The Impact of Market Size and Composition on Health Insurance Premiums: Evidence from the First Year of the ACA

Michael J. Dickstein, Mark Duggan, Joseph Orsini and Pietro Tebaldi

No 20907, NBER Working Papers from National Bureau of Economic Research, Inc

Abstract: Under the Affordable Care Act, individual states have discretion in how they define coverage regions, within which insurers must charge the same premium to buyers of the same age, family structure, and smoking status. We exploit variation in these definitions to investigate whether the size of the coverage region affects outcomes in the ACA marketplaces. We find large consequences for small and rural markets. When states combine small counties with neighboring urban areas into a single region, the included rural markets see .6 to .8 more active insurers, on average, and savings in annual premiums of between $200 and $300.

JEL-codes: I11 I13 I18 (search for similar items in EconPapers)
Date: 2015-01
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Published as Dickstein, Michael J., Mark Duggan, Joe Orsini, and Pietro Tebaldi. 2015. "The Impact of Market Size and Composition on Health Insurance Premiums: Evidence from the First Year of the Affordable Care Act." American Economic Review, 105 (5): 120-25. DOI: 10.1257/aer.p20151083

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