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The Affordable Care Act 10 Years In: What Nursing Leaders Should Know

The Affordable Care Act (ACA) introduced wide-ranging health care reforms but faces many challenges. This article reviews 6 key points for today’s nurse leader on the law’s 10th anniversary: a renewed legal battle is on its way to the Supreme Court; 27 million people still lack coverage, partly due to nonexpansion of Medicaid in 15 states; Medicaid waivers provide coverage for some low-income people but leave many people out; value-based purchasing has allocated billions of dollars in rewards and penalties; ACA Marketplace plans are not always affordable, but premiums are stabilizing; and the 2020 elections could result in dramatic consequences for health care reform.

Willingness to Pay for Health Insurance among Urban Poor: An Evidence from Urban Primary Health Care Project in Bangladesh

Background and Objective: With the growing concern over treatment cost in health care and the desire to improve the effectiveness and equality of healthcare financing and the quality of the care, policy-makers have turned their attention to health insurance, especially, for the poor. This study attempted to determine the willingness to pay for health insurance among the mothers who utilized the urban primary health care clinic (UPHCC) for maternal and child health.
 Methods: This cross-sectional study was carried out in the working areas of UPHC Project in Bangladesh following two-stage cluster sampling technique to select the participants. Data were collected from 3949 women aged 15-49 years having at least one child aged two years or less. The data on willingness to pay for health insurance was collected using the contingent valuation method with bidding style. Data analysis was done by SPSS 22.0 version. Two generalized linear models with binary logit link function and normal identity link function were developed to identify the potential predictors for willingness to pay for monthly health insurance.
 Results: Three-fifths (67.5%) of the respondents agreed to pay for monthly health insurance. The median monthly premium for health insurance was BDT 15.5. Multivariate analysis revealed that utilization of UPHC clinic, quality of life, family size, age, wealth index, level of education, husband and respondent’s occupation, ownership status of the house, religion and family income appeared to be potential predictors for health insurance (p<0.05). However, utilization of UPHC clinic and quality of life appeared to be important predictors across all the models.
 Conclusion: A large proportion of the community agreed to pay premium for health insurance. Based on the finding of the current study the policy makers might consider introducing a scheme for health insurance especially among the urban poor.
 Bangladesh Journal of Medical Science Vol.19(3) 2020 p.433-443

The Value Premium

Value premiums, which we define as value portfolio returns in excess of market portfolio returns, are on average much lower in the second half of the July 1963-June 2019 period. But the high volatility of monthly premiums prevents us from rejecting the hypothesis that expected premiums are the same in both halves of the sample. Regressions that forecast value premiums with book-to-market ratios in excess of market (BM-BM_M) produce more reliable evidence of second-half declines in expected value premiums, but only if we assume the regression coefficients are constant during the sample period.

High Health Care Premiums in Charlottesville: Who Is to Blame? And What Should Be Done?

When Karl Quist, a resident of Charlottesville, Virginia, looks at the rate increases in his unsubsidized, individual-market Affordable Care Act (ACA) health care insurance premiums in November 2017, he realizes that they have nearly tripled from the year before and that he will have to spend over $35,000 during the year in premiums for coverage that will entitle him to a benefit only after he has spent another $14,400 in deductible payments. Astonished, Quist starts asking questions. He connects with others experiencing the same situation and reaches out for meetings with the Virginia Commissioner of Insurance and Board of Insurance to understand and explore possible solutions. This case covers the basic history of the ACA; explains how pricing is set for both ACA and non-ACA policies; and discusses risk pools, medical loss ratios, area rate factors, allowable adjustments, and self-insured employer plans. It provides a deep dive into the continued rise in cost of health care premiums and asks, Who is to blame? This case is suitable for graduate or undergraduate business classes with a focus on the health care industry, leading health care organizations, ethics, government and public policy, or industry regulation. Excerpt UVA-E-0439 Mar. 16, 2020 High Health Care Premiums in Charlottesville: Who Is to Blame? And What Should Be Done? November 2017: Sticker Shock Karl Quist, a resident and local business owner in Charlottesville, Virginia, recalled his incredulity when he logged on during the health insurance open enrollment period in November 2017 to find out what his monthly premium bill would be the following year. Quist was an entrepreneur and a sole proprietor without the minimum number of full-time employees that might qualify him for small-group insurance rates. So, for nearly 10 years, he had purchased an individual health insurance policy to cover himself, his wife, and his growing family. Prior to the 2010 introduction of the Affordable Care Act (ACA) and the associated open market for ACA-compliant health care plans (launched in 2014), he had purchased his individual policy directly from an insurance company such as Anthem. He had accepted and learned to absorb the astonishing increase in premium rates that he inevitably saw from year to year—which usually landed somewhere in the range of 10% to 30%. . . .

Rural-Urban Differences In Individual-Market Health Plan Affordability After Subsidy Payment Cuts.

This article investigates changes in the affordability of individual health plans (Marketplace plans) that were compliant with the Affordable Care Act following the termination of cost-sharing reduction subsidy payments in 2017. We examined how states' and insurers' responses to these cuts affected enrollees differently depending on whether they lived in rural or urban geographic areas and were or were not eligible for Advance Premium Tax Credits. Using data for 2014-19 from the Health Insurance Exchange Compare database and other sources, we found that subsidy-eligible enrollees in rural markets gained access to Marketplace plans that were more affordable than those available to their urban counterparts, after the cuts affected premiums in 2018. Average minimum net monthly premiums for subsidized enrollees in majority-rural geographic rating areas decreased from $288 in 2017 to $162 in 2019, while those of their urban counterparts decreased from $275 to $180. In contrast, rural enrollees without subsidies faced the least affordable premiums for Marketplace plans.

PCN143 HOW MUCH DO INDIVIDUALS VALUE ACCESS TO INNOVATIVE LUNG CANCER THERAPIES? A REVEALED PREFERENCE SURVEY OF HEALTHY ADULTS IN THE UNITED STATES (US)

To measure the value healthy individuals place on coverage of novel therapies that improve survival in the event they develop lung cancer. A recent web-based survey was administered to US adults without cancer to measure the incremental insurance premium respondents were willing to pay to access lung cancer therapies that improve survival. The survey used a ‘multiple random staircase revealed preference’ method to elicit willingness to pay—in terms of monthly premiums—for coverage of novel therapies associated with survival gains. Survival was calibrated based on a clinical trial comparing nivolumab to standard-of-care chemotherapy among patients with non-small cell lung cancer. Of 84,937 individuals invited via email, 1,191 responded and 163 completed the survey and met all eligibility criteria. The mean age of respondents was 50.0 (SD: 14.6) years, and 55.2% were female. On average, respondents were willing to pay an additional $57.00 (95% confidence interval (CI): $51.62-$62.37) monthly for coverage of novel therapy providing a 5-year survival of 15%, compared to standard-of-care therapy with a 5-year survival of 4%. Assuming risk neutrality, a lognormal survival distribution and annual lung cancer incidence of 0.07%, the mean survival gain conditional on being diagnosed with lung cancer is 1.95 years and the implied ex-ante value of a life-year under the expected utility framework is $500,066 (95% CI: $452,867-$547,177). Individuals place a higher value on insurance coverage for lung cancer treatments than previously estimated. Potential explanations may include: high valuations of life year gains for lung cancer and/or large risk premium individuals place on an insurance reducing future mortality risks.

The Value at Risk of Selling Option on Crude Oil West Texas Intermediate

The Value at Risk (VaR) of selling option on crude oil WTI has not been widely known, whereas this trade is the largest transactions in the world. This study aimed to analyze the Value at Risk (VaR) of the far out of the money (FOTM) and the in the money (ITM) strike position of selling option on crude oil WTI investment. The monthly option premium return data ranging from April 1984 to May 2017 was analyzed by the ARCH-GARCH and VaR method to get the risk of FOTM and ITM strike position. Empirical results indicate that the risk of the FOTM strike was much lower than the ITM strike positions. It meant that selecting the FOTM strike position of the selling option on crude oil WTI investment could be considered by stakeholders because its risk was much lower than the ITM strike position.

Is Financial Flexibility a Priced Factor in the Stock Market?

AbstractThis paper develops a factor analysis–based measure for shifts in corporate financial flexibility (FFLEX) that can be observed from public accounting information. Companies that experience positive shifts in FFLEX are associated with higher future investment growth opportunities. We show that FFLEX is a robust determinant of future stock returns. Firms that have increased their financial flexibility are associated with lower stock returns in the subsequent period. A zero‐cost return portfolio produces a significant positive monthly premium of 0.69%, which is driven by covariance (risk). Risk inherent in the flexibility factor is not explained away by either prominent pricing characteristics or factors.

Adverse Selection in ACA Exchange Markets: Evidence from Colorado

This study tests for adverse selection in the Affordable Care Act (ACA) health insurance exchanges established in 2014, and quantifies the welfare consequences. Using a new statewide dataset of medical claims from Colorado, I use plausibly exogenous premium variation generated by geographic discontinuities to test for selection. Specifically, each $1 increase in monthly premiums causes a $0.85–0.95 increase in annual medical expenditures of the insured population in 2014, with attenuated effects in 2015. These estimates are consistent with the prevalence of chronic conditions, and difference-in-differences estimates. The results offer the first quasi-experimental evidence of adverse selection in the ACA markets. (JEL D82, G22, H51, H75, I13, I18)

Understanding the Organizational Barriers of Promoting Electronic Delivery Options in the United States Health Care System: An Insurer’s Perspective

Consumer-driven technologies are rapidly transforming how industries conduct business both internally and externally. From online banking to retail, the broad adoption of smart devices, internet access, and wearables amongst consumers has shifted the way enterprises develop software and conduct information technology (IT) operations. Although successful adoption of consumer-driven technologies is a reality for many industries, the healthcare platform is lagging. The promotion and adoption of online patient engagement is widely perceived to be one of the biggest hurdles faced by healthcare organizations (Carr, 2014). While setting up patient portals and electronic delivery options can be relatively simple, promoting consumer utilization and achieving widespread use of these portals use has posed challenges. The healthcare paradigm has shifted in recent decades from viewing the patient as incidental to the delivery of healthcare to a more patient-centric approach. The previous model of indirectly funding Medicare, Medicaid, or employers has been noted as one of the greatest flaws of the healthcare system by contributing to cost inflation (Carr, 2014). Recent trends have promoted patient-empowered care, but have generally transferred the burden of cost to the individual. The Affordable Care Act (ACA) stimulated this shift by creating insurance exchanges which allow insurers to directly reach consumers; however, these readily-available healthcare options now require higher monthly premium payments from shoppers. This new model proposes that as patients become increasingly financially liable, they become more invested in their healthcare trajectories.

Expected willingness to pay for wind energy in Atlantic Canada

We investigate the demand-side of wind energy in three provinces in Atlantic Canada, including New Brunswick, Nova Scotia and Prince Edward Island. Empirical questions addressed include: (i) What are the determinants of the probability of paying a non-zero premium for electricity generated using wind technology?; (ii) Given participation, what drives how much more households are willing to pay a month, and what is the monthly premium or expected willingness-to-pay (WTP)?; and (iii) Is there heterogeneity in the expected WTP? The study design follows the contingent valuation framework and the survey questionnaire follows a payment-scale format, reducing the starting point bias and reduces the incidence of item non-response. The data is from a stratified random sample. We employ two-stage models, Cragg's hurdle and the two-part econometric models in the analysis. Scope and 0 WTP effects are explicitly explored. We find that the overall probability of participation is 0.73. University education, income, residential property ownership, concerns about the presence of wind turbines in neighborhoods, and externality affect the likelihood of participation. Households are willing to pay 14% more per month in energy bill for wind power. There is evidence of scope sensitivity. The results provide insights on what proportion of the population will participate and how much more they are willing to pay for wind energy.

Evidências do Prêmio do Mês do Dividendo no Mercado Acionário Brasileiro

Este artigo testa a presença do prêmio do mês do dividendo no mercado acionário brasileiro. Esse prêmio consiste na existência de retornos anormais quando é prevista a emissão de dividendos por parte das empresas. Construímos portfólios através de um algoritmo de previsão de dividendos e então verificamos a existência de retornos anormais utilizando modelos de precificação multifatoriais. Encontramos evidências de um prêmio positivo e significativo em torno de 1% ao mês, porém este efeito é reduzido ao retirarmos da nossa amostra ações com baixa liquidez. Também encontramos evidências de que o prêmio do mês do dividendo é maior para portfólios com maior composição de ações small caps e de ações com maior razão dividendo-preço.

Nonparametric Estimates of Demand in the California Health Insurance Exchange

We estimate the demand for health insurance in the California Affordable Care Act marketplace (Covered California) without using parametric assumptions about the unobserved components of utility. To do this, we develop a computational method for constructing sharp identified sets in a nonparametric discrete choice model. The model allows for endogeneity in prices (premiums) and for the use of instrumental variables to address this endogeneity. We use the method to estimate bounds on the effects of changing premium subsidies on coverage choices, consumer surplus, and government spending. We find that a $10 decrease in monthly premium subsidies would cause between a 1.6% and 7.0% decline in the proportion of low-income adults with coverage. The reduction in total annual consumer surplus would be between $63 and $78 million, while the savings in yearly subsidy outlays would be between $238 and $604 million. Comparable logit models yield price sensitivity estimates towards the lower end of the bounds.

What are consumers willing to pay for a broad network health plan?: Evidence from covered California

Health Insurance Marketplaces have received considerable attention for their narrow network health plans. Yet, little is known about consumer tastes for network breadth and how they affect plan selection. I estimate demand for health plans in California’s Marketplace, Covered California. Using 2017 individual enrollment data and provider network directories, I develop a geospatial measure of network breadth that reflects the physical locations of households and network providers. I find that households are sensitive to network breath in their plan choices. Mean willingness to pay for a broad network plan relative to a narrow network plan, defined as a two standard deviation, 17.44 percentage point increase in network breadth, is $45.83 in post-subsidy monthly premiums. Variation in WTP indicates a selection mechanism exists whereby older households sort into broader network plans. I also find that households are highly premium sensitive, which may be a result of plan standardization in Covered California.

Health insurance in Myanmar: Knowledge, perceptions, and preferences of Social Security Scheme members and general adult population.

SummaryObjectiveOur study explores the knowledge, perceptions, willingness to pay, and preferences of potential health insurance beneficiaries about health insurance in Myanmar.MethodsCross‐sectional survey data were collected among two samples: the general population and Social Security Scheme (SSS) member. Mann‐Whitney U test and independent sample t test were applied to compare the two samples. The data on willingness to pay for health insurance were analyzed using regression analysis.ResultsLow level of knowledge and weak positive perception are found in both samples. More than 90% of the SSS sample and 75% of the general sample are willing to pay health insurance premiums. The largest shares of both samples are willing to pay for monthly premiums between 2000 and 4000 MMK (1.8‐3.6 USD). Health status, age, gender, income, and trust are significantly associated with willingness to pay for health insurance among general sample while occupation, civil status, income, and positive perception on prepayment principle are found among SSS sample.ConclusionsThe government of Myanmar should be aware of the preferences of beneficiaries to pay a relatively low level of monthly health insurance premiums without co‐payment.

The changing texture of the city-size wage differential in Chinese cities – Effects of skill and identity

This study examines the city-size wage premium (CSWP) for local urban hukou holders (citizens) and rural migrants by utilizing data from the Chinese Household Income Project surveys (CHIP 2002 and 2013) employing OLS and Propensity Score Matching method. Heterogeneity of skills (measured by level of education) is found to be one determinant of the city-size wage disparity. But irrespective of skills, citizens receive a higher city-size premium than the rural migrants; nevertheless, the premium received by rural migrants has increased over the past few years. Within the similar occupation and type of firm, a highly skilled citizen received a CSWP of Yuan 880.08 in 2013 (Yuan 347.48 in 2002) on average per month. Whereas, a highly skilled rural migrant received an average monthly premium of Yuan 601.71 in 2013, and an insignificant premium in 2002. The corresponding values for low skilled citizens and rural migrants in 2013 are Yuan 415.67 and 267.27 respectively. Our results establish that there has been a positive effect on rural migrants from the relaxation of policies and labour laws, and a move towards equalization within the same level of skills.

Volatility Lessons

The average monthly premium of the Market return over the one-month T-bill return is substantial, as are average premiums of value and small stocks over Market. As the return horizon increases, premium distributions become more disperse, but they move to the right (toward higher values) faster than they become more disperse. There is, however, some bad news. Even if future expected premiums match high past averages, high volatility means that for the 3- and 5-year periods commonly used to evaluate asset allocations, the probabilities of negative realized premiums are substantial, and the probabilities are nontrivial for 10- and 20-year periods.

ROLE OF MOBILE MONEY TRANSFER ON THE RATE OF PREMIUM REMITTANCE OF HEALTH INSURANCE FROM SELF-EMPLOYED NHIF MEMBERS IN KENYA: A CASE STUDY OF NHIF MERU BRANCH

National health insurance is health insurance that insures a national population for the costs of health care and usually is instituted as a program of healthcare reform. In Kenya, the only National Health Insurance Fund is the NHIF. The study’s specific objectives are; To establish the influence of transaction cost on premium remittance, to determine if convenience of using M-Pesa influence the collection of contribution payments, to determine the influence of level of premium and collection mechanisms on the rate of collection of premium payments, and to determine if accessibility of mobile money services influence the collection of contribution premium payments to the NHIF a case study of NHIF Meru branch. The Kenya National Health Insurance Fund has deploying the use of mobile payments to enhance the quality of their services and increase growth. In this study, a survey research design technique was used to collect data which involved the use of both primary and secondary data sources. Structured questionnaires are used to collect primary data. The target population consist of 70 informal sector members who include the self-employed and unemployed members of NHIF particularly residents of Meru county . A sample size of 35 respondents from Meru town in Meru County is drawn . The study established that mobile money had made a significant contribution to the way the NHIF members from the informal sector make their monthly premium remittance. Majority of the NHIF members from informal sector rely on it as opposed to the formal sector for their monthly premium remittance. Thus, this study achieved its objectives and obtained detailed information arising from the use of mobile money services by NHIF members. In respect to the conceptual framework, mobile money transactional costs, convenience and financial accessibility have all been shown to affect prompt premium remittance through the service leading to increased enrolment in mobile money services therefore leading to low rate of NHIF defaulters. Article visualizations:

PENENTUAN CADANGAN PREMI DENGAN PERHITUNGAN PROSPEKTIF UNTUK ASURANSI PENDIDIKAN

The purpose of this research is to get formula to calculate premium reserve value with prospective calculation for education insurance. This study examines the value of premium reserves for people aged 40 years with a coverage period of 17 years. In determining the value of premium reserve using the prospective calculation. It will be started by completing the value of the Indonesian Mortality Table 2011 using the interest rate of 6.5%, calculating the cash value of the benefit, the annuity value, the net annual premium value, and the net monthly premium value. The results of this study indicate that the value of premium reserves with a prospective calculation for benefits paid at the end of the year and the premium reserve value for benefits paid at the time the insured dies, its value with the value of the cash price set by the insurer at the end of year- 17 on the insurance contract.

Why we need more data on the dental insurance market

Why we need more data on the dental insurance market