兰德公司美国医疗保健法对2020年和2026年健康保险覆盖面和联邦消费的影响

CORPORATIONResearchReportTheEffectsoftheAmericanHealthCareActonHealthInsuranceCoverageandFederalSpendingin2020and2026ChristineEibner,JodiL.Liu,SarahA.NowakLimitedPrintandElectronicDistributionRightsThisdocumentandtrademark(s)containedhereinareprotectedbylaw.ThisrepresentationofRANDintellectualpropertyisprovidedfornoncommercialuseonly.Unauthorizedpostingofthispublicationonlineisprohibited.Permissionisgiventoduplicatethisdocumentforpersonaluseonly,aslongasitisunalteredandcomplete.PermissionisrequiredfromRANDtoreproduce,orreuseinanotherform,anyofitsresearchdocumentsforcommercialuse.Forinformationonreprintandlinkingpermissions,pleasevisit’spublicationsdonotnecessarilyreflecttheopinionsofitsresearchclientsandsponsors.SupportRANDMakeatax-deductiblecharitablecontributionat:978-0-8330-9817-7PublishedbytheRANDCorporation,SantaMonica,Calif.©Copyright2017RANDCorporationR®isaregisteredtrademark.iiiPrefaceInthisreport,weanalyzedaversionoftheAmericanHealthCareAct(AHCA),abillproposedbytheU.S.HouseofRepresentativesonMarch6,2017.ThebillwouldhaverepealedmanyoftheprovisionsoftheAffordableCareAct(ACA)andreplacedthemwithalternativereforms.WeusedRAND’sComprehensiveAssessmentofReformEffortsmicrosimulationmodeltoassesshowtheAHCAwouldhaveaffectedsuchoutcomesashealthinsuranceenrollment,consumerout-of-pocketcosts,andthefederaldeficitrelativetotheACA.Thereportmaybeofinteresttopolicymakers,researchers,andjournalistsconsideringhowproposalsliketheAHCAmightinfluencehealthcarecoverageandfederalspending.FundingforthisstudywasprovidedbytheCommonwealthFund.AdditionalsupportwasmadepossiblebythegenerouscontributionsoftheRANDHealthBoardofAdvisorsandotherdonors.WethankKatherineCarman,LeightonKu,andEvanSaltzmanfortheirhelpfulreviewsofthisdocument.TheresearchwasconductedinRANDHealth,adivisionoftheRANDCorporation.AprofileofRANDHealth,abstractsofitspublications,andorderinginformationcanbefoundat FiguresandTables...........................................................................................................................v Abbreviations.................................................................................................................................vi Overview.........................................................................................................................................1 Results.............................................................................................................................................6 ComparisonwithCBOEstimates...........................................................................................................12 Conclusion...............................................................................................................................................17 MethodsAppendix:COMPAREOverview..................................................................................18 ApproachtoModelingtheAffordableCareAct.....................................................................................19 ApproachtoModelingtheAmericanHealthCareAct...........................................................................23 SensitivitytoAssumptionsAbouttheIndividualMarket.......................................................................29 References.....................................................................................................................................32 vFiguresandTablesFiguresFigure1.NumberRemainingUninsuredinSelectDemographicGroups,CurrentLawandtheAHCA,2020............................................................................................................................9 Figure2.NumberRemainingUninsuredinSelectDemographicGroups,CurrentLawandtheAHCA,2026..........................................................................................................................10 TablesTable1.ProvisionsModeled...........................................................................................................5 Table2.InsuranceCoverageUnderCurrentLawandtheAHCAwithAge-BasedTaxCredits...7 Table3.PercentageofIndividualsandFamiliesEnrolledintheIndividualMarketUnderCurrentLawWhoWouldHavePaidMorefora70-PercentActuarialValuePlanUndertheAHCA................................................................................................................................8 Table4.NetDeficitEffect,2020..................