scholarly journals Adverse Selection in ACA Exchange Markets: Evidence from Colorado

2019 ◽  
Vol 11 (2) ◽  
pp. 1-36 ◽  
Author(s):  
Matthew Panhans
Keyword(s):  
Health Insurance ◽  
Adverse Selection ◽  
Affordable Care Act ◽  
Chronic Conditions ◽  
Medical Expenditures ◽  
Difference In Differences ◽  
Medical Claims ◽  
Quasi Experimental ◽  
Exchange Markets ◽  
Insurance Exchanges

This study tests for adverse selection in the Affordable Care Act (ACA) health insurance exchanges established in 2014, and quantifies the welfare consequences. Using a new statewide dataset of medical claims from Colorado, I use plausibly exogenous premium variation generated by geographic discontinuities to test for selection. Specifically, each $1 increase in monthly premiums causes a $0.85–0.95 increase in annual medical expenditures of the insured population in 2014, with attenuated effects in 2015. These estimates are consistent with the prevalence of chronic conditions, and difference-in-differences estimates. The results offer the first quasi-experimental evidence of adverse selection in the ACA markets. (JEL D82, G22, H51, H75, I13, I18)

scholarly journals Regulating Markups in US Health Insurance

2019 ◽  
Vol 11 (4) ◽  
pp. 71-104 ◽  
Author(s):  
Steve Cicala ◽  
Ethan M. J. Lieber ◽  
Victoria Marone
Keyword(s):  
Health Insurance ◽  
Affordable Care Act ◽  
Natural Experiment ◽  
Loss Ratio ◽  
Profit Margins ◽  
Medical Claims ◽  
Commercial Markets ◽  
Individual Market ◽  
The Individual ◽  
Medical Loss Ratio

A health insurer's Medical Loss Ratio (MLR) is the share of premiums spent on medical claims, or the inverse markup over average claims cost. The Affordable Care Act introduced minimum MLR provisions for all health insurance sold in fully insured commercial markets, thereby capping insurer profit margins, but not levels. While intended to reduce premiums, we show this rule creates incentives to increase costs. Using variation created by the rule's introduction as a natural experiment, we find medical claims rose nearly one-for-one with distance below the regulatory threshold: 7 percent in the individual market and 2 percent in the group market. Premiums were unaffected. (JEL G22, H51, I13, I18)

scholarly journals Have the ACA's Exchanges Succeeded? It's Complicated

2020 ◽  
Vol 45 (4) ◽  
pp. 661-676 ◽  
Author(s):  
David K. Jones ◽  
Sarah H. Gordon ◽  
Nicole Huberfeld
Keyword(s):  
Health Insurance ◽  
Affordable Care Act ◽  
Health Reform ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Rapid Evolution ◽  
Middle Income ◽  
State Variation ◽  
Individual Decisions ◽  
Insurance Exchanges

Abstract The fight over health insurance exchanges epitomizes the rapid evolution of health reform politics in the decade since the passage of the Affordable Care Act (ACA). The ACA's drafters did not expect the exchanges to be contentious because they would expand private insurance coverage to low- and middle-income individuals who were increasingly unable to obtain employer-sponsored health insurance. Instead, exchanges became one of the primary fronts in the war over Obamacare. Have the exchanges been successful? The answer is not straightforward and requires a historical perspective through a federalism lens. What the ACA has accomplished has depended largely on whether states were invested in or resistant to implementation, as well as individual decisions by state leaders working with federal officials. Our account demonstrates that the states that have engaged with the ACA most consistently appear to have experienced greater exchange-related success. But each aspect of states' engagement with or resistance to the ACA must be counted to fully paint this picture, with significant variation among states. This variation should give pause to those considering next steps in health reform, because state variation can mean innovation and improvement but also lack of coverage, disparities, and diminished access to care.

scholarly journals Narrow Networks on the Health Insurance Exchanges: What Do They Look Like and How Do They Affect Pricing? A Case Study of Texas

2015 ◽  
Vol 105 (5) ◽  
pp. 110-114 ◽  
Author(s):  
Leemore Dafny ◽  
Igal Hendel ◽  
Nathan Wilson
Keyword(s):  
Health Insurance ◽  
Affordable Care Act ◽  
First Year ◽  
Narrow Gap ◽  
Limited Evidence ◽  
Hospital Networks ◽  
Using Data ◽  
Narrow Networks ◽  
Insurance Exchanges

The Affordable Care Act has engendered significant changes in the design of health insurance products. We examine the “narrowness” of hospital networks affiliated with plans offered in the first year of the marketplaces. Using data from Texas, we find limited evidence of a tight link between pricing and a simple measure of network breadth, or a more complex measure of network value derived from a logit model of hospital choice. The state's largest insurer priced its narrow networks at a fairly constant discount relative to its broad networks, notwithstanding significant variation in its broad-narrow gap across geographic markets in Texas.

scholarly journals Health insurance enrollment strategies during the Affordable Care Act (ACA): a scoping review on what worked and for whom

2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Angelo Ercia ◽  
Nga Le ◽  
Runguo Wu
Keyword(s):  
Health Insurance ◽  
Affordable Care Act ◽  
Scoping Review ◽  
Empirical Studies ◽  
Private Insurance ◽  
Community Outreach ◽  
Inclusion Criteria ◽  
Quasi Experimental ◽  
The Affordable Care Act ◽  
Keyword Searches

Abstract Background The Affordable Care Act (ACA) provided an opportunity for millions of people in the U.S. to get coverage from the publicly funded Medicaid program or private insurance from the newly established marketplace. However, enrolling millions of people for health insurance was an enormous task. The aim of this review was to examine the strategies used to enroll people for health insurance and their effectiveness after implementing the ACA’s coverage expansion. Methods The PRISMA Extension for Scoping Review (PRISMA-ScR) guided this review. Included studies were empirical studies that met the inclusion criteria and published between 2010 and 2020. Studies were searched mainly from two scholarly databases, CINAHL Plus and Medline (PubMed) using keyword searches. Hand searches from the references of selected journals were also performed. Content analysis was conducted by two authors in which codes were inductively developed to identify themes. Results There were 2213 potential studies identified from the search, but 10 met the inclusion criteria. The research design of the studies varied. Two studies were randomized trials, one quasi-experimental trial, three mixed-methods, two qualitative and two quantitative. All studies focused on strategies used to inform and help people enroll for either Medicaid or private insurance from the marketplace. This review identified three key strategies used to help enroll people for coverage: 1) individual assistance; 2) community outreach; and 3) health education and promotion (HE&P). Conclusion Community-based organizations were likely to use a combination of the three strategies simultaneously to reach uninsured individuals and directly help them enroll for health insurance. Other organizations that aimed to reach a wider segment of the population used single strategies, such as community outreach or HE&P.

scholarly journals Does Awareness of the Affordable Care Act Reduce Adverse Selection? A Study of the Long-term Uninsured in South Carolina

2017 ◽  
Vol 54 ◽  
pp. 004695801772710 ◽  
Author(s):  
Lu Shi ◽  
Chaoling Feng ◽  
Sarah Griffin ◽  
Joel E. Williams ◽  
Lee A. Crandall ◽  
...  
Keyword(s):  
South Carolina ◽  
Health Insurance ◽  
Health Status ◽  
Adverse Selection ◽  
Affordable Care Act ◽  
The Past ◽  
Individual Mandate ◽  
Reported Health ◽  
Self Reported Health Status

Adverse selection predicts that individuals with lower health status would be more likely to sign up for health insurance. This hypothesis was tested among the long-term uninsured population in South Carolina (SC). This study used data from an in-person survey conducted from May 2014 to January 2015. Interviews were held with the long-term uninsured individuals at multiple sites throughout the state, using a multistage sampling method. SC residents aged 18 to 64 years who had had no health insurance for at least 24 consecutive months were eligible for the survey. The dependent variable is the participants’ attempt to obtain insurance coverage. Key independent variables are self-reported health status, hospitalization in the past year, use of emergency department in the past year, and presence of serious long-standing health problems. The analysis is stratified by the awareness of the Affordable Care Act (ACA)’s individual mandate while controlling for age, gender, race/ethnicity, and household income. Participants’ self-reported health status was not significantly associated with the attempt to sign up for health insurance in both groups (those aware and those unaware of the individual mandate). Being hospitalized in the previous year was significantly associated with their attempt to sign up for insurance in both groups. Participants with serious long-term health problems were more likely to have attempted to sign up for insurance among those who were not aware of the ACA. However, this association was statistically insignificant among those who had heard of ACA. Sicker people were more likely to attempt to sign up for insurance. However, being aware of the ACA’s individual mandate seemed to play a role in reducing adverse selection.

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