Access to Employer-Sponsored Insurance and Subsidy Eligibility in Health Benefits Exchanges: Two Data-Based Approaches

Research Report

Access to Employer-Sponsored Insurance and Subsidy Eligibility in Health Benefits Exchanges: Two Data-Based Approaches

Abstract

Consumers offered employer-sponsored insurance (ESI) can be ineligible for subsidies in health insurance exchanges (HIX). Until better ESI data become available, HHS proposes using post-enrollment audits, rather than pre-enrollment verification for this eligibility requirement. Using the Health Insurance Policy Simulation Model (HIPSM), we find that more than 70 percent of eligible consumers work for firms that do not sponsor ESI. HIXes could thus avoid the need to audit them by developing databases that show which employers sponsor ESI. Alternatively, HIXes could target non-ESI recipients for audits based on HIPSM results that show their relative likelihood of being offered ESI.

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