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Health Insurance Underwriting and the Heterogeneous Effects of the Affordable Care Act

Author

Listed:
  • Pietro Tebaldi
  • Andrea Scalenghe
  • Joseph Orsini

Abstract

The Affordable Care Act, the largest US welfare reform since 1965, banned health insurance underwriting and rejections based on pre-existing conditions and introduced large premium subsidies for low- to middle-income individuals. Yet how many people the ban made better off, and how its effects varied by health risk, remain unknown—because data on who was rejected before the reform have been lacking. Using a proprietary dataset of pre-ACA insurance applications and underwriting decisions, we document, model, and estimate the reform's heterogeneous effects by age, income, and health risk. We find its benefits were concentrated among low-income, high-risk, or over-50 individuals.

Suggested Citation

  • Pietro Tebaldi & Andrea Scalenghe & Joseph Orsini, 2026. "Health Insurance Underwriting and the Heterogeneous Effects of the Affordable Care Act," NBER Working Papers 35692, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberwo:35692
    Note: EH IO PE
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    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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