title: State-based Marketplaces using 'clearinghouse' plan management models are associated with lower premiums.
abstract: The state-based and federally facilitated health insurance Marketplaces, or exchanges, enrolled more than eight million people during the first open enrollment period, which ended March 31, 2014. There is significant variation in how states have designed and implemented their Marketplaces. We examined how premiums varied with states' involvement in the Marketplaces through governance, plan management authority, and strategy during the first year that the exchanges have been open. State-based Marketplaces using "clearinghouse" plan management models had significantly lower adjusted average premiums for all plans within each metal level compared to state-based Marketplaces using "active purchaser" models and the federally facilitated and partnership Marketplaces. Clearinghouse management models are those in which all health plans that meet published criteria are accepted. Active purchaser models are those in which states negotiate premiums, provider networks, number of plans, and benefits. Our baseline estimates provide valuable benchmarks for evaluating future performance of states' involvement in governance, plan management, and regulatory authority of the insurance Marketplaces.
authors.affiliation: Kelly Krinn is a recent graduate of the master of public policy program at the Humphrey School of Public Affairs, University of Minnesota, in Minneapolis.
authors.forename: Kelly
authors.initials: K
authors.lastname: Krinn
authors.affiliation: Pinar Karaca-Mandic (pkmandic@umn.edu) is an associate professor in the Health Policy and Management Division, School of Public Health, University of Minnesota.
authors.forename: Pinar
authors.initials: P
authors.lastname: Karaca-Mandic
authors.affiliation: Lynn A. Blewett is a professor in the Health Policy and Management Division, School of Public Health, University of Minnesota.
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Blewett
mesh_terms: D017046:Cost Savings / Q000191:economics*; D018166:Health Care Reform / Q000191:economics / Q000458:organization & administration; D062265:Health Insurance Exchanges / Q000191:economics* / Q000458:organization & administration*; D006284:Health Plan Implementation / Q000191:economics* / Q000458:organization & administration*; D006801:Humans; D007341:Insurance / Q000191:economics* / Q000458:organization & administration*; D017146:Models, Organizational; D013221:State Health Plans / Q000191:economics* / Q000458:organization & administration*; D014481:United States
keywords: Health Reform; Insurance Market < Insurance