Beginning in 2014, the health insurance exchanges created under the Affordable Care Act (ACA) will be available in every state as marketplaces for individuals without employer insurance and small employers. All plans will include the same package of essential health benefits, but will vary by four different levels of "actuarial value," or the percentage of medical costs that a plan pays for on average. The actuarial value of a plan will be indicated by the tiers of bronze, silver, gold, and platinum, and comparative information will be available to help people select plans. A new study recently published by the Commonwealth Fund looks at out-of-pocket costs that might result from plans with various designs and actuarial values. The study found that average out-of-pocket expenses decline as actuarial values rise, but two plans with similar actuarial values might result in different out-of-pocket costs for a given person. The overall affordability of a plan also will be influenced by age rating, income-related premium subsidies, and out-of-pocket subsidies, report the authors.

A new paper titled, “Multi-State Plans under the Affordable Care Act,” was recently released by the George Washington University School of Public Health and Health Services. Authored by Trish Riley and Jane Hyatt Thorpe of the GW Department of Health Policy and funded by The Commonwealth Fund, the paper examines key issues related to the development of multi-state plans (MSPs), a new type of insurance coverage created by a provision of the Affordable Care Act (ACA). MSPs will be administered through the federal Office of Personnel Management (OPM) and offered across state lines through the new state health insurance exchanges. The findings in this paper are based on interviews with federal and state policy makers and other stakeholders, and are intended to inform the development and implementation of MSPs. A primary goal of the ACA is to...