Association for Public Policy Analysis & Management

Panel: Coverage, Consumer Choice, and Access in the Health Insurance Marketplaces

(Health Policy)

The 2010 Affordable Care Act (ACA) expanded health insurance coverage in part by creating Health Insurance Marketplaces that offer subsidized private health insurance plans. Heading into its third year of existence, a number of questions remain regarding consumer demand for and experiences in these Marketplaces, as well as the stability of the Marketplaces for insurers. In the Marketplaces, consumers can sign up for or switch plans during the annual open enrollment period, and issuers also have an opportunity to exit, enter, or change their service areas or plan designs each year. As the Marketplaces become a key part of insurance coverage in the U.S. policymakers will need well-designed research to guide their implementation and ensure their success. In this panel, we present four papers focused on health insurance coverage through the Marketplaces. These papers use multiple methodologies and address a range of topics relevant to Marketplace policy, including the types of plans that are offered, how consumers choose plans, and whether the Marketplaces are a stable and attractive market for insurers. The first paper analyzes consumer access to plans with varying benefit design among the 2014, 2015, and 2016 plans sold through the ACA's Federally-facilitated Marketplace. This paper uses restricted administrative data to assess what types of consumers enroll in different types of plans and how these patterns change over time. The second paper provides details on the characteristics of likely Marketplace enrollees and how they choose plans. The third paper presents evidence from a randomized intervention to test the effect personalized information about the amount a household could save by switching to a lower cost plan with a similar level of cost sharing on enrollee shopping behavior and their eventual choice of plan. Finally the fourth paper presents new evidence on insurance market stability before and after the introduction of the 2014 ACA reforms. Access to high quality insurance is a key goal of the ACA and research on plan offerings and consumer choices can play an important role in the design and success of the Marketplaces. The findings of these four papers are highly relevant to the ongoing discussions on Marketplace policy and design.