Figure 1A: Average Morbidity (Monthly Costs) under the ACA for Wisconsin (Assumes Medicaid Expansion) Transitions in Coverage under the ACA Baseline Coverage
Total
Employer Exchange
Individual Exchange
Private Employer
Private NonGroup
Medicare/ TRICARE
Medicaid/ CHIP
Uninsured
Employer 2-50
$476
$537
$559
$433
$151
$25
$527
$160
Employer 51-100
$573
$486
$671
$583
$617
$0
$121
$906
Employer 101+
$567
$0
$1,061
$552
$1,128
$289
$362
$301
$1,176
$1,220
$939
$1,808
$0
$0
$2,155
$0
Other Non-Group
$258
$249
$240
$165
$320
$0
$194
$159
Retiree
$187
$0
$0
$182
$0
$0
$1,730
$0
TRICARE
$650
$0
$0
$0
$0
$649
$0
$0
Medicare
$902
$0
$0
$0
$0
$902
$0
$0
$1,274
$0
$0
$0
$0
$1,279
$0
$0
$393
$468
$391
$331
$41
$533
$407
$0
High Risk Pool
Dual Eligible Medicaid/CHIP Uninsured
$154
$320
$317
$556
$2,054
$0
$378
$108
Total
$542
$503
$482
$526
$363
$954
$418
$120
Assumes that all ACA provisions are fully implemented. Costs include total expected health care spending PMPM in 2014 but should not be confused with premium, since important items such as administrative costs, taxes, and premium subsidies are not included.
Population Movement The population movement under the ACA is estimated using various simulation decisions for employers and individuals in the micro-simulation database. HBSM includes a model of the individual insurance market. The model defines the non-group insurance markets to include all people who are not otherwise eligible for coverage under an employer plan, Medicare, Medicaid or TRICARE (i.e., military dependents and retirees). The model simulates premiums for individuals using the rules that prevail in each state. Premiums can be varied by age, gender and health status. This is done by compiling a “rate book” based upon the HBSM health spending data for the state reflecting how costs vary with individual characteristics. Once the employer coverage option is simulated for employers, we simulate individual take- up of insurance given the options available. We begin by simulating eligibility and enrollment for the Medicaid program. The probability model of enrollment that we use shows a lower rate of enrollment for people with access to employer coverage. We then simulate enrollment in employer health plans for people who have access to employer insurance. Finally, we simulate the decision to take non-group coverage based upon the cost of insurance less the premium subsidy, if eligible. We do this by using an individual insurance rating model to estimate the premium an individual would pay for a standard benefits package under current rating practices and again under the ACA reform rating rules. 9 We then estimate the premium subsidies an individual 9
The standard benefit plan is an illustrative “silver” tiered plan covering all acute care services except adult dental
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