How Did Take-Up of Marketplace Plans Vary with Price, Income, and Gender?

Benjamin Hopkins, Jessica Banthin and Alexandra Minicozzi

American Journal of Health Economics, 2025, vol. 11, issue 1, 63 - 90

Abstract: We estimate the demand for subsidized insurance in the Affordable Care Act marketplaces using administrative enrollment data for the 39 states that used Healthcare.gov between 2015 and 2017. Our results expand the existing literature on marketplace take-up, the extensive margin, in several important ways. First, we provide the first estimates of price elasticities based on administrative data from states with Federally Facilitated Marketplaces, which accounted for three-quarters of all marketplace enrollment and include states that did not expand Medicaid. Our estimates suggest that price elasticities may be lower in our sample of states than in states such as California (a major data source for other studies), which expanded Medicaid and pursued policies that may have increased price sensitivity. Our analysis also yields new evidence suggesting that many people in the coverage gap in non-expansion states obtain subsidies by reporting income just above the federal poverty line at the time of enrollment, especially in Florida. Finally, we update the existing literature describing higher demand for insurance coverage by women by estimating the difference in take-up rates by gender while controlling for eligibility for subsidies, finding that these gender differences persist among both young and older adults.

Date: 2025
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