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The Affordable Care Act After a Decade: Industrial Organization of the Insurance Exchanges

Author

Listed:
  • Benjamin Handel

    (Department of Economics, University of California, Berkeley, California, USA)

  • Jonathan Kolstad

    (Department of Economics, University of California, Berkeley, California, USA)

Abstract

The regulated insurance exchanges set up in the Affordable Care Act (ACA) were designed to deliver affordable, efficient health coverage through private insurers. It is crucial to study the complex industrial organization (IO) of these exchanges in order to assess their impacts during the first decade of the ACA and to project their effects going forward. We revisit the inherent market failures in health care markets that necessitate key ACA exchange regulations and investigate whether they have succeeded in their goals of expanding coverage, creating robust marketplaces, providing product variety, and generating innovation in health care delivery. We discuss empirical IO research to date and also highlight shortcomings in the existing research that can be addressed moving forward. We conclude with a discussion of IO research-based policy lessons for the ACA exchanges and, more generally, for managed competition of private insurance in health care.

Suggested Citation

  • Benjamin Handel & Jonathan Kolstad, 2022. "The Affordable Care Act After a Decade: Industrial Organization of the Insurance Exchanges," Annual Review of Economics, Annual Reviews, vol. 14(1), pages 287-312, August.
    • Handle: RePEc:anr:reveco:v:14:y:2022:p:287-312
    DOI: 10.1146/annurev-economics-051420-114714
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    Citations

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    Cited by:

    1. Pietro Tebaldi & Alexander Torgovitsky & Hanbin Yang, 2023. "Nonparametric Estimates of Demand in the California Health Insurance Exchange," Econometrica, Econometric Society, vol. 91(1), pages 107-146, January.

    More about this item

    Keywords

    health insurance; Affordable Care Act; adverse selection; moral hazard; managed competition; subsidies;
    All these keywords.

    JEL classification:

    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • G22 - Financial Economics - - Financial Institutions and Services - - - Insurance; Insurance Companies; Actuarial Studies
    • D81 - Microeconomics - - Information, Knowledge, and Uncertainty - - - Criteria for Decision-Making under Risk and Uncertainty

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