Ilana Graetz, PhD; Cameron M. Kaplan, PhD; Erin K. Kaplan, PhD; James E. Bailey, MD, MPH; Teresa M. Waters, PhD
Acknowledgment: The authors thank Dr. Robert L. Davis for carefully reviewing the manuscript, Chelsea Temple for helping to collect the data used in these analyses, and Dr. Courtney Collins for her creative assistance in animating our findings.
Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-0757.
Requests for Single Reprints: Ilana Graetz, PhD, Department of Preventive Medicine, University of Tennessee Health Science Center, 66 North Pauline Street, Suite 633, Memphis, TN 38163; e-mail, email@example.com.
Current Author Addresses: Drs. Graetz, C.M. Kaplan, and Waters: Department of Preventive Medicine, University of Tennessee Health Science Center, 66 North Pauline Street, Suite 633, Memphis, TN 38163.
Dr. E.K. Kaplan: Rhodes College, 2000 North Parkway, Memphis, TN 38112.
Dr. Bailey: Department of Medicine, University of Tennessee Health Science Center, 956 Court Avenue, Coleman D222, Memphis, TN 38163.
Author Contributions: Conception and design: I. Graetz, C.M. Kaplan, E.K. Kaplan, T.M. Waters.
Analysis and interpretation of the data: I. Graetz, C.M. Kaplan, E.K. Kaplan, J.E. Bailey, T.M. Waters.
Drafting of the article: I. Graetz, C.M. Kaplan, E.K. Kaplan, T.M. Waters.
Critical revision of the article for important intellectual content: I. Graetz, C.M. Kaplan, E.K. Kaplan, J.E. Bailey, T.M. Waters.
Final approval of the article: I. Graetz, C.M. Kaplan, E.K. Kaplan, J.E. Bailey, T.M. Waters.
Statistical expertise: I. Graetz, C.M. Kaplan, E.K. Kaplan, T.M. Waters.
Administrative, technical, or logistic support: I. Graetz.
Collection and assembly of data: I. Graetz, C.M. Kaplan, E.K. Kaplan.
Graetz I, Kaplan CM, Kaplan EK, Bailey JE, Waters TM. The U.S. Health Insurance Marketplace: Are Premiums Truly Affordable?. Ann Intern Med. 2014;161:599-604. doi: 10.7326/M14-0757
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Published: Ann Intern Med. 2014;161(8):599-604.
The Patient Protection and Affordable Care Act requires that individuals have health insurance or pay a penalty. Individuals are exempt from paying this penalty if the after-subsidy cost of the least-expensive plan available to them is greater than 8% of their income. For this study, premium data for all health plans offered on the state and federal health insurance marketplaces were collected; the after-subsidy cost of premiums for the least-expensive bronze plan for every county in the United States was calculated; and variations in premium affordability by age, income, and geographic area were assessed. Results indicated that—although marketplace subsidies ensure affordable health insurance for most persons in the United States—many individuals with incomes just above the subsidy threshold will lack affordable coverage and will be exempt from the mandate. Furthermore, young individuals with low incomes often pay as much as or more than older individuals for bronze plans. If substantial numbers of younger, healthier adults choose to remain uninsured because of cost, health insurance premiums across all ages may increase over time.
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