State Health Benefit Exchanges and Their Effect on Uninsured, Middle-Income Citizens

As of 2010, the number of uninsured Americans totaled 50.7 million, with an expected growth rate of 20% by 2013. The Patient Protection and Affordability Care Act (PPACA) required each state to develop a policy to provide affordable premiums for its uninsured through health benefit exchanges (HBE). The problem is that some states are non-compliant and costs remain unaffordable. The purposes of this mixed method study were to research a state's HBE to (a) identify the cost burden for the uninsured middle income population and (b) assess stakeholder acceptance of HBEs' intent to provide affordability. The conceptual framework of social and market justice set the background for the research. Ninety five secondary literature sources were qualitatively analyzed using Roe's Narrative Policy Analysis method to identify key perspectives for affordability to the uninsured. The stakeholders comprised (a) uninsured middle-income citizens, (b) health care providers, (c) insurance carriers, and (d) HBE legislative teams. Stakeholders' influence and interest levels were qualitatively analyzed into 4 matrices. ANOVAs were then employed to measure mean differences among stakeholders' perspectives. Quantitative findings were statistically significant, indicating stakeholders' rejection of the current HBE policy intent as a complete solution. HBE meets federal affordability definitions but lacks the realistic monetary means to decrease the rate of uninsured among the middle income. The positive social change implication of this study provides policy makers with information for improving HBE effectiveness and efficiency in the delivery of affordable premiums.