Association for Public Policy Analysis & Management

Panel: Impacts of Health Policy Design on Insurance Coverage and Utilization

(Health Policy)

Background: The Affordable Care Act (ACA) was designed to improve the health of Americans by increasing access to affordable health insurance coverage and facilitating preventive medical care utilization. There are many provisions under the ACA, such as expanding Medicaid, creating the Marketplace health exchange, issuing the individual mandate, and regulating essential health benefits (e.g., coverage of preventive care). Many provisions of the ACA took effect in January 2014. The impacts of the ACA’s provisions so far are mixed and highly debated. After the 2016 election, there are more uncertainties over the ACA’s future. The individual mandate was repealed in 2017. Significant rollbacks of related laws and benefits are expected to grow in the near future.

Purpose/Goal: This panel explores the impacts of different provisions of the ACA on health insurance coverage and preventive care use. We explore insurance coverage outcomes for different groups of individuals who face a complex set of decisions based on their income, employment and coverage stability in the context of new reforms and options implemented through the ACA.

Findings: Using a variety of methodological approaches, we find that individuals who differently value the benefits provided by the ACA make different decisions about insurance coverage. Individuals with larger potential gains from utilizing preventive care (e.g., smokers) are more likely to change health insurance, thus decreasing health insurers’ incentive to cover preventive care. Compared with other lower income adults, single childless adults have significant and substantial increase in insurance rate after the establishment of the Marketplace. Finally, uninsurance rates for part-time workers declined substantially after the implementation of the main ACA provisions, compared to full-time workers. These workers benefited from both the Medicaid expansion and the new options available through the Marketplace.

Discussion: Our findings provide evidence for action by helping policy makers better understand the complexity of incentives, access and health insurance take-up among policy-relevant groups of Americans. Understanding the health insurance needs of Americans can potentially improve policy design. Given the uncertain future of the ACA, our findings provide critical illustrations of the potential consequences of future government health reforms.