Becker Friedman Institute
for Research in Economics
The University of Chicago

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health insurance

Estimating Equilibrium in Health Insurance Exchanges: Price Competition and Subsidy Design under the ACA

Pietro Tebaldi

To design premium subsidies in a health insurance market it is necessary to estimate consumer demand, cost, and study how different subsidy schemes affect insurer's incentives. I combine data on household-level enrollment and plan-level claims from the California Affordable Care Act insurance exchange with a model of insurance demand and insurers' competition to assess equilibrium outcomes under alternative subsidy designs. I estimate that younger households are significantly more price sensitive and cheaper to cover.

Regulated Age-based Pricing in Subsidized Health Insurance: Evidence from the Affordable Care Act

Pietro Tebaldi, Joe Orsini

We study age-rating restrictions in the health insurance marketplaces introduced by the Affordable Care Act. Although age-rating restrictions affect pre-subsidy premiums, participation is primarily driven by subsidy generosity rather than pricing decisions because most buyers are subsidized. By combining pre- and post-reform data on prices and enrollment, we find that age-rating restrictions alter pre-subsidy premiums, with an increase of $230 per year for buyers under 50 years old and a decrease of $900 per year for buyers over 50.

The Welfare Implications of Health Insurance

Sonia Jaffe, Anup Malani

We analyze the financial value of insurance when individuals have access to credit markets. Loans allow consumers to smooth shocks across time, decreasing the value of the smoothing (across states of the world) provided by insurance. We derive a simple formula for the incremental value of insurance and show how it depends on individual characteristics and the features of available loans. Our central contribution is to derive formulas for aggregate welfare that can be taken to data from typical studies of health insurance.

Equilibrium Provider Networks: Bargaining and Exclusion in Health Care Markets

Kate Ho and Robin S. Lee

Why do insurers choose to exclude medical providers, and when would this be socially desirable? We examine network design from the perspective of a profit maximizing insurer and a social planner in order to evaluate the effects of narrow networks and restrictions on their use—a form of quality regulation. An insurer may wish to exclude hospitals in order to steer patients to less expensive providers, cream-skim enrollees, and negotiate lower reimbursement rates.

The Evolution of Health Insurer Costs in Massachusetts, 2010-12

Kate Ho, Ariel Pakes, Mark Shepard

We analyze the evolution of health insurer costs in Massachusetts between 2010-2012, paying particular attention to changes in the composition of enrollees. This was a period in which Health Maintenance Organizations (HMOs) increasingly used physician cost control incentives but Preferred Provider Organizations (PPOs) did not. We show that cost growth and its components cannot be understood without accounting for (i) consumers’ switching between plans, and (ii) differences in cost characteristics between new entrants and those leaving the market.

Work Incentives of Medicaid Beneficiaries and the Role of Asset Testing

Svetlana Pashchenko, Ponpoje Porapakkarm

Should asset testing be used in means-tested programs? These programs target low-income people, but low income can result not only from low productivity but also from low labor supply. We aim to show that in the asymmetric information environment, there is a positive role for asset testing. We focus on Medicaid, one of the largest means-tested programs in the US, and we ask two questions: 1) Does Medicaid distort work incentives? 2) Can asset testing improve the insurance-incentives trade-off of Medicaid?

Adverse Selection and Switching Costs in Health Insurance Markets: When Nudging Hurts

Benjamin Handel

This paper investigates consumer switching costs in the context of health insurance markets, where adverse selection is a potential concern. Switching costs contribute to poor choices when the market environment changes and consumers do not adjust appropriately. Though previous work has studied the problems of adverse selection and consumer choice inadequacy in isolation, these phenomena interact in a way that directly impacts market outcomes.