Premium subsidies, the mandate, and Medicaid expansion: Coverage effects of the Affordable Care Act
Premium subsidies, the mandate, and Medicaid expansion: Coverage effects of the Affordable Care Act
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DOI：
10.1016/j.jhealeco.2017.02.004
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发表时间：
2017-05-01
影响因子：
3.5
通讯作者：
Sommers, Benjamin D.
中科院分区：
文献类型：
--
作者：
Frean, Molly;Gruber, Jonathan;Sommers, Benjamin D.
通过对私人保险、个人授权和医疗补助扩张的保费补贴，《平价医疗法案》（ACA）增加了保险覆盖面。我们使用2012-2015年美国社区调查和三重差异估计策略，利用收入，地理和时间的变化，对这些规定的影响进行了首次全面评估。总体而言，我们的模型解释了2014-2015年60%的覆盖率增长。我们发现，覆盖范围是适度的价格补贴，以国家为基础的保险交易所比联邦交易所更大的收益。个别任务的豁免和处罚对覆盖率几乎没有影响。该法案增加了在ACA下获得资格的个人和以前符合资格的人群（“木工效应”）中的医疗补助，即使在非扩张州，也没有导致私人保险的减少。总的来说，交换保费补贴产生了我们ACA政策措施所解释的40%的覆盖率收益，而医疗补助占其他60%，其中1/2发生在以前符合条件的个人中。(C)2017爱思唯尔B. V.保留所有权利。
Using premium subsidies for private coverage, an individual mandate, and Medicaid expansion, the Affordable Care Act (ACA) has increased insurance coverage. We provide the first comprehensive assessment of these provisions' effects, using the 2012-2015 American Community Survey and a triple difference estimation strategy that exploits variation by income, geography, and time. Overall, our model explains 60% of the coverage gains in 2014-2015. We find that coverage was moderately responsive to price subsidies, with larger gains in state-based insurance exchanges than the federal exchange. The individual mandate's exemptions and penalties had little impact on coverage rates. The law increased Medicaid among individuals gaining eligibility under the ACA and among previously-eligible populations ("woodwork effect") even in non-expansion states, with no resulting reductions in private insurance. Overall, exchange premium subsidies produced 40% of the coverage gains explained by our ACA policy measures, and Medicaid the other 60%, of which 1/2 occurred among previously-eligible individuals. (C) 2017 Elsevier B.V. All rights reserved.