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Adverse Selection in ACA Exchange Markets: Evidence from Colorado

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  • Matthew Panhans
Abstract
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.

Suggested Citation

  • Matthew Panhans, 2019. "Adverse Selection in ACA Exchange Markets: Evidence from Colorado," American Economic Journal: Applied Economics, American Economic Association, vol. 11(2), pages 1-36, April.
    • Handle: RePEc:aea:aejapp:v:11:y:2019:i:2:p:1-36
    Note: DOI: 10.1257/app.20170117
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    References listed on IDEAS

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    Cited by:

    1. Mérel, Pierre & Ortiz-Bobea, Ariel & Paroissien, Emmanuel, 2021. "How big is the “lemons” problem? Historical evidence from French wines," European Economic Review, Elsevier, vol. 138(C).
    2. Liran Einav & Amy Finkelstein, 2023. "Empirical analyses of selection and welfare in insurance markets: a self-indulgent survey," The Geneva Risk and Insurance Review, Palgrave Macmillan;International Association for the Study of Insurance Economics (The Geneva Association), vol. 48(2), pages 167-191, September.
    3. Evan Saltzman, 2021. "Managing adverse selection: underinsurance versus underenrollment," RAND Journal of Economics, RAND Corporation, vol. 52(2), pages 359-381, June.
    4. Daniel W. Sacks & Khoa Vu & Tsan‐Yao Huang & Pinar Karaca‐Mandic, 2021. "How do insurance firms respond to financial risk sharing regulations? Evidence from the Affordable Care Act," Health Economics, John Wiley & Sons, Ltd., vol. 30(6), pages 1443-1460, June.
    5. Reagan A. Baughman, 2022. "The Affordable Care Act and regulation: Coverage effects of guaranteed issue and ratings reform," Health Economics, John Wiley & Sons, Ltd., vol. 31(12), pages 2575-2592, December.
    6. Joan Costa-Font & Nilesh Raut & Courtney H. Van Houtven, 2024. "Medicaid Expansion and the Mental Health of Spousal Caregivers," Review of Economics of the Household, Springer, vol. 22(3), pages 1047-1084, September.
    7. Giampiero Marra & Rosalba Radice & David Zimmer, 2021. "Did the ACA's “guaranteed issue” provision cause adverse selection into nongroup insurance? Analysis using a copula‐based hurdle model," Health Economics, John Wiley & Sons, Ltd., vol. 30(9), pages 2246-2263, September.
    8. Maria Polyakova & Stephen P. Ryan, 2019. "Subsidy Targeting with Market Power," NBER Working Papers 26367, National Bureau of Economic Research, Inc.
    9. Mette Ejrnæs & Stefan Hochguertel, 2022. "Identifying Risk-based Selection in Social Insurance: New Approaches and Findings," Tinbergen Institute Discussion Papers 22-040/V, Tinbergen Institute.
    10. Nathaniel Hendren, 2021. "Measuring Ex Ante Welfare in Insurance Markets [Some Aspects of Optimal Unemployment Insurance]," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 88(3), pages 1193-1223.
    11. Casey Rothschild & Paul D. Thistle, 2022. "Supply, demand, and selection in insurance markets: Theory and applications in pictures," Risk Management and Insurance Review, American Risk and Insurance Association, vol. 25(4), pages 419-444, December.

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    More about this item

    JEL classification:

    • D82 - Microeconomics - - Information, Knowledge, and Uncertainty - - - Asymmetric and Private Information; Mechanism Design
    • G22 - Financial Economics - - Financial Institutions and Services - - - Insurance; Insurance Companies; Actuarial Studies
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health
    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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