The individual insurance market saw five years of significant change under the ACA—and there are lessons for policymakers to take away from both the successes and failures, a new study shows.
Researchers at Georgetown University looked back at how the Affordable Care Act impacted the individual insurance markets between 2014 and 2019 and found that the healthcare law’s vulnerability to ongoing policy change “serves as both a lesson and a warning” for future reformers.
Sabrina Corlette, co-director of Georgetown’s Center on Health Insurance Reforms and the study’s lead author, told FierceHealthcare that lesson is valuable for potential reform on both the right and left sides of the political spectrum.
“There can be very well-intentioned policies that can have unintended consequences to the stability of the market,” Corlette said.
A change in the magnitude of a Medicare for All single-payer transition or a full repeal of the ACA is not required to have a major impact on the market, she said.
Whether it’s the design of a public option or Medicare buy-in on one side or growing use of health reimbursement arrangements to buy coverage on the other, even the smallest detail can have a snowball effect on several factors.
“I think there are a lot of lessons to be learned from the ACA—and the fact that fairly small changes in policies can influence the number of insurance companies that are willing and interested in participating,” Corlette said.
Over the course of five years, the ACA’s changes to the individual market did boost coverage and access, though the affordability question has yet to be solved, the study said.
What could the next five years, or next decade, look like for the individual markets? Barring a massive overhaul led by either the Republicans or Democrats, Corlette predicts stable enrollment and modest price changes over time.
If the status quo is maintained, the markets are likely to remain dominated by the same current forces, namely insurers largely focused on the Medicaid market before expanding to the exchanges, such as Centene Corporation and Molina Healthcare.
That’s not likely to lead to much innovation in benefit design and slow expansion into new geographic regions, Corlette said.
“I think it’s still a very vulnerable market,” she said. “This is true of any market that depends on private companies to deliver the benefits—they need policy certainties, and in the absence of that they’re going to be very conservative and risk-averse.”