Eight Years Later: Analyses of ACA Health Insurance Markets
Friday, Jan. 5, 2018 10:15 AM - 12:15 PM
- Chair: Donald Yett, University of Southern California
Early ACA Medicaid Expansions: Impacts on Enrollment and Access
AbstractWe use four states that were early adopters of Medicaid expansion to study how this expansion affects enrollment and access to physicians for Medicaid enrollees. We use the universe of Medicaid enrollment and claims data to construct state-month-level measures of enrollment, enrollee composition, and access to physicians. Using a differences-in-differences framework, we find that Medicaid expansion leads to a 13 percent increase in overall enrollment, a 27 percent increase in enrollment among adults ages 23 to 65, and a 16 percent increase in the number of Medicaid patients seen by primary care physicians. We find no statistically significant increase in the number of Medicaid patients seen among obstetricians/gynecologists and pediatricians, who are less likely to be affected by the expansion. We find that Medicaid expansion increases physician participation on the intensive margin but not on the extensive margin.
Consumer Choice and Learning in Private Insurance Markets: Evidence From the ACA Marketplaces
AbstractIn this paper, we examine consumer plan choice and learning in 2015 and 2016 in the Federally facilitated Marketplaces (FFM) for health insurance established by the Affordable Care Act (ACA). The FFM offers a useful context for studying choice in private insurance markets.
Plans offered in the FFM are displayed in an online “exchange” and are required to meet requirements regarding coverage, premiums, benefits, and cost-sharing, including minimum actuarial values. These requirements as well as the design of the exchange is intended to facilitate consumer shopping among plans and there is evidence that consumers actively shop and switch plans in the FFM at higher rates than in the market for employer-sponsored insurance. Understanding the dynamics of consumer choice in this setting is important given that the Marketplaces are still relatively new markets for consumers and insurers and that the regulations described above were intended to standardize and improve the options for consumers getting insurance through the non-group market. A deeper understanding of consumer decision-making is fundamental to improving the design of insurance markets as well as ensuring that the individual insurance market is attractive to insurers.
A combination of public data on plans available through the FFM at the county level and associated benefit design features and administrative individual-level panel data on FFM enrollment allows us to identify each enrollee’s choice set and their chosen plan as well as to see how their choices evolved over time. Further, these data allow us to calculate the actual premiums, deductibles, and max OOP levels that consumers faced, taking into account cost-sharing reductions and other subsidies for which they were eligible. We characterize the choice sets of Marketplace enrollees and estimate discrete choice models of individual-level plan choice that account for plan characteristics and interactions with individual characteristics. These choice models allow us to
- I1 - Health