbers of younger, healthier adults choose to remain uninsured due to cost, health insurance premiums across all ages may increase over time,” the paper said.
“I do think in general, the subsidies did a lot to improve affordability of health insurance,” Dr. Graetz said.
“The main message is not that the Affordable Care Act is not working, but just that there are some gaps that I think we can address to make it better,” she said. “So, my hope is that this paper draws some attention to these gaps and helps the policymakers keep improving the law.”
Dr. Graetz received a doctorate in Health Services and Policy Analysis from the University of California Berkeley and joined the Department of Preventive Medicine at UTHSC in September 2013.