Coleman Drake
Doctoral Candidate, Division of Health Policy & Management, University of Minnesota School of Public Health

A rich literature regarding the Health Insurance Marketplaces (i.e., Exchanges) created by the Affordable Care Act (ACA) has emerged since their implementation in 2014. Particularly over the last year, the quality of available Marketplace data has improved substantially, increasing the potential for valuable contributions to the literature. In this brief, I will discuss available Marketplace data on insurer plan offerings, enrollment, and provider networks, as well as common data sets to use in conjunction with Marketplace data.

Three data sets are available to researchers investigating the offerings of insurers in the Marketplaces. Healthcare.gov’s Qualified Health Plan Landscape File (QHP) provides information on plans’ premiums and cost-sharing attributes, as well as where they offered. Plan information is available in the QHP at the county level for each state that used the healthcare.gov platform from 2014 through 2017. Separate QHP data exist for dental plans and the Small Business Health Options Program (SHOP). The Leonard Davis Institute (LDI) and the Robert Wood Johnson Foundation (RWJF) have released their HIX Compare data sets from 2014 through 2017. The HIX Compare data is similar to the QHP, but it covers all 50 states, not just those that used the healthcare.gov platform. Additionally, the HIX Compare data spans the entire individual market (i.e., off-Exchange plans) as well as the small group market through 2016. Plan information is only available at the rating area level in HIX Compare, though it is possible to identify the number of insurers participating in a county using the HIX Compare’s accompanying issuer county report files. The Center for Consumer Information & Insurance Oversight (CCIIO) at the Centers for Medicare & Medicaid Services (CMS) also provides Marketplace Public Use Files (PUF). The PUFs are considerably more detailed than either the QHP or, to a lesser extent, HIX Compare. They are, however, more cumbersome due to greater detail and database-style formatting. For each year, the PUFs are separated into at least six separate files, each outlining different aspects of plans’ rates and benefits. The PUFs are available from 2014 through 2017 for states that used the healthcare.gov platform, as well as for 2016 for states that used State-based Marketplaces. Researchers that do not require the extra information available in the PUFs should use either the QHP or HIX Compare. The QHP is necessary if the researcher wishes to conduct plan-specific research at the county level. Otherwise, the researcher should use HIX Compare data.

Data on Marketplace enrollment has been available since 2015, though issuer-specific enrollment data only recently became available. The Assistant Secretary for Planning and Evaluation (ASPE), part of the Department of Health & Human Services, has released ZIP code- and county-level enrollment from 2014 through 2017. CCIIO recently released issuer-specific enrollment data at both the plan-state and issuer-county levels for 2014 and 2015. The issuer-county level data is stratified by age, sex, federal poverty level, and smoking status, though the plan-state data is not. Researchers should use the CCIIO data unless they have a need to perform analyses at the ZIP code-level, though the CCIIO data is limited to 2014-2015. Both data sets have some censoring for geographic areas and plans with low enrollment. When merging the CCIIO data to other data sets, it is preferable to use the alphanumeric issuer and plan identifiers included in the data sets.

The Leonard Davis Institute at the University of Pennsylvania created a nearly comprehensive database of all providers included in Marketplace plans’ networks in 2014. A file that lists provider totals at the plan-geographic rating area level is publicly available on their website. The raw, physician-level file is available from LDI under certain restrictions. The file may be easily merged to the 2014 HIX Compare file due to the two data sets having common identifiers, though it is possible to merge it to the QHP or PUFs. Network data for 2016 and 2017 have recently become available through Vericred, a healthcare data services company. Through its Researcher Data Initiative with the Robert Wood Johnson Foundation, non-commercial researchers may access the 2016 and 2017 network data.

Several commonly used data sets are ideal for use with the Marketplace data. These include the American Community Survey (ACS), Current Population Survey (CPS), the Area Health Resource File (AHRF), and the Medical Expenditure Panel Survey – Household Component (MEPS-HC). The ACS may be used to construct county-level estimates of the population targeted for enrollment in the Marketplaces (i.e., non-elderly persons not eligible for other forms of insurance).^1–3 The ACS and CPS data may be obtained in an easy-to-use format from the Integrated Public Use Microdata Series (IPUMS) maintained by the Minnesota Population Center.^4,5

This review of Marketplace data sets is not comprehensive, though it does provide a starting point for researchers seeking to engage in Marketplace research. Other data sets have been released by specific states, such as California, Colorado, and Washington, as well as in various reports by CMS, CCIIO, and ASPE.

Even though Congress may modify the ACA, the Marketplaces still provide a rich environment in which health economists may analyze consumer and insurer behavior. It will be especially important for health economists to learn what we can from the existing individual health insurance market in order to understand how it can be improved. As sweeping policy changes loom, understanding the incentives facing both individuals and insurers will be more important than ever.

References

Drake C, Abraham J, McCullough JS. Rural Enrollment in the Federally-Facilitated Marketplace. J Rural Heal. 2016;32(3):332-339.

Boudreaux M, Blewett L, Fried B, Hempstead K, Karaca-Mandic P. Community Characteristics and Qualified Health Plan Selection during the First Open Enrollment Period. Health Serv Res. 2016;June:1-16.

Claxton G, Levitt L, Damico A, et al. Methodology for Estimating the Number of People Eligible for Premium Tax Credits under the Affordable Care Act. Henry J Kaiser Fam Found. 2015.

Ruggles S, Genadek K, Goeken R, Grover J, Sobek M. Integrated Public Use Microdata Series. Version 6. Minneapolis, MN: University of Minnesota; 2015.

King M, Ruggles S, Alexander JT, et al. Integrated Public Use Microdata Series, Current Population Survey. Version 3. Minneapolis, MN: Minnesota Population Center; 2010.

¹ Both LDI data sets contain consistent plan identifier

² The publicly available file is at the plan-geographic rating area level

³ County identifiers are not available for some CPS respondents

⁴ State identifiers may be access for the MEPS-HC in Census Research Data Centers