CBO’s health insurance simulation model (HISIM) generates estimates of health insurance coverage and premiums for the population under age 65. HISIM is used to help develop baseline projections (which incorporate the assumption that current law generally remains the same) and also to model proposed changes in policies that affect health insurance coverage.
Currently, CBO is developing and testing a new version of HISIM to respond to continued Congressional interest in understanding the effects of legislative proposals that significantly affect health insurance coverage. The new model will be used to help develop CBO’s spring 2019 baseline projections and subsequent cost estimates.
Presentation by Jessica Banthin, Deputy Assistant Director in CBO’s Health, Retirement, and Long-Term Analysis Division (HRLD), and Alexandra Minicozzi, Chief of HRLD’s Health Insurance Modeling Unit, to the American Academy of Actuaries.
HISIM generates estimates of health insurance coverage and premiums for the U.S. population under age 65. CBO’s analysts use that model to develop baseline projections and to simulate the effects of proposed changes to policies involving health insurance coverage.
On June 19, two analysts will explain how HISIM is used to help estimate the cost of a proposal affecting health insurance coverage and how a new version of the model is being developed to enhance CBO’s analytic capabilities.
Presentation by Jessica Banthin, Deputy Assistant Director in CBO’s Health, Retirement, and Long-Term Analysis Division (HRLD), and Alexandra Minicozzi, Chief of HRLD’s Health Insurance Modeling Unit, at the Bipartisan Policy Center.
CBO analysts use the agency’s revised health insurance simulation model, HISIM2, to generate estimates of health insurance coverage and premiums for the population under age 65. The model is used in conjunction with other models to develop baseline budget projections (which incorporate the assumption that current law generally remains the same). It is also used to estimate the effects of proposed changes in policies that affect health insurance coverage. This presentation provides an overview of the model.
The federal government subsidizes health insurance for most Americans through a variety of programs and tax provisions. In 2017, net subsidies for people under age 65 will total $705 billion, CBO and the staff of the Joint Committee on Taxation (JCT) estimate.
This presentation provides an overview of CBO and JCT’s current baseline projections of health insurance coverage and how those projections have changed since March 2016, highlighting changes in Medicaid and CHIP enrollment and nongroup coverage.
Presentation by Jessica Banthin, Deputy Assistant Director in CBO’s Health, Retirement, and Long-Term Analysis Division, at a Congressional Research Service seminar on CBO’s methods for developing cost estimates.
To prepare its spring 2019 baseline budget projections, CBO is using new sources of data as inputs and has completely revamped the way it models consumers’ and employers’ behavior. To that end, it has developed HISIM2, a new version of the model CBO uses to generate estimates of health insurance coverage and premiums for the population under age 65. The model is used in conjunction with other models to develop baseline budget projections (which incorporate the assumption that current law generally remains the same). It is also used to estimate the effects of proposed changes in policies that affect health insurance coverage.
HISIM2 incorporates new base data, including data from surveys and administrative data. It changes the way individuals and families are projected to choose among coverage options. And it changes the way firms are projected to take workers’ preferences into account when deciding whether to offer employment-based coverage.
CBO prepares cost estimates for proposed legislation to assist Congress. The estimates identify the budgetary effects and impact on health insurance coverage over 10 years. To estimate the cost of repealing the ACA individual mandate, CBO used its HISIM model and additional analysis. This showed repealing the mandate would increase the federal deficit by $338 billion from 2018-2027 by reducing penalty revenues and increasing uninsured populations.
An analysis of social impact bonds in the us federal governmentJeff Smith
This document provides background on social impact bonds (SIBs), including:
1) SIBs blend private financing, performance-based contracting, and data evaluation to allow governments to pay for social programs based on results rather than promises of success.
2) The first SIB was launched in the UK in 2010 to reduce recidivism among short-term prisoners.
3) SIBs are an emerging impact investing tool that can help governments overcome barriers to adopting modern evaluation techniques.
CBO’s work follows processes specified in the Congressional Budget and Impoundment Control Act of 1974 (which established the agency) or developed by the agency in concert with the House and Senate Budget Committees and the Congressional leadership.
CBO is strictly nonpartisan; conducts objective, impartial analysis; and hires its employees solely on the basis of professional competence, without regard to political affiliation. The agency does not make policy recommendations, and each report and cost estimate summarizes the methodology underlying the analysis.
Presentation by Keith Hall, CBO Director, at the 10th Annual Meeting of the OECD Network of Parliamentary Budget Officials and Independent Fiscal Institutions.
This document summarizes a presentation given by Ben Hopkins of the Health Analysis Division to the International Microsimulation Association on December 2, 2021. The presentation discussed the methods used by the Congressional Budget Office (CBO) to construct synthetic firms in their health insurance microsimulation model HISIM2. Specifically, it described how CBO uses data from tax filings and health surveys to select traits like age, income, and health spending of synthetic coworkers for each individual modeled in HISIM2. This allows HISIM2 to realistically model employer decisions about offering health insurance based on the characteristics of their synthetic employee workforce.
HISIM generates estimates of health insurance coverage and premiums for the U.S. population under age 65. CBO’s analysts use that model to develop baseline projections and to simulate the effects of proposed changes to policies involving health insurance coverage.
On June 19, two analysts will explain how HISIM is used to help estimate the cost of a proposal affecting health insurance coverage and how a new version of the model is being developed to enhance CBO’s analytic capabilities.
Presentation by Jessica Banthin, Deputy Assistant Director in CBO’s Health, Retirement, and Long-Term Analysis Division (HRLD), and Alexandra Minicozzi, Chief of HRLD’s Health Insurance Modeling Unit, at the Bipartisan Policy Center.
CBO analysts use the agency’s revised health insurance simulation model, HISIM2, to generate estimates of health insurance coverage and premiums for the population under age 65. The model is used in conjunction with other models to develop baseline budget projections (which incorporate the assumption that current law generally remains the same). It is also used to estimate the effects of proposed changes in policies that affect health insurance coverage. This presentation provides an overview of the model.
The federal government subsidizes health insurance for most Americans through a variety of programs and tax provisions. In 2017, net subsidies for people under age 65 will total $705 billion, CBO and the staff of the Joint Committee on Taxation (JCT) estimate.
This presentation provides an overview of CBO and JCT’s current baseline projections of health insurance coverage and how those projections have changed since March 2016, highlighting changes in Medicaid and CHIP enrollment and nongroup coverage.
Presentation by Jessica Banthin, Deputy Assistant Director in CBO’s Health, Retirement, and Long-Term Analysis Division, at a Congressional Research Service seminar on CBO’s methods for developing cost estimates.
To prepare its spring 2019 baseline budget projections, CBO is using new sources of data as inputs and has completely revamped the way it models consumers’ and employers’ behavior. To that end, it has developed HISIM2, a new version of the model CBO uses to generate estimates of health insurance coverage and premiums for the population under age 65. The model is used in conjunction with other models to develop baseline budget projections (which incorporate the assumption that current law generally remains the same). It is also used to estimate the effects of proposed changes in policies that affect health insurance coverage.
HISIM2 incorporates new base data, including data from surveys and administrative data. It changes the way individuals and families are projected to choose among coverage options. And it changes the way firms are projected to take workers’ preferences into account when deciding whether to offer employment-based coverage.
CBO prepares cost estimates for proposed legislation to assist Congress. The estimates identify the budgetary effects and impact on health insurance coverage over 10 years. To estimate the cost of repealing the ACA individual mandate, CBO used its HISIM model and additional analysis. This showed repealing the mandate would increase the federal deficit by $338 billion from 2018-2027 by reducing penalty revenues and increasing uninsured populations.
An analysis of social impact bonds in the us federal governmentJeff Smith
This document provides background on social impact bonds (SIBs), including:
1) SIBs blend private financing, performance-based contracting, and data evaluation to allow governments to pay for social programs based on results rather than promises of success.
2) The first SIB was launched in the UK in 2010 to reduce recidivism among short-term prisoners.
3) SIBs are an emerging impact investing tool that can help governments overcome barriers to adopting modern evaluation techniques.
CBO’s work follows processes specified in the Congressional Budget and Impoundment Control Act of 1974 (which established the agency) or developed by the agency in concert with the House and Senate Budget Committees and the Congressional leadership.
CBO is strictly nonpartisan; conducts objective, impartial analysis; and hires its employees solely on the basis of professional competence, without regard to political affiliation. The agency does not make policy recommendations, and each report and cost estimate summarizes the methodology underlying the analysis.
Presentation by Keith Hall, CBO Director, at the 10th Annual Meeting of the OECD Network of Parliamentary Budget Officials and Independent Fiscal Institutions.
This document summarizes a presentation given by Ben Hopkins of the Health Analysis Division to the International Microsimulation Association on December 2, 2021. The presentation discussed the methods used by the Congressional Budget Office (CBO) to construct synthetic firms in their health insurance microsimulation model HISIM2. Specifically, it described how CBO uses data from tax filings and health surveys to select traits like age, income, and health spending of synthetic coworkers for each individual modeled in HISIM2. This allows HISIM2 to realistically model employer decisions about offering health insurance based on the characteristics of their synthetic employee workforce.
CBO analysts use the agency’s revised health insurance simulation model, HISIM2, to generate estimates of health insurance coverage and premiums for the population under age 65. The model is used in conjunction with other models to develop baseline budget projections (which incorporate the assumption that current law generally remains the same). It is also used to estimate the effects of proposed changes in policies that affect health insurance coverage.
This presentation provides an overview of the current model’s underlying data, calibration estimates, code segments, and the results highlighted in CBO’s recent report Federal Subsidies for Health Insurance Coverage for People Under Age 65: 2019 to 2029.
This presentation explains how much the federal government spends on the major health care programs: Medicare, Medicaid, the Children’s Health Insurance Program, and marketplace subsidies and related expenditures. In 2018, about 155 million people were enrolled in those programs. CBO projects that net outlays for the programs will grow from about $1.0 trillion in 2018 to about $2.0 trillion in 2028.
Presentation by Jessica Banthin, Deputy Assistant Director in CBO’s Health, Retirement, and Long-Term Analysis Division, at the Alliance for Health Policy Summit on Health Care Costs in America.
The document describes the Congressional Budget Office's Health Insurance Simulation Model (HISIM) which is a microsimulation model used to estimate the budgetary and coverage effects of health insurance proposals including the Affordable Care Act. The model uses individual-level data and elasticities to simulate how individuals and employers would respond to changes in policies and estimate the resulting impacts on federal spending and insurance coverage. Recent applications of the model estimated that the Affordable Care Act would reduce the number of uninsured Americans and result in net increased federal spending of over $1 trillion from 2015 to 2024.
This article focuses on the
strategic steps taken by the
City of Baltimore to manage the
cost of benefit programs, to
bring the level of benefit offered
more in-line with the other comparable
public entities, and to
take advantage of the opportunities
brought by the evolving
healthcare law in order to satisfy
the City's short- and longterm
goals while maintaining
financial health.
This document describes a new spreadsheet-based tool developed to help states model the impacts of complex health policy changes, such as those in the Affordable Care Act, on health insurance coverage. The tool uses state-specific data and allows users to adjust assumptions to predict how policy changes might affect coverage among different population groups. It is intended to provide a more affordable, flexible and transparent alternative to traditional microsimulation models for states to analyze policy impacts.
ACA Healthcare legislation and attempts at increasing regulation of self-funding and stop loss coverage are driving more employers toward stop loss captives.
The document discusses rising healthcare costs in the US and a new study projecting that health care spending will grow faster than GDP over the next decade. It also summarizes strategies that large employers are using to control costs, such as account-based health plans, engagement of employees in wellness programs, and accountability measures. Updates on the Affordable Care Act include expanded preventive coverage for women and guidelines for employer health subsidies in 2014.
The document discusses healthcare reform and its potential repeal. It notes that while repeal seems out of reach currently, many aspects of the law have already taken effect. These include eliminating pre-existing condition exclusions for children, covering dependents until age 26, and minimum loss ratios for insurance companies. The document also discusses the costs and implementation of state health insurance exchanges. It provides the perspective of the author who has advised on the impacts of healthcare reform.
This document discusses flashbulb memories, which are vivid and emotionally significant memories of notable events. Flashbulb memories include details of where one was and how they felt when the event occurred. Not all memorable events produce flashbulb memories - the event must capture attention and elicit strong personal emotions. While flashbulb memories contain more details than regular memories, the specific details may not be completely accurate. The document also provides a personal example of a flashbulb memory the author has of their parents renewing their marriage vows.
The document provides a summary of the short-term implications of federal health reform. It discusses how the reform will impact public program enrollment, the private insurance market, high-risk pools, health insurance exchanges, and delivery system/payment reform in the short-term. Key points include that millions more may gain eligibility for Medicaid and subsidies, insurers face new regulations on premiums/benefits, a temporary high-risk pool is established, and delivery reforms aim to improve quality and reduce costs through various pilot programs. The source is an independent research center that assists states with health policy analysis.
The document discusses rising healthcare costs in the US and a new study projecting that healthcare spending will increase substantially over the next decade. It also summarizes strategies that large employers are implementing to better manage costs, such as health improvement programs, engagement of employees, accountability measures, and use of technology. Finally, it provides legislative updates on expanded preventive care coverage for women and subsidies available through the Affordable Care Act.
Primary Care spend in the State of Rhode island and its impact on overall cost trend a report worth reading for sure
Primary care Spend in RI went up from 47 million in 2008 to 67 million in 2013
BUT !!!
Total Spend went down from 823 Million in 2008 to 661 Million in 2013
This document provides an introduction and literature review for a study examining differences in healthcare offerings and perceptions of the Affordable Care Act across industries. The introduction outlines the motivation for studying these issues and provides background on the ACA. The literature review summarizes past research on interindustry wage differences, differences in fringe benefits across firm size and industry, and the potential effects of healthcare reform similar to the ACA. The document concludes by describing the data source, a 2014 survey of over 1,000 US businesses, which will be analyzed to study industry differences related to healthcare offerings and views of the ACA.
The Affordable Care Act and Its Impact on Workers’ CompensationCognizant
While the Affordable Care Act (ACA) is expected to reduce the number of uninsured and improve personal wellness in the U.S., the law's changes in workforce definitions will significantly impact workforce dynamics, employee hiring, employers' benefits strategies and wellness programs -- requiring a reevaluation of how workers' compensation is accounted for and delivered.
hCentive Health Insurance Exchange PlatformAlisha North
Take advantage of hCentive's deep expertise in the healthcare insurance industry. Browse through or download our white papers to get an in-depth understanding of the industry.
Shifting away from employer-provided healthcare means individuals will be responsible for cost containment.
With the onset of the ACA, will the Government become the last -or- best resort for the private sector's healthcare cost containment?
Ontario and U.S. Programs offer different approaches to help fund innovation in medical technology
In this bulletin, we highlight two new government funding incentive programs for private
companies in the biotech / medical-device sectors.
Growth and Dispersion of Accountable Care OrganizationsLeavitt Partners
The Leavitt Partners Center for ACO Intelligence, which tracks national and regional trends related to ACOs and other emerging care delivery systems, published a white paper entitled "Growth and Dispersion of Accountable Care Organizations." This is the first report of its kind regarding the types and locations of ACOs. The report provides data-driven insights into the evolution of ACOs following federal health reform and the recent announcement of the Medicare Shared Savings Program. Data and analysis on the growth and national dispersion trends of more than 160 ACO or ACO-like organizations are highlighted.
Health Reform Bulletin 143 | Status of ACA Litigation; Murky Future of AHPs; ...CBIZ, Inc.
Litigation challenging and rescinding various aspects of the Affordable Care Act (ACA) continues to reign. Last December, Judge Reed O’Connor of the Fifth Circuit Court of Appeals opined that the individual mandate, in the absence of the tax repealed by the Tax Cuts and Jobs Act, is unconstitutional; and since it is a cornerstone of the ACA, then the entire ACA must fall (see our prior CBIZ Health Reform Bulletin 142).
CBO’s health insurance simulation model (HISIM) generates estimates of health insurance coverage and premiums for the population under age 65. HISIM is used to help develop baseline projections (which incorporate the assumption that current law generally remains the same) and also to model proposed changes in policies that affect health insurance coverage.
Currently, CBO is developing and testing a new version of HISIM to respond to continued Congressional interest in understanding the effects of legislative proposals that significantly affect health insurance coverage. The new model will be used to help develop CBO’s spring 2019 baseline projections and subsequent cost estimates.
Presentation by Jessica Banthin, Deputy Assistant Director in CBO’s Health, Retirement, and Long-Term Analysis Division (HRLD), and Alexandra Minicozzi, Chief of HRLD’s Health Insurance Modeling Unit, to CBO’s panel of health advisers.
HISIM2 is an updated version of the model CBO uses to generate estimates of health insurance coverage and premiums for people under age 65. The model is used along with other models to develop CBO’s baseline budget projections (which incorporate the assumption that current law generally remains the same). It is also used to estimate the effects of proposed changes in policies that affect health insurance coverage.
CBO analysts use the agency’s revised health insurance simulation model, HISIM2, to generate estimates of health insurance coverage and premiums for the population under age 65. The model is used in conjunction with other models to develop baseline budget projections (which incorporate the assumption that current law generally remains the same). It is also used to estimate the effects of proposed changes in policies that affect health insurance coverage.
This presentation provides an overview of the current model’s underlying data, calibration estimates, code segments, and the results highlighted in CBO’s recent report Federal Subsidies for Health Insurance Coverage for People Under Age 65: 2019 to 2029.
This presentation explains how much the federal government spends on the major health care programs: Medicare, Medicaid, the Children’s Health Insurance Program, and marketplace subsidies and related expenditures. In 2018, about 155 million people were enrolled in those programs. CBO projects that net outlays for the programs will grow from about $1.0 trillion in 2018 to about $2.0 trillion in 2028.
Presentation by Jessica Banthin, Deputy Assistant Director in CBO’s Health, Retirement, and Long-Term Analysis Division, at the Alliance for Health Policy Summit on Health Care Costs in America.
The document describes the Congressional Budget Office's Health Insurance Simulation Model (HISIM) which is a microsimulation model used to estimate the budgetary and coverage effects of health insurance proposals including the Affordable Care Act. The model uses individual-level data and elasticities to simulate how individuals and employers would respond to changes in policies and estimate the resulting impacts on federal spending and insurance coverage. Recent applications of the model estimated that the Affordable Care Act would reduce the number of uninsured Americans and result in net increased federal spending of over $1 trillion from 2015 to 2024.
This article focuses on the
strategic steps taken by the
City of Baltimore to manage the
cost of benefit programs, to
bring the level of benefit offered
more in-line with the other comparable
public entities, and to
take advantage of the opportunities
brought by the evolving
healthcare law in order to satisfy
the City's short- and longterm
goals while maintaining
financial health.
This document describes a new spreadsheet-based tool developed to help states model the impacts of complex health policy changes, such as those in the Affordable Care Act, on health insurance coverage. The tool uses state-specific data and allows users to adjust assumptions to predict how policy changes might affect coverage among different population groups. It is intended to provide a more affordable, flexible and transparent alternative to traditional microsimulation models for states to analyze policy impacts.
ACA Healthcare legislation and attempts at increasing regulation of self-funding and stop loss coverage are driving more employers toward stop loss captives.
The document discusses rising healthcare costs in the US and a new study projecting that health care spending will grow faster than GDP over the next decade. It also summarizes strategies that large employers are using to control costs, such as account-based health plans, engagement of employees in wellness programs, and accountability measures. Updates on the Affordable Care Act include expanded preventive coverage for women and guidelines for employer health subsidies in 2014.
The document discusses healthcare reform and its potential repeal. It notes that while repeal seems out of reach currently, many aspects of the law have already taken effect. These include eliminating pre-existing condition exclusions for children, covering dependents until age 26, and minimum loss ratios for insurance companies. The document also discusses the costs and implementation of state health insurance exchanges. It provides the perspective of the author who has advised on the impacts of healthcare reform.
This document discusses flashbulb memories, which are vivid and emotionally significant memories of notable events. Flashbulb memories include details of where one was and how they felt when the event occurred. Not all memorable events produce flashbulb memories - the event must capture attention and elicit strong personal emotions. While flashbulb memories contain more details than regular memories, the specific details may not be completely accurate. The document also provides a personal example of a flashbulb memory the author has of their parents renewing their marriage vows.
The document provides a summary of the short-term implications of federal health reform. It discusses how the reform will impact public program enrollment, the private insurance market, high-risk pools, health insurance exchanges, and delivery system/payment reform in the short-term. Key points include that millions more may gain eligibility for Medicaid and subsidies, insurers face new regulations on premiums/benefits, a temporary high-risk pool is established, and delivery reforms aim to improve quality and reduce costs through various pilot programs. The source is an independent research center that assists states with health policy analysis.
The document discusses rising healthcare costs in the US and a new study projecting that healthcare spending will increase substantially over the next decade. It also summarizes strategies that large employers are implementing to better manage costs, such as health improvement programs, engagement of employees, accountability measures, and use of technology. Finally, it provides legislative updates on expanded preventive care coverage for women and subsidies available through the Affordable Care Act.
Primary Care spend in the State of Rhode island and its impact on overall cost trend a report worth reading for sure
Primary care Spend in RI went up from 47 million in 2008 to 67 million in 2013
BUT !!!
Total Spend went down from 823 Million in 2008 to 661 Million in 2013
This document provides an introduction and literature review for a study examining differences in healthcare offerings and perceptions of the Affordable Care Act across industries. The introduction outlines the motivation for studying these issues and provides background on the ACA. The literature review summarizes past research on interindustry wage differences, differences in fringe benefits across firm size and industry, and the potential effects of healthcare reform similar to the ACA. The document concludes by describing the data source, a 2014 survey of over 1,000 US businesses, which will be analyzed to study industry differences related to healthcare offerings and views of the ACA.
The Affordable Care Act and Its Impact on Workers’ CompensationCognizant
While the Affordable Care Act (ACA) is expected to reduce the number of uninsured and improve personal wellness in the U.S., the law's changes in workforce definitions will significantly impact workforce dynamics, employee hiring, employers' benefits strategies and wellness programs -- requiring a reevaluation of how workers' compensation is accounted for and delivered.
hCentive Health Insurance Exchange PlatformAlisha North
Take advantage of hCentive's deep expertise in the healthcare insurance industry. Browse through or download our white papers to get an in-depth understanding of the industry.
Shifting away from employer-provided healthcare means individuals will be responsible for cost containment.
With the onset of the ACA, will the Government become the last -or- best resort for the private sector's healthcare cost containment?
Ontario and U.S. Programs offer different approaches to help fund innovation in medical technology
In this bulletin, we highlight two new government funding incentive programs for private
companies in the biotech / medical-device sectors.
Growth and Dispersion of Accountable Care OrganizationsLeavitt Partners
The Leavitt Partners Center for ACO Intelligence, which tracks national and regional trends related to ACOs and other emerging care delivery systems, published a white paper entitled "Growth and Dispersion of Accountable Care Organizations." This is the first report of its kind regarding the types and locations of ACOs. The report provides data-driven insights into the evolution of ACOs following federal health reform and the recent announcement of the Medicare Shared Savings Program. Data and analysis on the growth and national dispersion trends of more than 160 ACO or ACO-like organizations are highlighted.
Health Reform Bulletin 143 | Status of ACA Litigation; Murky Future of AHPs; ...CBIZ, Inc.
Litigation challenging and rescinding various aspects of the Affordable Care Act (ACA) continues to reign. Last December, Judge Reed O’Connor of the Fifth Circuit Court of Appeals opined that the individual mandate, in the absence of the tax repealed by the Tax Cuts and Jobs Act, is unconstitutional; and since it is a cornerstone of the ACA, then the entire ACA must fall (see our prior CBIZ Health Reform Bulletin 142).
CBO’s health insurance simulation model (HISIM) generates estimates of health insurance coverage and premiums for the population under age 65. HISIM is used to help develop baseline projections (which incorporate the assumption that current law generally remains the same) and also to model proposed changes in policies that affect health insurance coverage.
Currently, CBO is developing and testing a new version of HISIM to respond to continued Congressional interest in understanding the effects of legislative proposals that significantly affect health insurance coverage. The new model will be used to help develop CBO’s spring 2019 baseline projections and subsequent cost estimates.
Presentation by Jessica Banthin, Deputy Assistant Director in CBO’s Health, Retirement, and Long-Term Analysis Division (HRLD), and Alexandra Minicozzi, Chief of HRLD’s Health Insurance Modeling Unit, to CBO’s panel of health advisers.
HISIM2 is an updated version of the model CBO uses to generate estimates of health insurance coverage and premiums for people under age 65. The model is used along with other models to develop CBO’s baseline budget projections (which incorporate the assumption that current law generally remains the same). It is also used to estimate the effects of proposed changes in policies that affect health insurance coverage.
CBO and the Joint Committee on Taxation use HISIM2 to estimate the major sources of health insurance coverage and associated premiums for the U.S. population under age 65.
HISIM2 is used in conjunction with other models (for example, those for related taxes, Medicaid, and Medicare) to develop baseline insurance coverage projections and their associated budgetary costs. It is also used to estimate the effects of proposed changes in policies that affect health insurance coverage.
CBO uses HISIM2 to model firms’ decisions to offer health insurance as well as households’ decisions to enroll in health insurance. Like all of CBO’s models, HISIM2 is regularly updated. This slide deck describes the analytical methods used in HISIM2 to model firms’ decisions in CBO’s baseline budget projections as of March 6, 2020.
The Congressional Budget Office developed its Health Insurance Simulation Model (HISIM) in 2002 to model the effects of health insurance proposals on coverage levels. HISIM uses microdata to simulate individual and family coverage decisions and estimate the budgetary impacts of proposals over 10 years. It factors in economic forecasts and is regularly updated based on new data and research. HISIM models coverage through employers, Medicaid, ACA marketplaces, and the uninsured to help CBO prepare baseline budgets and estimate costs of new policies.
Spending on federal health care programs is growing rapidly, driven by rising enrollment and rising health care spending per enrollee. This presentation describes CBO’s analyses related to health care, explains how the agency uses its health insurance simulation model, and provides examples of how CBO documents its work.
Presentation by Robert Sunshine, Senior Advisor in CBO’s Office of the Director, at the 10th Annual Meeting of the OECD Network of Parliamentary Budget Officials and Independent Fiscal Institutions.
CBO’s new health insurance simulation model creates synthetic firms that mimic the real-world variations between firms to model employers’ decisions about whether to offer employment-based health insurance.
Presentation by Alexandra Minicozzi, a Unit Chief in CBO’s Health, Retirement, and Long-Term Analysis Division, at the 8th Annual Conference of the American Society of Health Economists.
Microsimulation of Demand for Health Insurance- A Method Based on ElasticitiesDr Dev Kambhampati
The document describes the Congressional Budget Office's Health Insurance Simulation Model (HISIM) which is a microsimulation model used to estimate the budgetary and coverage effects of health insurance proposals including the Affordable Care Act. The model uses individual-level data and elasticities to simulate how individuals and employers would respond to changes in policy and estimates the resulting impacts on federal spending and insurance coverage. Recent applications of the model estimated that the Affordable Care Act would reduce the number of uninsured Americans and result in net increased federal spending of over $1 trillion from 2015 to 2024.
The federal government subsidizes health insurance for most Americans through a variety of programs and tax provisions. In 2017, net subsidies for people under age 65 will total $705 billion, CBO and the staff of the Joint Committee on Taxation (JCT) estimate.
This presentation provides an overview of CBO and JCT’s current projections of health insurance coverage and how those projections have changed since March 2016, highlighting changes in Medicaid and CHIP enrollment and nongroup coverage.
Jessica Banthin, Deputy Assistant Director in CBO’s Health, Retirement, and Long-Term Analysis Division, will deliver this presentation on December 7, 2017, at the Inforum Outlook Conference at the University of Maryland.
CBO provides summaries of its health care analysis methods and recent work. It evaluates health care proposals using a 10-year horizon, examining insurance coverage, health care spending projections, and more. Recent reports analyzed the uninsured, health care prices, and single-payer proposals. CBO also provides cost estimates and scores legislation on issues like surprise billing, the ACA, Medicare expansions, and drug pricing. It describes how it uses modeling, behavior assumptions, and a 10-year window in its analyses.
The document summarizes recent studies and trends related to rising healthcare costs in the US. It discusses projections that healthcare spending will grow faster than GDP over the next decade and account for 20% of national spending by 2020. It also outlines strategies that large employers are using to better manage costs, such as engaging employees in wellness programs, linking provider strategies to quality outcomes, and using health technology. Additional sections provide updates on provisions and guidelines under the Affordable Care Act.
This document summarizes key points from a presentation on rural health issues and healthcare reform. It discusses potential government shutdowns if a budget is not passed, changes to Medicare and Medicaid under the Affordable Care Act, provisions already in effect, and new delivery models like accountable care organizations. Key uncertainties are noted, such as the impact of healthcare reform on rural providers and workforce shortages.
1) The payment models in healthcare are shifting from fee-for-service to value-based models that tie reimbursement to quality outcomes and cost savings. This transition is being driven by rising healthcare costs, the Affordable Care Act, and commercial insurers.
2) Providers now need to accelerate preparations for managing clinical and financial risk through value-based contracts. This requires changes to business models, physician alignment, and supporting patients through the transition.
3) For organizations to succeed under value-based contracts, they must define population health strategies, implement coordinated care delivery models, and carefully sequence clinical and financial transformations to capture savings while maintaining stability.
The Congressional Budget Office (CBO) provides objective, impartial analysis to support the congressional budget process. It prepares a 10-year budget baseline and cost estimates for nearly every bill approved by congressional committees. CBO prioritizes transparency and makes no policy recommendations, hiring staff based solely on competence.
Presentation by Lara Robillard, Principal Analyst, CBO’s Budget Analysis Division, to the Leadership Fellowship Program at the National Hispanic Medical Association.
Discussion Question (250-300 words long) Describe the princip.docxelinoraudley582231
Discussion Question: (250-300 words long)
Describe the principles of fee-for-service plans and managed care plans. What are the similarities and differences?
I want you to discuss and answer this question and to help you to do so I will upload a PowerPoint file helping you to answer this question.
Here are two of the classmates responses to this question read it and try to connect their responses to your answer and discussion.
Gabrielle
Fee-for-service plans (FSS) and managed care plans are both classes of insurance programs. In fee-for-service plans, the doctors and hospitals get paid for the service that they perform and test that they order. This plan provides protection against health care expenses in the form of a cash benefit that is paid to the insurer or directly to the health care provider after the employee has received health care services. However under this plan, the insurance company determines a deductible for the patient to pay and then they are responsible for the remainder of the amount. Under managed care plans, the plans emphasize cost control by limiting the patient’s choice of doctors and hospitals that they can use. The plan provides a list of physicians and hospitals that the plan holder can use at a reduced price.
These plans are both similar because they offer a reduced price for medical and health coverage. Some differences between the two include how a patient can choose a physician or hospital. Under FSS, you can see a physician whenever you want or feel necessary. However, under managed care, when you see only the physicians that are affiliated with the plan, they then receive a strong financial incentive.
Trevor
The principles of a fee-for-service plan include a health insurance programs that that use cash benefits in order to help protect employees of an organization from expense that come from health care. Some things that are covered by this are physician charges, hospital expenses, and surgical expenses. One type of these service plans are indemnity plans. These plans are when the insurance company and the employer have a contract that specifically covers certain expenses. The next type of these plans are self-funded plans. These plans are when a company pays benefits from their own assets. Managed care plans control costs by limiting employee's decisions on doctors and hospitals. Fee-for-service plans and managed care plans are similar because they both provide health insurance for employees. Managed health care plans are more confusing because they have so many specifications, meanwhile fee-for-service plans is more basic that offers cash benefit for expenses.
until after a probationary period of at least three months so that they can prove that they are going to be great asset to the company.
Instructions:
1. Login to our database using the phpmyadmin.soe.ucsc.edu interface.
2. Develop SQL query to answer each question.
3. In a WORD compatible document and for each question:
· State .
Online Conference Takes “Deep Dive” into Affordable Care ActPYA, P.C.
PYA’s Martie Ross, Principal, joined three other panelists in a full-day, online conference sponsored by the American Institute of Certified Public Accountants to offer an in-depth look at healthcare reform under the Affordable Care Act (ACA).
Dr. David Muhlestein and Mathew Petersen, both of whom participate with Leavitt Partners' research on Accountable Care Organizations, co-authored the article ACO Results: What We Know So Far in Health Affairs Blog column on May 30th, 2014.
The document is a newsletter from Mike Wojcik discussing rising healthcare costs, the impacts of the Affordable Care Act, and strategies for controlling costs. It notes that a new study projects healthcare spending to grow faster than GDP over the next decade. It also discusses provisions of the ACA like expanded preventive care coverage for women and guidelines for employer health subsidies in 2014. The newsletter provides updates on legislative actions and profiles initiatives by healthcare organizations like Blue Shield to reduce costs and improve care.
Riportella priester 2013 the affordable care actMarissa Stone
This document provides an overview of the Affordable Care Act (ACA). It discusses key provisions of the law including expanding Medicaid eligibility, establishing health insurance marketplaces, mandating individuals have health insurance, and enforcing employer responsibilities. The document outlines how the ACA aims to increase access to health insurance through a combination of public programs, employer coverage, and online marketplace coverage. It also addresses ongoing implementation challenges and debates around the law.
IBM's Watson technology will be used by WellPoint to help improve patient care and reduce costs. Watson will initially be used by nurses to review doctor treatment requests and manage patient cases. WellPoint believes Watson can process medical information quickly and help ensure patients receive the right care.
Similar to CBO’s Health Insurance Simulation Model: Overview of Planned Updates (20)
Presentation by Jared Jageler, David Adler, Noelia Duchovny, and Evan Herrnstadt, analysts in CBO’s Microeconomic Studies and Health Analysis Divisions, at the Association of Environmental and Resource Economists Summer Conference.
Presentation by Mark Hadley, CBO's Chief Operating Officer and General Counsel, at the 2nd NABO-OECD Annual Conference of Asian Parliamentary Budget Officials.
Presentation by Daria Pelech, an analyst in CBO’s Health Analysis Division, at the Center for Health Insurance Reform McCourt School of Public Policy, Georgetown University.
This slide deck highlights CBO’s key findings about the outlook for the economy as described in its new report, The Budget and Economic Outlook: 2024 to 2034.
Presentation by CBO analysts Rebecca Heller, Shannon Mok, and James Pearce, and Census Bureau research economist Jonathan Rothbaum at the American Economic Association Annual Meeting, Committee on Economic Statistics.
Presentation by Eric J. Labs, an analyst in CBO’s National Security Division, at the Bank of America 2024 Defense Outlook and Commercial Aerospace Forum.
Presentation by Elizabeth Ash, William Carrington, Rebecca Heller, and Grace Hwang of CBO’s Labor, Income Security, and Long-Term Analysis and Health Analysis divisions to the Children’s Health Group, American Academy of Pediatrics.
Presentation by Molly Dahl, Chief of CBO’s Long-Term Analysis Unit, at a meeting of the National Conference of State Legislatures’ Budget Working Group.
In the President’s 2024 budget request, total military compensation is $551 billion, including veterans' benefits. That amount represents an increase of 134 percent since 1999 after removing the effects of inflation.
Combined Illegal, Unregulated and Unreported (IUU) Vessel List.Christina Parmionova
The best available, up-to-date information on all fishing and related vessels that appear on the illegal, unregulated, and unreported (IUU) fishing vessel lists published by Regional Fisheries Management Organisations (RFMOs) and related organisations. The aim of the site is to improve the effectiveness of the original IUU lists as a tool for a wide variety of stakeholders to better understand and combat illegal fishing and broader fisheries crime.
To date, the following regional organisations maintain or share lists of vessels that have been found to carry out or support IUU fishing within their own or adjacent convention areas and/or species of competence:
Commission for the Conservation of Antarctic Marine Living Resources (CCAMLR)
Commission for the Conservation of Southern Bluefin Tuna (CCSBT)
General Fisheries Commission for the Mediterranean (GFCM)
Inter-American Tropical Tuna Commission (IATTC)
International Commission for the Conservation of Atlantic Tunas (ICCAT)
Indian Ocean Tuna Commission (IOTC)
Northwest Atlantic Fisheries Organisation (NAFO)
North East Atlantic Fisheries Commission (NEAFC)
North Pacific Fisheries Commission (NPFC)
South East Atlantic Fisheries Organisation (SEAFO)
South Pacific Regional Fisheries Management Organisation (SPRFMO)
Southern Indian Ocean Fisheries Agreement (SIOFA)
Western and Central Pacific Fisheries Commission (WCPFC)
The Combined IUU Fishing Vessel List merges all these sources into one list that provides a single reference point to identify whether a vessel is currently IUU listed. Vessels that have been IUU listed in the past and subsequently delisted (for example because of a change in ownership, or because the vessel is no longer in service) are also retained on the site, so that the site contains a full historic record of IUU listed fishing vessels.
Unlike the IUU lists published on individual RFMO websites, which may update vessel details infrequently or not at all, the Combined IUU Fishing Vessel List is kept up to date with the best available information regarding changes to vessel identity, flag state, ownership, location, and operations.
Donate to charity during this holiday seasonSERUDS INDIA
For people who have money and are philanthropic, there are infinite opportunities to gift a needy person or child a Merry Christmas. Even if you are living on a shoestring budget, you will be surprised at how much you can do.
Donate Us
https://serudsindia.org/how-to-donate-to-charity-during-this-holiday-season/
#charityforchildren, #donateforchildren, #donateclothesforchildren, #donatebooksforchildren, #donatetoysforchildren, #sponsorforchildren, #sponsorclothesforchildren, #sponsorbooksforchildren, #sponsortoysforchildren, #seruds, #kurnool
The Antyodaya Saral Haryana Portal is a pioneering initiative by the Government of Haryana aimed at providing citizens with seamless access to a wide range of government services
Monitoring Health for the SDGs - Global Health Statistics 2024 - WHOChristina Parmionova
The 2024 World Health Statistics edition reviews more than 50 health-related indicators from the Sustainable Development Goals and WHO’s Thirteenth General Programme of Work. It also highlights the findings from the Global health estimates 2021, notably the impact of the COVID-19 pandemic on life expectancy and healthy life expectancy.
Jennifer Schaus and Associates hosts a complimentary webinar series on The FAR in 2024. Join the webinars on Wednesdays and Fridays at noon, eastern.
Recordings are on YouTube and the company website.
https://www.youtube.com/@jenniferschaus/videos
AHMR is an interdisciplinary peer-reviewed online journal created to encourage and facilitate the study of all aspects (socio-economic, political, legislative and developmental) of Human Mobility in Africa. Through the publication of original research, policy discussions and evidence research papers AHMR provides a comprehensive forum devoted exclusively to the analysis of contemporaneous trends, migration patterns and some of the most important migration-related issues.
CBO’s Health Insurance Simulation Model: Overview of Planned Updates
1. Congressional Budget Office
Webinar for the
American Academy of Actuaries
October 25, 2018
Jessica Banthin and Alexandra Minicozzi
Health, Retirement, and Long-Term Analysis Division
CBO’s Health Insurance
Simulation Model:
Overview of Planned Updates
2. 1
CBO
The Role of the Health
Insurance Simulation
Model (HISIM) at CBO
3. 2
CBO
HISIM generates estimates of health insurance coverage and premiums
for the population under age 65.
The model is used to help develop baseline projections (which
incorporate the assumption that current law generally remains the same)
and also to model proposed changes in policies that affect health
insurance coverage.
What Is HISIM Used For?
4. 3
CBO
How Does CBO Use HISIM to Help Estimate the
Cost of Proposals Affecting Health Insurance
Coverage?
Develop a
Modeling Strategy
Analyze the Proposal in
HISIM
Review HISIM’s Output
Analyze the Proposal’s
Effects on Medicaid
Enrollment and Costs
Analyze the Proposal in the
Joint Committee on
Taxation’s Tax Models
Write and Review
the Formal Estimate
5. 4
CBO
CBO is creating a new version of HISIM to respond to continued
Congressional interest in understanding the effects of legislative
proposals that significantly affect health insurance coverage. The new
model:
Incorporates new data into early stages of the modeling process,
Better accounts for consumers’ selection of types of insurance plans,
and
Allows easier simulation of new insurance products.
The new model is in a development and testing phase.
Why Update HISIM?
6. 5
CBO
The new model will be used to help develop CBO’s spring 2019 baseline
projections and subsequent cost estimates.
CBO is incorporating feedback obtained during presentations like this
one while the new model is in the development and testing phase.
The current model will be maintained to serve as a point of reference in
2019.
When Will the New Model Replace the Current
One?
7. 6
CBO
Between now and the publication of the spring 2019 baseline, CBO will
examine how the current model’s estimates of effects on health
insurance coverage differ from the new one’s. At this point, it is too early
to tell.
Underlying relationships among individuals, families, employment,
income, and insurance coverage are different in the new model because
of new data, so the new model may yield different coverage decisions
and budgetary costs—just as the technical improvements that CBO
makes to its models every year have yielded differences.
What remains the same, even when CBO updates its models, is its
reliance on evidence. The new model, like the current one, will be
aligned with the latest available evidence about consumers’ and
employers’ responses to health insurance subsidies.
How Will the New Model Change CBO’s Cost
Estimates?
8. 7
CBO
CBO has established a technical review panel to review the new model.
The agency is also making presentations to various groups to solicit
feedback.
Furthermore, CBO’s annual report on federal subsidies for health
insurance will include a discussion of differences between the
spring 2019 baseline and the previous one.
And the spring 2019 baseline will be accompanied by:
An updated slide deck describing the new model,
Additional documentation describing the sources and preparation of
input data, and
Segments of computer code related to the model’s simulations of
certain decisions about insurance choices.
How Will CBO Be Transparent About the New
Model?
9. 8
CBO
Data or analyses that would improve our modeling of expected health
care spending
More information on risk selection—how people with different health
risks choose different types of plans in nongroup, small-group, and
large-group markets
Data or analyses that would improve our modeling of employers’
decisions to offer types of plans
What Information Would Be Especially Helpful to
Obtain?
11. 10
CBO
The base data for the new model are from the Current Population Survey
(CPS) and were collected in years after the implementation of the
Affordable Care Act.
Those data have several advantages:
They constitute a large, representative data set for the U.S.
noninstitutionalized population;
They represent reliable, timely information about income, employment
status, employers’ offers of health insurance, health status, and
insurance coverage; and
They are representative of states’ populations.
The Source of the Data
12. 11
CBO
CBO edited the following variables to align them with information from
better sources:
Firm size,
Self-employment income, and
Whether employers offered insurance.
Also, CBO imputed additional variables:
Medicaid eligibility,
Characteristics of employers’ insurance offers (the type of plan offered
and the employers’ contribution),
Marginal tax rates, and
The health spending distribution for each individual.
Adjustments to the Data
13. 12
CBO
Because the new model uses an expected utility approach, it requires an
estimate of each individual’s expected health spending.
A single expected spending amount would be sufficient for a simple
model, but CBO chose to impute a discrete probability distribution of
potential health spending to each individual. Two advantages of that
approach are that:
The variance in health spending for a given insurance choice directly
affects the expected utility resulting from that choice, and
Out-of-pocket costs can be calculated to compare expected utility
under plans with different cost-sharing attributes.
In this approach, an individual’s health spending distribution is defined
among 16 discrete health spending “states,” which are defined by dollar-
amount ranges ($0, $1–$250, $251–$500, …, $20,001–$25,000,
>$25,000) in 2015.
Individual Health Spending Distribution
14. 13
CBO
CBO constructs synthetic firms to help model employers’ decisions.
A synthetic firm is constructed for each worker in the data on the basis of
that worker’s profile. It consists of a set of randomly drawn coworkers
matching a distribution of age and earnings that is based on that worker’s
profile. For example, a firm could consist of mostly young, low-earning
employees, or it could have employees with a mix of ages and earnings.
In the new model, newly accessible administrative tax data (from Form
W-2s linked to Form 941s) provide more accurate information about the
earnings and ages of workers within actual firms.
Thus, in the new model, synthetic firms’ decisions will vary for workers
with similar age and earnings profiles, reflecting heterogeneity in the age-
earnings distribution among actual firms.
Synthetic Firms
15. 14
CBO
Previous Method
New Method
Variation in Age and Earnings Among and Within
Synthetic Firms
20 30 40 50 60
Distribution of Coworkers’ Age
Firm for
Worker 1
Firm for
Worker 2
Firm for
Worker 3
20 30 40 50 60
Distribution of Coworkers’ Age
$0 $25,000 $50,000 $75,000 $100,000 $125,000
Distribution of Coworkers’ Earnings
$0 $25,000 $50,000 $75,000 $100,000 $125,000
Distribution of Coworkers’ Earnings
16. 15
CBO
In the new model, premiums are endogenously constructed within the model by
means of individual-level health spending distributions, plan characteristics, and
load factors.
Premiums for employment-based coverage are constructed to closely match
average premiums by plan and coverage type in the Medical Expenditure Panel
Survey–Insurance Component (MEPS–IC).
Premiums for marketplace coverage are aligned to match actual national average
premiums.
Because premiums within the model are constructed on the basis of the
individuals who are enrolled in each type of coverage, the model can better
estimate changes in premiums that would result from proposed policies.
Constructing Premiums Within the Model
18. 17
CBO
In the new model, health insurance units (HIUs) make decisions about
health insurance coverage on the basis of the expected utility of all
options available to them.
The utility of each option is a function of the HIU’s total income minus
health care spending, including premiums, out-of-pocket spending,
subsidies, taxes, and mandate penalties. (Out-of-pocket spending is
determined by the health status of each member of the HIU and by plan
parameters.)
Utility is assumed to decrease with risk as measured by variance in out-
of-pocket spending. Many utility-function parameters are estimated under
the constraint that the predictions from the model must be close to the
distribution of coverage in the base year of data. Other parameters are
set on the basis of CBO’s assessment of the research literature.
Overview of Health Insurance Units’ Behavior
19. 18
CBO
HIUs select the type of insurance for each person in the unit from
choices such as these:
Employment-based coverage, single: preferred provider organization
(PPO), health maintenance organization (HMO), or high-deductible
health plan (HDHP)
Employment-based coverage, nonsingle: PPO, HMO, or HDHP
Nongroup in the marketplaces: bronze, silver, or gold plan
Nongroup outside the marketplaces: bronze, silver, or gold plan
Medicaid
Children’s Health Insurance Program (CHIP)
Medicare
Uninsured
Overview of HIUs’ Behavior (Continued)
20. 19
CBO
The choice set is determined by the characteristics of an HIU and by
CBO’s decision to keep the model relatively simple.
Single-person and multiperson HIUs have different choice sets.
The choice set of an HIU is restricted by the eligibility of its members
for public insurance and subsidized private insurance.
The choice sets of the model are restricted to maintain as much
realism as possible while simplifying the model to a manageable level,
limiting the computational time it takes to simulate coverage effects of
proposed policies.
Choice Sets
21. 20
CBO
The choice set for single-person HIUs consists of options that are
categorized into one of five “nests.”
Options within the same nest are considered closer substitutes than
options in different nests.
Choice Set: Single-Person HIUs
Nest Options
Uninsured Uninsured
Nongroup outside the marketplaces Bronze, silver, gold
Nongroup in the marketplaces Bronze, silver, gold
Employment-based coverage Employment-based coverage
Public insurance Medicaid, CHIP, Medicare
22. 21
CBO
Choice Set: Multiperson HIUs
Multiperson HIUs have a larger choice set than single-person HIUs do
because different members of an HIU can have different types of
coverage.
Each nest represents a combination of different types of coverage that
CBO allows an HIU to enroll its members in.
Under each option within a nest, members of the HIU are sorted into
different types of coverage on the basis of their eligibility.
23. 22
CBO
There are eight nests in the choice set for multiperson HIUs:
Uninsured
Nongroup outside the marketplaces, public insurance, and uninsured
Nongroup in the marketplaces, public insurance, and uninsured
Employment-based coverage
Employment-based coverage and public insurance
Employment-based coverage, public insurance, and uninsured
Employment-based coverage and uninsured
Public insurance
Choice Set: Multiperson HIUs (Continued)
24. 23
CBO
Data Used to Calibrate Utility-Function
Parameters
Coverage Source
Employment-
Based
Medical Expenditure Panel Survey
(MEPS–IC and MEPS–Household Component)
Nongroup Robert Wood Johnson Foundation HIX Compare
database, state-level data, Centers for Medicare
and Medicaid Services (CMS), and National
Association of Insurance Commissioners
None (Uninsured) National Health Interview Survey (NHIS) and
MEPS–Household Component
Medicaid and CHIP CBO’s estimates on the basis of CMS Form 64
and Medicaid Statistical Information Statistics
(MSIS)
26. 25
CBO
In the new model, firms make decisions about whether to offer coverage
and what type of plan to offer on the basis of their expected utility from
each option.
Firms may only offer one type of plan: an HDHP, HMO, or PPO.
Firms make decisions before HIUs do, so their choices are deterministic.
The assumption that firms make decisions before HIUs makes the HIU
choice set smaller and greatly decreases computational time.
The utility of each option is a function of a firm’s expected premium
contributions, tax liabilities, and penalty payments under the option and
their employees’ willingness to pay for it.
Parameters are calibrated on the basis of CBO’s assessment of the
research literature and simulations of firms’ responses to changes in
premiums.
Overview of Firms’ Behavior
27. 26
CBO
CBO constructs a synthetic firm for each employee in the model.
Each firm consists of a set of coworkers sampled on the basis of their
traits and the traits of the worker for whom the firm is being constructed.
The traits of a firm’s employees influence the firm’s expected utility from
each of their options.
CBO imputes the premiums and cost-sharing characteristics for each
type of plan that a firm can offer and the share of premiums that a firm
would pay for single and nonsingle plans of any type.
Firms’ Characteristics
28. 27
CBO
For the base year of the model, CBO imputes firms’ decisions.
A firm’s decision about offering coverage is informed largely by CPS
data and is calibrated to MEPS–IC estimates of offer rates.
If a firm offers coverage, the type of plan that it offers is imputed on the
basis of a preliminary estimate of its worker’s valuation of the plan and
MEPS–IC data on the share of firms offering each type of plan.
For subsequent years, firms make decisions on the basis of their
expected utility.
If the calculated probability of a firm’s offering coverage is greater than
or equal to one-half, the firm offers coverage.
Firms then offer the type of plan that maximizes their expected utility.
Firms’ Decisions
29. 28
CBO
Its base data are from the CPS.
Those base data are edited, and several key variables are imputed.
Synthetic firms are constructed to match the distribution of workers’ ages
and earnings within and among firms.
Simulated coverage behavior depends on how much utility is derived
from each coverage option.
Many parameters in the utility functions are estimated within the model;
some are set on the basis of CBO’s assessment of the research
literature.
Employers select the coverage option that maximizes workers’ valuation
of an offer net of the expected cost to the employer.
Summary of the New Model’s Specifications
30. 29
CBO
How CBO Defines and Estimates Health Insurance Coverage for People
Under Age 65 (May 2018), www.cbo.gov/publication/53822.
Federal Subsidies for Health Insurance Coverage for People Under Age
65: 2018 to 2028 (March 2018), https://www.cbo.gov/publication/53826.
How CBO and JCT Analyze Major Proposals That Would Affect Health
Insurance Coverage (February 2018), www.cbo.gov/publication/53571.
“The Health Insurance Simulation Model Used in Preparing CBO’s 2018
Baseline” (February 2018), www.cbo.gov/publication/53592.
Related Publications by CBO