Premium subsidies, the mandate, and Medicaid expansion: Coverage effects of the Affordable Care Act
Name
Gruber_Premium subsidies.pdf
Description
Submitted version
Size
483.88 KB
Format
Adobe PDF
Checksum (MD5)
99cf57b673e6d79474fc8a7e4e2a602d
Author(s)
Frean, Molly
Gruber, Jonathan
Sommers, Benjamin D.
Date Issued
May 2017
Journal
Journal of Health Economics
Publisher
Elsevier BV
Citation
Frean, Molly et al. "Premium subsidies, the mandate, and Medicaid expansion: Coverage effects of the Affordable Care Act." Journal of Health Economics 53 (May 2017): 72-86 © 2017 Elsevier B.V.
Version
Original manuscript
Abstract
Using premium subsidies for private coverage, an individual mandate, and Medicaid expansion, the Affordable Care Act (ACA) has increased insurance coverage. We provide the first comprehensive assessment of these provisions’ effects, using the 2012–2015 American Community Survey and a triple-difference estimation strategy that exploits variation by income, geography, and time. Overall, our model explains 60% of the coverage gains in 2014–2015. We find that coverage was moderately responsive to price subsidies, with larger gains in state-based insurance exchanges than the federal exchange. The individual mandate's exemptions and penalties had little impact on coverage rates. The law increased Medicaid among individuals gaining eligibility under the ACA and among previously-eligible populations (“woodwork effect”) even in non-expansion states, with no resulting reductions in private insurance. Overall, exchange premium subsidies produced 40% of the coverage gains explained by our ACA policy measures, and Medicaid the other 60%, of which 1/2 occurred among previously-eligible individuals.
MIT Department
Massachusetts Institute of Technology. Department of Economics
Terms of Use
Creative Commons Attribution-NonCommercial-NoDerivs License
Persistent DSpace Link
DOI of Published Version
https://doi.org/10.1016/j.jhealeco.2017.02.004
