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Demand for health insurance: Evidence from the California and Washington ACA exchanges

Evan Saltzman

Journal of Health Economics, 2019, vol. 63, issue C, 197-222

Abstract: I estimate demand for health insurance using consumer-level data from the California and Washington ACA exchanges. I use the demand estimates to simulate the impact of policies targeting adverse selection, including subsidies and the individual mandate. I find (1) own-premium elasticities of −7.2 to −10.6 and insurance coverage elasticities of −1.1 to −1.2; (2) limited response to the mandate penalty amount, but significant response to the penalty's existence, suggesting consumers have a “taste for compliance”; (3) mandate repeal slightly increases consumer surplus because the ACA's price-linked subsidies shield most consumers from premium increases resulting from repeal and some consumers are not compelled to purchase insurance against their will; and (4) mandate repeal decreases consumer surplus if ACA subsidies are replaced with vouchers that expose consumers to premium increases. The economic rationale for the mandate depends on the extent of adverse selection and the presence of other policies targeting selection.

Keywords: Insurance; Health reform; Individual mandate; Adverse selection (search for similar items in EconPapers)
Date: 2019
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Citations: View citations in EconPapers (18)

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Persistent link: https://EconPapers.repec.org/RePEc:eee:jhecon:v:63:y:2019:i:c:p:197-222

DOI: 10.1016/j.jhealeco.2018.11.004

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Journal of Health Economics is currently edited by J. P. Newhouse, A. J. Culyer, R. Frank, K. Claxton and T. McGuire

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