How do low‐income enrollees in the Affordable Care Act marketplaces respond to cost‐sharing?

Lavetti, Kurt; DeLeire, Thomas; Ziebarth, Nicolas R.

doi:10.1111/jori.12416

Cited by 5 publications

(2 citation statements)

References 88 publications

(106 reference statements)

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“…He also identifies the value of setting deductible levels relative to income levels. The other, by Lavetti et al (2023), examines the effect of reduced cost‐sharing on medical utilization for low‐income enrollees in the Affordable Care Act (ACA) and finds elasticities comparable to those previously identified for higher‐income populations.…”

Section: Overview Of Papers In the Issuementioning

confidence: 91%

Special issue on health insurer decision‐making

Sydnor

2023

J of Risk & Insurance

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Section: Overview Of Papers In the Issuementioning

confidence: 91%

Special issue on health insurer decision‐making

Sydnor

2023

J of Risk & Insurance

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“…For example, young people may choose plans with lower AVs and they would face a lower premium. Additionally, enrollees of plans with higher AVs may utilize more care because of moral hazard (Lavetti et al, 2023). While risk adjustment is intended to mitigate the premium effect of health selection across plans, it does allow for premium differences to reflect plan generosity and associated moral hazard.…”

Section: Methodsmentioning

confidence: 99%

How does health spending among demographic groups compare to Affordable Care Act premium regulations?

Hanson,

Minicozzi

2023

J of Risk & Insurance

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The Affordable Care Act (ACA) substantially altered regulations in the nongroup and small group health insurance markets and those markets continue to receive significant policy attention. To understand how those markets have functioned in recent years and how they would be impacted by policy changes, we estimated enrollment and spending by age and sex using claims data covering enrollment in ACA risk‐adjusted plans in 2017–2019 and compared spending to a federal default age‐rating curve for premiums. Our results suggest that women aged 55–64 helped stabilize the nongroup market through high enrollment and relatively low spending. Men enrolled in the marketplace also subsidized other nongroup enrollees but to a lesser extent than expected. In fact, men aged25–50 enrolled in nongroup plans spent 18% more than their counterparts enrolled through a small employer. These unique spending patterns have interesting policy implications, including that lowering the Medicare eligibility age would likely increase premiums in the nongroup market.

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Estimating Equilibrium in Health Insurance Exchanges: Price Competition and Subsidy Design under the ACA

Tebaldi

2024

Review of Economic Studies

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Regulations to design private yet publicly sponsored health insurance markets are increasingly adopted in many OECD countries. Here I combine data and economic theory to analyze the interaction between insurers’ competition and the design of premium subsidies in determining equilibrium outcomes. My empirical model includes adverse selection, rich heterogeneity in preferences for vertically and horizontally differentiated plans and accommodates alternative assumptions on pricing conduct. In the context of the Affordable Care Act in the US, I estimate the joint distribution of preferences and expected cost using Californian administrative records on 3.7 million plan choices between 2014-2017, combined with plan and survey data on medical claims. An empirical horse race between conduct assumptions favors oligopoly pricing over perfect competition. Considering alternative subsidy designs shows that, in equilibrium, shifting subsidy generosity toward the “young invincibles” would lower premiums for all enrollees while increasing enrollment and profits.

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How do low‐income enrollees in the Affordable Care Act marketplaces respond to cost‐sharing?

Abstract: NBER working papers are circulated for discussion and comment purposes. They have not been peer-reviewed or been subject to the review by the NBER Board of Directors that accompanies official NBER publications.

Cited by 5 publications

References 88 publications

Special issue on health insurer decision‐making

Special issue on health insurer decision‐making

How does health spending among demographic groups compare to Affordable Care Act premium regulations?

Estimating Equilibrium in Health Insurance Exchanges: Price Competition and Subsidy Design under the ACA

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