By Leila Sullivan

In March, we anticipated sunshine and warmer days while keeping up with the latest health policy research. We read about marketplace plan deductibles, physician turnover in private-equity acquired practices, and estimated savings from prescription drug rebates.

Low Marketplace Premiums Often Reflect High Deductibles

John Holahan, Michael Simpson and Erik Wengle. The Commonwealth Fund. March 2025. Available here. 

Researchers for Urban Institute collected Marketplace data about multiple insurers in urban areas of varying size, available through state and federal online databases, to examine deductibles and out-of-pocket maximums to estimate reform impacts using the Health Insurance Policy Simulation Model.

What it Finds

• Silver and bronze marketplace plans often feature deductibles exceeding $5,000 and $7,500, respectively, which can represent up to 21% of annual income for individuals earning 250% of the federal poverty level.
• While cost-sharing reductions (CSRs) effectively shield those below 200% of the federal poverty level, individuals above 200% of the federal poverty level face limited protections, leading to significant out-of-pocket expenses.
• The “Improving Health Insurance Affordability Act” suggests shifting the marketplace benchmark plan from silver to gold coverage and expanding CSRs, which could reduce out-of-pocket spending by an average of 24% at an estimated annual federal cost of $15 billion.

Why it Matters

These findings reveal a critical gap in health insurance affordability. While premiums for some plans may seem low, many marketplace plans burden consumers — especially those with moderate incomes — with prohibitively high deductibles and out-of-pocket costs. This disconnect can deter people from seeking necessary care or lead to financial hardship when medical needs arise. Yet the Trump administration has proposed a rule that would increase consumers’ annual out-of-pocket costs by $900, for marketplace and employer-sponsored insurance alike. Understanding the challenges associated with high cost-sharing is essential for policymakers and consumers alike, as it highlights the need for reforms that ensure not just coverage, but affordable access to healthcare.

Physician Turnover Increased In Private Equity-Acquired Physician Practices

Yashaswini Singh, Geronimo Bejarano Cardenas, Hamid Torabzadeh, Durga Borkar, and Christopher M Whaley. Health Affairs. March 2025. Available here. 

Researchers for Brown University and Duke University used 2014-2021 data from private equity acquisition of clinics to examine physician employment and turnover in private equity-acquired practices. 

What it Finds

• After private equity acquisition, physician turnover in acquired practices rose by 13 percentage points, representing a 265% increase compared to practices that were not acquired by private equity.
• Following private equity acquisition, the total number of clinicians (including ophthalmologists and optometrists) in the acquired practices increased by 46.8% over a three-year period. This suggests that private equity firms may expand the workforce in these practices as part of their initial operating strategy.

Why it Matters

These findings highlight the significant impact that private equity acquisitions can have on physician turnover and workforce dynamics within healthcare practices, potentially affecting quality of care and patient outcomes. At the same time, the growth in clinician numbers points to a shift in practice operations under private equity, which may influence the structure and functioning of healthcare delivery. Understanding these effects can help policymakers and healthcare leaders better assess the benefits and risks of private equity ownership in healthcare settings.

Estimated Savings From Extending Prescription Drug Inflationary Rebates To All Commercial Plans

Marissa B Reitsma, Stacie B Dusetzina, Jeromie M Ballreich, Antonio J Trujillo, and Michelle M Mello. Health Affairs. March 2025. Available here. 

Researchers for Health Affairs analyzed data from Merative MarketScan Commercial Database for drug prescriptions filled from January 1, 2017, through December 31, 2021 to estimate savings from prescription drug inflationary rebates across commercial plans. 

What it Finds

• The study estimates that applying the Inflation Reduction Act’s (IRA) inflationary rebates to all commercial health plans could have resulted in an approximate savings of $8.1 billion in 2021. These savings would come from imposing inflation-based rebates on approximately 1,100 drugs, which represents a significant reduction in drug spending within the commercial insurance market.
• The research highlights that focusing inflationary rebates on high-cost drugs—defined as those with monthly prices exceeding $830—or on the top 300 drugs by total spending could lead to substantial savings. This approach would reduce the overall number of drugs eligible for rebates, simplifying administration while still achieving considerable savings in drug costs.
• The study further suggests that limiting rebate eligibility to the top 300 drugs, which constitute a significant portion of total drug spending, could capture up to 85% of the total potential savings. This strategy aims to make the policy more administratively feasible, while maintaining the majority of the savings associated with broader rebate application.

Why it Matters

These findings offer a clear and actionable path for reducing prescription drug spending in commercial health plans, which has been a major driver of commercial market premium cost growth. Extending inflationary rebates to the commercial sector would not only generate substantial savings—potentially up to $8.1 billion annually—but also address a growing concern about the affordability of high-cost medications. Additionally, focusing rebates on the highest-cost drugs and limiting the scope to the top 300 drugs by total spending helps streamline the administrative process, making it more feasible for insurers to implement without overwhelming their operations. Overall, these findings highlight how policy adjustments targeting the most expensive drugs could provide significant financial relief for both commercial health plans and consumers.