PERSPECTIVE
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Success and Failure in the Insurance Exchanges
n engl j med 376;10 nejm.org March 9, 2017
insurers that remained in the ex-
change market had a greater lo-
cal market share of fully insured
products.
In supplementary analyses, we
also compared characteristics of
insurers and plans entering the
exchange market in 2017 and
found that new plans had sub-
stantially lower premiums than
their local competitors (premiums
are $30 per month lower for a
35-year-old enrollee). Moreover,
issuers of these new plans were
more likely to have experience
with Medicaid managed care but
less likely to have direct experi-
ence in the markets they entered.
This finding is consistent with
the existence of a functioning
market in which firms that were
initially successful are moving into
new geographic areas.
Taken together, our estimates
demonstrate that the insurers par-
ticipating in the exchange market
in 2017 are systematically differ-
ent from the firms that have ex-
ited it. Furthermore, the dimen-
sions on which they differ, such
as experience in pricing premiums
and managing risk for low-income
populations, may be those most
likely to contribute to commercial
success in a reformed nongroup
market. It is possible that the ex-
perience of insurers operating in
the 17 state-based marketplaces
we did not examine could be dif-
ferent; further work examining
those marketplaces would be use-
ful. But claims that the failure of
certain insurers is evidence of un-
workable policies seems misguid-
ed. The available data reveal pat-
terns of market entry and exit
that are consistent with natural
competitive processes separating
out firms that are best suited to
adapt to a new market. We be-
lieve that efforts to reform or re-
place the ACA should therefore
proceed with the knowledge that
highly publicized market exits are
a poor and probably inaccurate
signal of a failing market.
Disclosure forms provided by the authors
are available at NEJM.org.
From the Kellogg School of Management,
Northwestern University, Evanston, IL (C.G.);
and Vanderbilt University School of Medi-
cine, Nashville (J.A.G.).
This article was published on February 1,
2017, at NEJM.org.
1. Levitt L, Claxton G, Damico A, Cox C.
Assessing ACA marketplace enrollment.
Kaiser Family Foundation issue brief. March
2016 (http://files.kff.org/attachment/issue
-brief-assessing-aca-marketplace-enrollment).
2. Johnson CY. UnitedHealth Group to exit
Obamacare exchanges in all but a ‘handful’
of states. Washington Post. April 19, 2016
(https://www.washingtonpost.com/news/
wonk/wp/2016/04/19/unitedhealth-group
-to-exit-obamacare-exchanges-in-all-but-a
-handful-of-states/).
3. Tracer Z. Anthem threatens Obamacare
retreat if results don’t improve. Bloomberg
Businessweek. November 2, 2016.
4. Wilde Matthews A. Molina outperforms
rivals in ACA marketplaces. Wall Street Jour-
nal. October 6, 2016.
DOI: 10.1056/NEJMp1614545
Copyright © 2017 Massachusetts Medical Society.
At Risk for Serious Mental Illness — Screening Children
of Patients with Mood Disorders or Schizophrenia
Michel Maziade, M.D.
A
10-year-old boy has cogni-
tive deficits, and his school
performance and social skills
have been deteriorating gradually
since he was 7. Neither his 12-
year-old brother nor his 14-year-
old sister has similar problems.
Their mother, a 37-year-old school-
teacher, has been treated for bi-
polar disorder since she was 28
and has had stable periods inter-
rupted by acute episodes for which
she was hospitalized. Recogniz-
ing that she shares cognitive dys-
functions with her younger son
and reminded by his difficulties
of the similar ones she had at his
age, she consults her family doc-
tor, worried about her son’s future
mental health. Her doctor reas-
sures her that her son still exhibits
no seriously problematic behavior
but adds that if the deterioration
persists until adolescence, a psy-
chiatric consultation could be con-
sidered. Unfortunately, most clini-
cians would similarly defer clinical
investigation in this case.
There are situations in which
current medical practice does not
reflect the relevant science, and
the lack of attention to the mil-
lions of children born to a parent
with schizophrenia, bipolar dis-
order, or recurrent major depres-
sion is a case in point. This ne-
glect is out of phase with the
massive need in primary care and
the available scientific evidence.
Children with a parent who
has serious mental illness can no
longer be regarded as an extreme
and isolated subpopulation. An
estimated 4% of the populations
of the Group of Seven (G7) indus-
The New England Journal of Medicine
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