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Consumers’ responses to mandates may be influenced by nonfinancial factors that are difficult to measure, including a desire to comply with the law, beliefs about enforcement, and inertia in decision-making. Under a range of scenarios that reflect alternative assumptions about responses to these factors, we find that enrollment falls by 2.8 million to 13 million people and premiums for bronze plans increase by 3 percent to 13 percent when the mandate penalty is removed. The impact on the federal budget deficit is more uncertain, with effects ranging from a reduction of $8 billion to an increase of $3.6 billion in 2020. The effect on the deficit depends on how enrollees who are eligible for tax credits and Medicaid — those who have little financial reason to drop coverage — respond to the penalty’s elimination. (Eibner and Nowak, 7/11)

Social determinants of health can be related to health care spending, and they often reflect material hardships people face. However, research on the relationship between specific hardships and medical care utilization across the US adult population is limited. Using 2010–11 data from the Survey of Income and Program Participation (SIPP), we study three specific hardships—food insecurity, housing insecurity, and housing quality—and their relationship to annual medical care utilization and out-of-pocket spending. Adults who faced housing quality hardships had higher utilization and spending (14.9 percent more provider visits and 16.9 percent higher out-of-pocket spending), as did adults who faced housing insecurity (22.1 percent more provider visits and 28.5 percent higher out-of-pocket spending). We find less evidence of a relationship between food insecurity and medical care utilization, especially after accounting for the presence of multiple hardships. (Caswell and Zuckerman, 6/27)

One in four people in traditional Medicare (25 percent) had private, supplemental health insurance in 2015—also known as Medigap—to help cover their Medicare deductibles and cost-sharing requirements, as well as protect themselves against catastrophic expenses for Medicare-covered services. This issue brief provides an overview of Medigap enrollment and analyzes consumer protections under federal law and state regulations that can affect beneficiaries’ access to Medigap. In particular, this brief examines implications for older adults with pre-existing medical conditions who may be unable to purchase a Medigap policy or change their supplemental coverage after their initial open enrollment period. (Boccuti, 7/11)

Although rates of lower extremity amputations among US patients with ESRD who receive dialysis decreased by 51% during a recent 15-year period, mortality rates remained high, with nearly half of patients dying within a year after lower extremity amputation. Our results highlight the need for more research on ways to prevent lower extremity amputation in this extremely high-risk population. (Franz et al, 7/9)