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"Sticker Shock" in Individual Insurance under Health Reform

Author

Listed:
  • Mark Pauly
  • Scott Harrington
  • Adam Leive

Abstract

This paper provides estimates of the changes in premiums, average or expected out of pocket payments, and the sum of premiums and out of pocket payments (total expected price) for a sample of consumers who bought individual insurance in 2010 to 2012, comparing total expected prices before the Affordable Care Act with estimates of total expected prices if they were to purchase silver or bronze coverage after reform, before the effects of any premium subsidies. We provide comparisons for purchasers of self only coverage in California and in 23 states with minimal prior state premium regulation before the ACA now using federally managed exchanges. Using data from the Current Population Survey, we find that the average prices increased by 14 to 28 percent, with similar changes in California and the federal exchange states; we attribute the increase primarily to higher premiums in exchanges associated with insurer expectations of a higher risk population being enrolled. The increase in total expected price is similar for age-gender population subgroups except for a larger than average increases for older women. A welfare calculation of the change in risk premium associated with moving from coverage that prevailed before reform to bronze or silver coverage finds small changes.

Suggested Citation

  • Mark Pauly & Scott Harrington & Adam Leive, 2014. ""Sticker Shock" in Individual Insurance under Health Reform," NBER Working Papers 20223, National Bureau of Economic Research, Inc.
  • Handle: RePEc:nbr:nberwo:20223
    Note: HC HE
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    References listed on IDEAS

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    1. Alma Cohen & Liran Einav, 2007. "Estimating Risk Preferences from Deductible Choice," American Economic Review, American Economic Association, vol. 97(3), pages 745-788, June.
    2. Leemore Dafny & Jonathan Gruber & Christopher Ody, 2015. "More Insurers Lower Premiums: Evidence from Initial Pricing in the Health Insurance Marketplaces," American Journal of Health Economics, MIT Press, vol. 1(1), pages 53-81, Winter.
    3. Martin B. Hackmann & Jonathan T. Kolstad & Amanda E. Kowalski, 2015. "Adverse Selection and an Individual Mandate: When Theory Meets Practice," American Economic Review, American Economic Association, vol. 105(3), pages 1030-1066, March.
    4. Ehrlich, Isaac & Becker, Gary S, 1972. "Market Insurance, Self-Insurance, and Self-Protection," Journal of Political Economy, University of Chicago Press, vol. 80(4), pages 623-648, July-Aug..
    5. John A. Graves & Jonathan Gruber, 2012. "How Did Health Care Reform in Massachusetts Impact Insurance Premiums?," American Economic Review, American Economic Association, vol. 102(3), pages 508-513, May.
    6. Depew, Briggs & Bailey, James, 2015. "Did the Affordable Care Act's dependent coverage mandate increase premiums?," Journal of Health Economics, Elsevier, vol. 41(C), pages 1-14.
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    Cited by:

    1. repec:zbw:espost:184648 is not listed on IDEAS
    2. Ian M. McCarthy & Michael Darden, 2015. "Quality Ratings and Premiums in the Medicare Advantage Market," Emory Economics 1501, Department of Economics, Emory University (Atlanta).

    More about this item

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private

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