JANUARY
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32. S&P Global Ratings, The ACA Individual Market: 2016 Will Be Better Than 2015, But Achieving<br />
Target Profitability Will Take Longer. December 22, 2016.<br />
33. Cynthia Cox, Gary Claxton, and Larry Levit, Analysis of Insurer Participation in 2016<br />
Marketplaces, Kaiser Family Foundation, November 2015.<br />
34. Paul Jacobs, Jessica Banthin, and Samuel Trachtman, “Insurer Competition in Federally<br />
Run Marketplaces is Associated with Lower Premiums,” Health Affairs 34:12 (2027-2035),<br />
December 2015.<br />
35. Cynthia Cox et al., 2017 Premium Changes and Insurer Participation in the Affordable Care Act’s<br />
Health Insurance Marketplaces, Kaiser Family Foundation, November 1, 2016.<br />
36. Caroline F. Pearson, 2017 Open Enrollment Preview, Avalere, October 25, 2016.<br />
37. Paul Jacobs, Jessica Banthin, and Samuel Trachtman, “Insurer Competition in Federally Run<br />
Marketplaces is Associated with Lower Premiums,” Health Affairs, December 2015.<br />
38. Too many health insurance plan choices can lead to suboptimal consumer decision making.<br />
Research suggests that 10 to 15 options can result in a sufficient range of choices and<br />
manageable decision making. See Consumers Union, The Evidence is Clear: Too Many Health<br />
Insurance Choices Can Impair, Not Help, Consumer Decision Making, November 2012.<br />
39. ASPE, Health Plan Choice and Premiums in the 2016 Health Insurance Marketplace, October<br />
31, 2015; ASPE, Health Plan Choice and Premiums in the 2017 Health Insurance Marketplace,<br />
October 24, 2016.<br />
40. CMS, March 31, 2016 Effectuated Enrollment Snapshot, June 30, 2016.<br />
41. McKinsey Center for U.S. Health System Reform, “2016 Exchange Market Remains in Flux:<br />
Plan Type Trends.” December 2015.<br />
42. Katherine Hempstead, Burnt Offerings? PPOs Decline in Marketplace Plans, Robert Wood<br />
Johnson Foundation Issue Brief, November 3, 2015.<br />
43. California HealthCare Foundation, Designing Coverage: Uninsured Californians Weigh the<br />
Options, June 2007.<br />
44. McKinsey Center for U.S. Health System Reform, 2016 Exchange Market Remains in Flux:<br />
Plan Type Trends, December 2015. McKinsey Center for U.S. Health Reform, 2017 Exchange<br />
Market: Plan Type Trends, as of November 3, 2016.<br />
45. Robert Pear, “Many Say High Deductibles Make Their Health Law Insurance All but Useless,”<br />
New York Times, November 14, 2015.<br />
46. Harris Meyer, “New Data Expose Mysterious World of Off-Exchange Health Plans,” Modern<br />
Healthcare, October 24, 2016.<br />
47. Daniel Polsky, Zuleyha Cidav, and Ashley Swanson, “Marketplace Plans with Narrow<br />
Physician Networks Feature Lower Monthly Premiums than Plans with Larger Networks.”<br />
Health Affairs 35 (10): 1842-1848, October 2016.<br />
48. Anne B. Martin, et al., “National Health Spending: Faster Growth in 2015 As Coverage<br />
Expands and Utilization Increases,” Health Affairs published online December 2, 2016.<br />
49. Sean P. Keehan, et al., “National Health Expenditure Projections, 2015−25: Economy, Prices,<br />
And Aging Expected To Shape Spending and Enrollment,” Health Affairs 35(8):1522-1531.<br />
August 2016.<br />
50. Institute of Medicine, Best Care at Lower Cost: The Path to Continuously Learning Health Care<br />
in America, September 6, 2012.<br />
51. Institute of Medicine, Variation in Health Care Spending: Target Decision Making, Not<br />
Geography, July 24, 2013.<br />
52. Martin A. Makary and Michael Daniel, “Medical Error—The Third Leading Cause of Death<br />
in the US,” BMJ May 3, 2016.<br />
AMERICAN ACADEMY OF ACTUARIES 41
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