Better methods will be needed to project incomes to estimate eligibility for subsidies in health insurance exchanges

Health Affairs

Volumn 31, Issue 7, 2012, Pages 1613-1622

  Graves, John A ^a  

^a VANDERBILT UNIVERSITY SCHOOL OF MEDICINE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; ECONOMIC ASPECT; HEALTH CARE POLICY; HEALTH INSURANCE; HUMAN; INCOME; MEDICAID;

COST SHARING; ELIGIBILITY DETERMINATION; FINANCING, GOVERNMENT; HEALTH INSURANCE EXCHANGES; HEALTH POLICY; HUMANS; INCOME; MEDICAID; PATIENT PROTECTION AND AFFORDABLE CARE ACT; TAX EXEMPTION; UNITED STATES;

EID: 84866267470     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2011.1140     Document Type: Article

References (22)

1. Congressional Budget Office. Updated projections for the insurance coverage provisions of the Affordable Care Act [Internet].Washington (DC): CBO; 2012 Mar [cited 2012 May 22]. Available from: http:// www.cbo.gov/sites/default/files/ cbofiles/attachments/03-13-Coverage%20Estimates.pdf.
2. A taxpayer's modified adjusted gross income is calculated using his or her adjusted gross income and adding other income sources and deductions for items such as foreign income, student loans, contributions to individual retirement accounts, and higher education payments
3. To access the Appendix, click on the Appendix link in the box to the right of the article online
4. Employer-sponsored insurance is considered affordable under the Affordable Care Act if the employee's share of the least expensive single plan with an actuarial value above 60 percent is less than 9.5 percent of that employee's income.
5. According to the Congressional Research Service, employer-based health maintenance organization plans cover, on average, 93 percent of expected costs. In contrast, a highdeductible health plan with an employer health savings account contribution covers 76 percent. At 70 percent, a silver plan in an exchange offers slightly less generous benefits. Congressional Research Service. Setting and valuing health insurance benefits [Internet]. Washington (DC): CRS; 2009 Apr 6 [cited 2012 May 7]. Available from: http:// www.policyarchive.org/handle/ 10207/bitstreams/19244.pdf.
6. Safe-harbor limits maximize reconciliation liabilities at $300 for single people and $600 for families earning below 250 percent of the federal poverty level. These limits rise to $1,250 for single people and $2,500 for families with incomes of 251- 400 percent of poverty. Dollar values will be indexed to the Consumer Price Index starting in 2015.
7. Department of Health and Human Services. Patient Protection and Affordable Care Act; exchange functions in the individual market; eligibility determinations; exchange standards for employers. Fed Regist. 2011;76(159):51202-37.
8. Short PF. Hitting a moving target: income-related health insurance subsidies for the uninsured. J Policy Anal Manage. 2000;19(3):383-405.
9. Short PF, Swartz K, Uberoi N, Graefe D (Pennsylvania State University, State College, PA). Realizing health reform's potential: maintaining coverage, affordability, and shared responsibility when income and employment change [Internet]. New York (NY): Commonwealth Fund; 2011 May 19 [cited 2012 May 7]. (Issue Brief). Available from: http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2011/May/1503_Short_maintaining_coverage_affordability_reform_brief.pdf
10. Sommers BD, Rosenbaum S. Issues in health reform: how changes in eligibility may move millions back and forth between Medicaid and insurance exchanges. Health Aff (Millwood). 2011;30(2):228-36.
11. Short PF, Graefe DR, Schoen C. Churn, churn, churn: how instability of health insurance shapes America's uninsured problem [Internet]. New York (NY): Commonwealth Fund; 2003 Nov [cited 2012 May 7]. (Issue Brief). Available from: http://www.commonwealthfund .org/usr_doc/Short_churn_688.pdf
12. Treasury Inspector General for Tax Administration. Reduction targets and strategies have not been established to reduce the billions of dollars in improper earned income tax credit payments each year [Internet]. Washington (DC): Department of the Treasury; 2011 Feb 7 [cited 2012 May 7]. Available from: http:// www.treasury.gov/tigta/ auditreports/2011reports/ 201140023fr.pdf
13. In states that elect to adopt a Basic Health Program, households with incomes of 139-200 percent of the federal poverty level will also be ineligible to participate in an exchange
14. Centers for Medicare and Medicaid Services. Medicaid program; eligibility changes under the Affordable Care Act of 2010; final rule. Fed Regist. 2012;77(57):17144-217.
15. Graves JA, Curtis R, Gruber J. Balancing coverage affordability and continuity under a basic health program option. N Engl J Med. 2011;365(24):e44.
16. Gruber J. Tax policy for health insurance. In: Poterba JM, editor. Tax policy and the economy, vol. 19. Cambridge (MA): MIT Press; 2005. p. 39-64.
17. Tax simulations were conducted using the TAXSIM algorithm at the National Bureau of Economic Research. See Feenberg D, Coutts E. An introduction to the TAXSIM model. J Policy Anal Manage. 1993;12(1): 189-94.
18. Czajka JL, Mabli J, Cody S. Sample loss and survey bias in estimates of Social Security beneficiaries: a tale of two surveys [Internet]. Washington (DC): Mathematica Policy Research; 2008 Feb [cited 2012 May 7]. Available from: http://www .mathematica-mpr.com/ publications/pdfs/ samplelosssurvey.pdf
19. Anderson R, Fields J. Explaining changes in SIPP monthly poverty rates in the 2004 panel. In: Proceedings of the 2010 Joint Statistical Meetings. Alexandria (VA): American Statistical Association; 2010 Aug.
20. Heckman JJ, Smith JA. The preprogram earnings dip and the determinants of participation in a social program: implications for simple program evaluation strategies [Internet]. Cambridge (MA): National Bureau of Economic Research; 1999 Feb [cited 2012 May 8]. (NBER Working Paper No. 6983). Available from: http://www.nber.org/papers/w6983.pdf
21. Manatt Health Solutions. Income verification project evaluation [Internet]. Albany (NY): Manatt Health Solutions; 2011 Oct [cited 2012 May 15]. Available from: http:// www.statereforum.org/system/ files/nys_income_verification_ resource_and_product_ evaluation.pdf
22. White House Office of the Press Secretary [Internet]. Washington (DC): The Office. Press release, Statement by the press secretary on H.R. 4; 2011 Apr 14 [cited 2012 May 15]. Available from:http:// www.whitehouse.gov/the-pressoffice/ 2011/04/14/statement-presssecretary-hr-4.