Ask anyone about their health care and you are likely to hear about ailments, doctors, maybe costs and insurance hassles. Most people don’t go straight from “my health” to a political debate, and yet that is what our country has been embroiled in for almost a decade.
A study out Thursday tries to set aside the politics to examine how the insurance markets function and what makes or breaks them in five specific states.
Researchers from The Brookings Institution were exploring a basic idea: If the goal is to replace or repair the Affordable Care Act, then it would be good to know what worked and what failed.
“The political process at the moment is not generating a conversation about how do we create a better replacement for the Affordable Care Act,” said Alice Rivlin, senior fellow at The Brookings Institution, who spearheaded the project. “It’s a really hard problem and people with different points of view about it have got to sit down together and say, ‘How do we make it work?’”
he researchers focused on California, Florida, Michigan, North Carolina and Texas, interviewing state regulators, health providers, insurers, consumer organizations, brokers and others to understand why insurance companies chose to enter or leave markets, how state regulations affected decision making and how insurers built provider networks.
“Both parties miss what makes insurance exchanges successful,” said Micah Weinberg, president of Bay Area Council Economic Institute who led the California research team. “And it doesn’t have anything to do with red and blue states and it doesn’t have anything to do with total government control or free markets.”
Despite the political diversity of the five states, some common lessons emerged. Among them:
- Health Insurance Markets Are Local
- Consolidation Kills Competition
- More Sick People Signed Up Than Expected
- Some Consumers May Be “Gaming” The System
- Narrow Networks Appear To Be The New Normal
- The Sky May Be Falling, But Many Carriers Are Nevertheless Doing Well
- Medicaid Managed Care Plans Come Out Winners
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