Association for Public Policy Analysis & Management

Panel: Factors Shaping the ACA Marketplaces: Using Survey and Administrative Data to Provide Timely Feedback on Health Policy Performance

(Health Policy)

This panel probes the determinants of ACA individual marketplace performance. We focus on three elements of ACA implementation that have featured in state-level and national-level policy debates: (a) Medicaid expansions to provide free health insurance for low-income patients, (b) income-based subsidies for the purchase of health insurance, and (c) in-person assistance to aid consumers in filing for tax credits and purchasing health insurance. These topics remain highly timely given that funding for consumer assistance has been cut in recent years, whereas income-based subsidies and Medicaid expansions have been targeted in recent policy proposals.

The three papers in the panel combine survey and administrative data in new ways to illuminate how our three policies of interest interact to shape premiums, insurance uptake, and utilization of health care for consumers in the individual market. First, Ellis, Esson, and Frederick leverage administrative data on health insurance premiums to show that Medicaid expansion policy had a spillover effect on the individual market. In particular, the authors find that expanding Medicaid reduces average monthly premiums by $32.40, a decrease of 11.86%. Second, Kucko, Rinz, and Solow note that a lack of Medicaid expansion creates a notch in the tax schedule and income range in which no form of subsidized health insurance coverage is available. Exploiting this variation, they combine data from the universe of tax returns with the American Community Survey to show that premium tax credits increased the rate at which people are covered by directly purchased health insurance by 1.4 to 2.0 percentage points. Finally, Myerson and Lu exploit a 4-fold gap in consumer assistance funding per eligible uninsured across states to evaluate the contribution of consumer assistance funding to encouraging health insurance enrollment in the individual market, minimizing "churn" out of insurance, and bridging from access to insurance to use of health care. As part of this project, they merge newly extracted data on consumer assistance funding for each state over 2010-2014 with restricted use survey data that follows consumers’ health insurance and health care purchases over time.

In conclusion, the papers contribute to the policy literature by triangulating the impact of health policy design and implementation on the health insurance marketplaces, and by leveraging merged survey and administrative data in new ways.