Premium Subsidies, the Mandate, and Medicaid Expansion: Coverage Effects of the Affordable Care Act

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Premium Subsidies, the Mandate, and Medicaid Expansion: Coverage Effects of the Affordable Care Act

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Title: Premium Subsidies, the Mandate, and Medicaid Expansion: Coverage Effects of the Affordable Care Act
Author: Frean, Molly; Gruber, Jonathan; Sommers, Benjamin Daniel

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Citation: Frean, Molly, Jonathan Gruber, and Benjamin Sommers. 2017. Premium Subsidies, the Mandate, and Medicaid Expansion: Coverage Effects of the Affordable Care Act. Journal of Health Economics 53: 72-86. doi: 10.1016/j.jhealeco.2017.02.004
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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 essentially no crowd-out of 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.
Published Version: 10.1016/j.jhealeco.2017.02.004
Other Sources: http://www.nber.org/papers/w22213
Terms of Use: This article is made available under the terms and conditions applicable to Open Access Policy Articles, as set forth at http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#OAP
Citable link to this page: http://nrs.harvard.edu/urn-3:HUL.InstRepos:30461177
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