Insurance without Commitment: Evidence from the ACA Marketplaces

Rebecca Diamond, Michael J. Dickstein, Timothy McQuade and Petra Persson

No 24668, NBER Working Papers from National Bureau of Economic Research, Inc

Abstract: We study the dynamics of participation and health care consumption in the Affordable Care Act’s health insurance marketplaces. Unlike other health insurance contexts, we find individuals commonly drop coverage midyear–roughly 30% of enrollees exit within nine months of sign-up. While covered, dropouts spend more on health care than in the months before sign-up or after exit. We model the consequences of drop-out on equilibrium premiums and consumer welfare. While dropouts generate a type of adverse selection, the welfare effect from their participation is ambiguous and depends on the relative costs per month of part-year vs. full-year enrollees. In our empirical setting, we find that imposing a penalty that incentivizes participation for at least 3.5 months would lower premium levels and improve overall consumer welfare.

JEL-codes: H4 H51 I13 L1 (search for similar items in EconPapers)
Date: 2018-05
New Economics Papers: this item is included in nep-hea and nep-ias
Note: EH PE IO
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Working Paper: Insurance without Commitment: Evidence from the ACA Marketplaces (2020)
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