Research Alert: February 7, 2018

Distance and Networks: A Regional Analysis of Health Insurance Marketplaces

As of the fourth year of implementation of Health Insurance Marketplaces (HIMs), one characteristic is consistently evident in the data on issuer participation, numbers of plans available, premiums charged, and enrollment: there is a significant amount of geographic variation, both in terms of region of the country and in terms of rural and urban status of the place. The purpose of this paper is to examine whether rating area design and network adequacy standards may have contributed to HIMs' success, in terms of enrollment and/or affordability, or lack thereof in rural places. Using 2015-16 data on insurance issuer (or "firm") participation, premiums, and enrollment success for 15 Midwestern states, we examine the possibility that geographic distance to care plays a role in this variation through its effect on network adequacy from several angles and attempts to assess the moderating role that state-level policies on network adequacy standards and Rating Area design may have.

Additional Resources of Interest:

• More information about the RUPRI Center for Rural Health Policy Analysis
• More information from the Rural Health Information Hub's topic guides: Healthcare Access, Rural Health Policy