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2.
Health Econ ; 28(11): 1345-1355, 2019 11.
Article in English | MEDLINE | ID: mdl-31475424

ABSTRACT

This paper investigates the effect of the Affordable Care Act preexisting conditions provision on marriage. The policy was implemented to prevent insurers from denying insurance coverage to individuals with preexisting health conditions. We test whether the implementation of the provision led to decreases in marriage among affected adults. We add to earlier work on how marital behavior is influenced by spousal health insurance and examine for the presence of "marriage lock," a situation in which individuals remain married primarily for insurance. Using longitudinal data from the Panel Study of Income Dynamics from 2009 to 2017 and estimating difference-in-differences models, we find that male household heads with preexisting conditions are 7.12 percentage points (8.9 percent) less likely to be married after the policy. Using information on insurance status prior to the policy change, we find significant reductions in marriage among individuals with preexisting conditions who were previously insured by spousal health insurance plans. The findings suggest that the inability to attain individual coverage and reliance on spousal insurance provided incentives to remain married before 2014.


Subject(s)
Marriage/statistics & numerical data , Patient Protection and Affordable Care Act , Preexisting Condition Coverage , Adult , Female , Humans , Insurance Coverage/legislation & jurisprudence , Insurance Coverage/statistics & numerical data , Insurance, Health/legislation & jurisprudence , Insurance, Health/statistics & numerical data , Male , Middle Aged , Models, Statistical , Preexisting Condition Coverage/legislation & jurisprudence , Preexisting Condition Coverage/statistics & numerical data , United States
3.
Am J Public Health ; 109(4): 562-564, 2019 04.
Article in English | MEDLINE | ID: mdl-30789766

ABSTRACT

OBJECTIVES: To examine private insurance coverage for persons with diabetes before and after enactment of the preexisting condition mandate of the Affordable Care Act (ACA) in the United States. METHODS: We conducted a nationwide study in adults aged 20 to 59 years with private health insurance with the Clinformatics Data Mart Database (2005-2016). We used fixed-effects negative binomial regression to evaluate differences in pre-post mandate trends. RESULTS: There was a 4% decline in prevalence rates of type 1 diabetes in adults with private health insurance before the mandate and an 11% increase afterward (P < .001). Coverage increased to the greatest extent (-6% before, +20% after) in those aged 50 to 59 years (P < .001). For type 2 diabetes, there was a significant decline in prevalence before the mandate, which increased afterward in those aged 40 to 49 years (-4% before, 3% after; P = .031) and 50 to 59 years (-6% before, 15% after; P < .001). CONCLUSIONS: Adults with diabetes may have benefited in obtaining private health insurance after implementation of the preexisting condition mandate of the ACA. Public Health Implications. Efforts to limit enforcement of these protections are likely to contribute to setbacks in access to care.


Subject(s)
Diabetes Mellitus, Type 2/therapy , Insurance Coverage , Insurance, Health , Patient Protection and Affordable Care Act/legislation & jurisprudence , Preexisting Condition Coverage/legislation & jurisprudence , Adult , Age Factors , Female , Health Services Accessibility , Humans , Male , Middle Aged , United States , Young Adult
4.
J Law Med Ethics ; 46(2): 485-498, 2018 06.
Article in English | MEDLINE | ID: mdl-30147000

ABSTRACT

Previously diagnosed by symptoms alone, Alzheimer's disease is now also defined by measures of amyloid and tau, referred to as "biomarkers." Biomarkers are detectible up to twenty years before symptoms present and open the door to predicting the risk of Alzheimer's disease. While these biomarkers provide information that can help individuals and families plan for long-term care services and supports, insurers could also use this information to discriminate against those who are more likely to need such services. In this article, we evaluate whether state laws prohibit long-term care insurers from making discriminatory or unfair underwriting and coverage decisions based Alzheimer's disease biomarkers status. We report data demonstrating that current state laws do not provide meaningful protections from discrimination by long-term care insurers based on biomarker information.


Subject(s)
Alzheimer Disease/metabolism , Biomarkers/metabolism , Insurance Coverage/legislation & jurisprudence , Insurance, Long-Term Care/legislation & jurisprudence , Preexisting Condition Coverage/legislation & jurisprudence , Eligibility Determination , Humans , State Government , United States
5.
Fed Regist ; 83(86): 19431-6, 2018 May 03.
Article in English | MEDLINE | ID: mdl-30016050

ABSTRACT

On November 18, 2015, the Departments of Labor, Health and Human Services, and the Treasury (the Departments) published a final rule in the Federal Register titled "Final Rules for Grandfathered Plans, Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, Dependent Coverage, Appeals, and Patient Protections Under the Affordable Care Act" (the November 2015 final rule), regarding, in part, the coverage of emergency services by non- grandfathered group health plans and health insurance issuers offering non-grandfathered group or individual health insurance coverage, including the requirement that non-grandfathered group health plans and health insurance issuers offering non-grandfathered group or individual health insurance coverage limit cost-sharing for out-of-network emergency services and, as part of that rule, pay at least a minimum amount for out-of-network emergency services. The American College of Emergency Physicians (ACEP) filed a complaint in the United States District Court for the District of Columbia, which on August 31, 2017 granted in part and denied in part without prejudice ACEP's motion for summary judgment and remanded the case to the Departments to respond to the public comments from ACEP and others. In response, the Departments are issuing this notice of clarification to provide a more thorough explanation of the Departments' decision not to adopt recommendations made by ACEP and certain other commenters in the November 2015 final rule.


Subject(s)
Emergency Medical Services/legislation & jurisprudence , Insurance Coverage/legislation & jurisprudence , Insurance, Health/legislation & jurisprudence , Patient Protection and Affordable Care Act/legislation & jurisprudence , Preexisting Condition Coverage/legislation & jurisprudence , Emergency Medical Services/economics , Humans , Insurance Coverage/economics , Insurance, Health/economics , Patient Protection and Affordable Care Act/economics , Preexisting Condition Coverage/economics , United States
6.
Health Aff (Millwood) ; 37(7): 1153-1159, 2018 07.
Article in English | MEDLINE | ID: mdl-29985686

ABSTRACT

As of January 1, 2014, the Affordable Care Act designated mental health and substance use services as an essential health benefit in Marketplace plans and extended parity protections to the individual and small-group markets. We analyzed documents for seventy-eight individual and small-group plans in 2014 (after parity provisions took effect) and sixty comparison plans in 2013 (the year before parity provisions took effect) to understand the degree to which coverage for mental health and substance use care improved relative to medical/surgical benefits. The results suggest that plan issuers did what the provisions required them to do. Although in 2013 a lower proportion of plans covered mental health or substance use care, compared to medical/surgical care, in 2014 the proportions were the same. If essential health benefit requirements were to be removed and mental health and substance use coverage becomes similar to that in 2013, as many as 20 percent of the plans in our sample would not cover these conditions. To determine whether increases in behavioral health coverage will result in improved access to behavioral health services requires complementary data on the size of provider networks and use of services.


Subject(s)
Health Services Accessibility/legislation & jurisprudence , Insurance Benefits/legislation & jurisprudence , Insurance Coverage/legislation & jurisprudence , Insurance, Psychiatric/legislation & jurisprudence , Mental Health Services/statistics & numerical data , Patient Protection and Affordable Care Act/standards , Substance-Related Disorders/rehabilitation , Health Services Accessibility/economics , Humans , Insurance Benefits/statistics & numerical data , Insurance Coverage/statistics & numerical data , Insurance, Psychiatric/economics , Mental Disorders/economics , Mental Disorders/therapy , Mental Health Services/legislation & jurisprudence , Patient Protection and Affordable Care Act/economics , Preexisting Condition Coverage/economics , Preexisting Condition Coverage/legislation & jurisprudence , Substance-Related Disorders/economics , United States
7.
Paediatr Perinat Epidemiol ; 32(3): 281-286, 2018 05.
Article in English | MEDLINE | ID: mdl-29569366

ABSTRACT

BACKGROUND: Pre-existing conditions are imperfectly recorded in health care databases. We assessed whether pre-existing neurologic conditions (epilepsy, multiple sclerosis [MS]) were differentially recorded in the presence of major obstetric outcomes (Caesarean delivery, preterm delivery, preeclampsia) in delivery records. We also evaluated the impact of differential recording on measures of frequency and association between the conditions and outcomes. METHODS: The 2011-2014 Truven Health MarketScan® Commercial Claims Dataset was used to identify pregnancies. We calculated the relative recording of epilepsy and MS at delivery hospitalization compared with a 270-day pre-delivery window both overall and by the presence of major obstetric outcomes. We estimated risk ratios for the association between epilepsy and MS with the outcomes for each ascertainment window. RESULTS: We identified 909 065 pregnancies in women continuously enrolled from 270-days before the delivery date. Of women with epilepsy identified in the pre-delivery window, 73% had the condition coded at delivery. For MS, the proportion was 60%. MS recording at delivery did not vary by obstetric outcomes, however, delivery-coded epilepsy was less likely confirmed in the pre-delivery window in the presence of preeclampsia. Generally, the period of ascertainment did not meaningfully impact risk ratios, however, the risk ratio for preeclampsia associated with epilepsy was 1.67 (95% CI 1.47, 1.90) when epilepsy was ascertained at delivery and 1.26 (95% CI 1.07, 1.48) when epilepsy was ascertained in the pre-delivery window (heterogeneity, P = .007). CONCLUSIONS: Ascertainment of epilepsy and MS in delivery hospitalization records underestimated prevalence. However, the window of recording generally did not impact risk ratio estimates of associations with obstetric outcomes.


Subject(s)
Epilepsy/epidemiology , Insurance Claim Review , Multiple Sclerosis/epidemiology , Preexisting Condition Coverage/legislation & jurisprudence , Pregnancy Complications/epidemiology , Adult , Cesarean Section , Cross-Sectional Studies , Female , Humans , Odds Ratio , Pregnancy , Pregnancy Outcome/epidemiology , United States/epidemiology
8.
Issue Brief (Commonw Fund) ; 18: 1-12, 2017 06.
Article in English | MEDLINE | ID: mdl-28641364

ABSTRACT

ISSUE: Prior to the Affordable Care Act (ACA), people with preexisting health conditions could be denied insurance coverage or charged higher rates. If the law is repealed, these protections could be diluted or lost altogether. GOALS: Assess the ACA's impact on coverage and access for people with preexisting conditions and compare their coverage gains with state high-risk-pool enrollment pre-ACA. METHODS: Analysis of Behavioral Risk Factor Surveillance System data for the period 2011­13 to 2015. KEY FINDINGS AND CONCLUSIONS: Between 2013 and 2015, 16.5 million nonelderly adults gained coverage following full ACA implementation. Of those, 2.6 million had preexisting conditions that could have otherwise precluded them from coverage because of discriminatory denials and pricing; 9.4 million had conditions that could have otherwise affected insurance cost. We found strong correlations between these coverage gains and access to care. Coverage and access gains for people with preexisting conditions were unrelated to the size or existence of the state high-risk pools that 35 states funded for such individuals pre-ACA. Our findings suggest that proposals to replace current protections for people with preexisting conditions with high-risk pools are unlikely to be sufficient to maintain the ACA's gains.


Subject(s)
Health Services Accessibility/legislation & jurisprudence , Patient Protection and Affordable Care Act/statistics & numerical data , Preexisting Condition Coverage/legislation & jurisprudence , Adult , Forecasting , Health Services Accessibility/statistics & numerical data , Health Services Accessibility/trends , Humans , Middle Aged , Patient Protection and Affordable Care Act/trends , Patient-Centered Care/statistics & numerical data , Patient-Centered Care/trends , Preexisting Condition Coverage/statistics & numerical data , Preexisting Condition Coverage/trends , United States
14.
Rev Salud Publica (Bogota) ; 18(5): 827-836, 2016.
Article in Spanish | MEDLINE | ID: mdl-28453123

ABSTRACT

Since 1991, when the current Colombian Constitution came into force and the Constitutional Court was appointed as its guardian and protector, constitutional values have permeated all subjects and areas of law, even those that were previously considered as private matters. Prepaid medicine contracts are a good example of this phenomenon, since the Colombian Constitutional Court has limited individual freedom of contract to private parties -prepaid medical companies- for the benefit of final users of this service through "acción de tutela", in order to protect the right to healthcare and to prevent some behaviors that violate the principle of good faith. The Court has demanded private companies to assess the health condition of patients and has prohibited pre-existent and exclusion clauses that diminish the responsibilities of said companies. Nevertheless, there is a gap in the law regarding the duties of good faith that concern the user, which will be addressed in this paper.


Subject(s)
Contracts/legislation & jurisprudence , Preexisting Condition Coverage/legislation & jurisprudence , Prepaid Health Plans/legislation & jurisprudence , Colombia , Delivery of Health Care , Government Regulation , Humans
15.
Fed Regist ; 80(222): 72191-294, 2015 Nov 18.
Article in English | MEDLINE | ID: mdl-26595941

ABSTRACT

This document contains final regulations regarding grandfathered health plans, preexisting condition exclusions, lifetime and annual dollar limits on benefits, rescissions, coverage of dependent children to age 26, internal claims and appeal and external review processes, and patient protections under the Affordable Care Act. It finalizes changes to the proposed and interim final rules based on comments and incorporates subregulatory guidance issued since publication of the proposed and interim final rules.


Subject(s)
Insurance Benefits/legislation & jurisprudence , Insurance Coverage/legislation & jurisprudence , Insurance, Health/legislation & jurisprudence , Patient Protection and Affordable Care Act/legislation & jurisprudence , Preexisting Condition Coverage/legislation & jurisprudence , Cost Sharing/economics , Cost Sharing/legislation & jurisprudence , Humans , Insurance Benefits/economics , Insurance Claim Review/economics , Insurance Claim Review/legislation & jurisprudence , Insurance Coverage/economics , Insurance, Health/economics , Patient Protection and Affordable Care Act/economics , Preexisting Condition Coverage/economics , United States
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