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Estimating Equilibrium in Health Insurance Exchanges: Price Competition and Subsidy Design under the ACA

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  • Pietro Tebaldi

Abstract

In government-sponsored health insurance, subsidy design affects market outcomes. First, holding premiums fixed, subsidies determine insurance uptake and average cost. Insurers then respond to these changes, adjusting premiums. Combining data from the first four years of the California ACA marketplace with a model of insurance demand, cost, and insurers’ competition, I quantify the impact of alternative subsidy designs on premiums, enrollment, costs, public spending, and consumer surplus. Younger individuals are more price sensitive and cheaper to cover. Increasing subsidies to this group would make all buyers better off, increase market participation, and lower average costs and average subsidies.

Suggested Citation

  • Pietro Tebaldi, 2022. "Estimating Equilibrium in Health Insurance Exchanges: Price Competition and Subsidy Design under the ACA," NBER Working Papers 29869, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberwo:29869
    Note: EH IO
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    Cited by:

    1. Camille Landais & Arash Nekoei & Peter Nilsson & David Seim & Johannes Spinnewijn, 2021. "Risk-Based Selection in Unemployment Insurance: Evidence and Implications," American Economic Review, American Economic Association, vol. 111(4), pages 1315-1355, April.
    2. Naoki Aizawa & You Suk Kim, 2020. "Public and Private Provision of Information in Market-Based Public Programs: Evidence from Advertising in Health Insurance Marketplaces," NBER Working Papers 27695, National Bureau of Economic Research, Inc.
    3. Abe Dunn & Joshua D. Gottlieb & Adam Shapiro & Daniel J. Sonnenstuhl & Pietro Tebaldi, 2021. "A Denial a Day Keeps the Doctor Away," NBER Working Papers 29010, National Bureau of Economic Research, Inc.
    4. Matthew Panhans, 2019. "Adverse Selection in ACA Exchange Markets: Evidence from Colorado," American Economic Journal: Applied Economics, American Economic Association, vol. 11(2), pages 1-36, April.
    5. 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.
    6. Martin Gaynor & Kate Ho & Robert J. Town, 2015. "The Industrial Organization of Health-Care Markets," Journal of Economic Literature, American Economic Association, vol. 53(2), pages 235-284, June.
    7. Keaton S. Miller & Amil Petrin & Robert Town & Michael Chernew, 2019. "Optimal Managed Competition Subsidies," NBER Working Papers 25616, National Bureau of Economic Research, Inc.
    8. Steve Cicala & Ethan M. J. Lieber & Victoria Marone, 2019. "Regulating Markups in US Health Insurance," American Economic Journal: Applied Economics, American Economic Association, vol. 11(4), pages 71-104, October.
    9. Amy Finkelstein & Nathaniel Hendren & Mark Shepard, 2017. "Subsidizing Health Insurance for Low-Income Adults: Evidence from Massachusetts," NBER Working Papers 23668, National Bureau of Economic Research, Inc.
    10. Naoki Aizawa & Chao Fu, 2020. "Interaction of the Labor Market and the Health Insurance System: Employer-Sponsored, Individual, and Public Insurance," NBER Working Papers 26713, National Bureau of Economic Research, Inc.
    11. Sonia Jaffe & Mark Shepard, 2017. "Price-Linked Subsidies and Health Insurance Markups," Working Papers 2017-084, Human Capital and Economic Opportunity Working Group.
    12. Daniel W. Sacks & Khoa Vu & Tsan‐Yao Huang & Pinar Karaca‐Mandic, 2021. "How do insurance firms respond to financial risk sharing regulations? Evidence from the Affordable Care Act," Health Economics, John Wiley & Sons, Ltd., vol. 30(6), pages 1443-1460, June.
    13. Benjamin R. Handel & Jonathan T. Kolstad, 2021. "The Affordable Care Act After a Decade: Industrial Organization of the Insurance Exchanges," NBER Working Papers 29178, National Bureau of Economic Research, Inc.
    14. Sonia P. Jaffe & Mark Shepard, 2017. "Price-Linked Subsidies and Imperfect Competition in Health Insurance," NBER Working Papers 23104, National Bureau of Economic Research, Inc.
    15. Timothy Layton & Ellen J. Montz & Mark Shepard, 2017. "Health Plan Payment in U.S. Marketplaces: Regulated Competition with a Weak Mandate," NBER Working Papers 23444, National Bureau of Economic Research, Inc.
    16. Martin O'Connell & Kate Smith, 2021. "Optimal sin taxation and market power," IFS Working Papers W21/30, Institute for Fiscal Studies.

    More about this item

    JEL classification:

    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • L98 - Industrial Organization - - Industry Studies: Transportation and Utilities - - - Government Policy

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