Anatomy of a Slow-Motion Health Insurance Death Spiral
Harry Frech and
Michael P Smith
University of California at Santa Barbara, Economics Working Paper Series from Department of Economics, UC Santa Barbara
Adverse selection death spirals in health insurance are dramatic, and so far, exotic economic events. The possibility of death spirals has garnered recent policy and popular attention because the pricing regulations in the Affordable Care Act of 2010 make health plans more vulnerable to them (though some other aspects of the ACA limit them). Most death spirals tracked in the literature have involved selection against a group health plan that was dropped quickly by the employer. In this paper, we empirically document a death spiral in individual health insurance that was apparently triggered by a block closure in 1981 and developed slowly because the insurer partially subsidized the block. Indeed, we show that premiums rose dramatically from around the time of the block closure to at least 2009 (the last year of available data). By 2009, some, but very few policyholders remained in the block and premiums were roughly seven times that of a yardstick we developed. The history of this slow-moving event is directly relevant to current policy discussions because of both adverse selection in general and the particular problems induced by closing a block.
Keywords: Social and Behavioral Sciences; Adverse Selection; Death Spiral; Health Insurance; Affordable Care Act; Asymmetric Information; Community Rating; Underwriting (search for similar items in EconPapers)
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Journal Article: Anatomy of a Slow-Motion Health Insurance Death Spiral (2015)
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Persistent link: https://EconPapers.repec.org/RePEc:cdl:ucsbec:qt0w64d54d
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