Collaborative Research: Evaluation of ACA Reform

《平价医疗法案》（ACA）的核心是“个人授权”法。根据这项法律，ACA“健康保险交易所”的每个人都需要购买保险或支付罚款。个人授权可能是ACA中最具争议的部分。本研究旨在回答关于这一规律的两个关键问题。首先，取消个人强制保险后，不保险率会增加多少？其次，拟议中的替代法律能在多大程度上减轻这一提升对覆盖面的负面影响？这项研究开发了一个经济模型的医疗保健交流，结合不对称信息和消费者的动态。它考虑到了个人健康状况的异质性，使其能够捕捉到逆向选择--这是市场在没有个人授权的情况下崩溃的主要原因。该模型是动态的，使其能够捕捉消费者的前瞻性决策。这对于评估拟议的个人强制保险替代方案的影响至关重要，这些替代方案都惩罚了今天没有保险的消费者，限制了他们未来获得医疗保险的机会。研究人员利用该模型研究了取代或改革ACA的不同方式如何影响健康保险交易所的绩效和消费者福利。该奖项反映了NSF的法定使命，并且通过使用该基金会的智力价值和更广泛的影响力审查标准进行评估，被认为值得支持。

At the core of the Affordable Care Act (ACA) is the "individual mandate" law. Under this law, each individual in the ACA's "health insurance exchanges" needs to buy coverage or pay a penalty. Individual mandate has perhaps been the most controversial part of the ACA. This research aims at answering two crucial questions about this law. First, by how much would the uninsurance rate increase after lifting individual mandate? Second, to what extent could the proposed replacements to this law mitigate the negative impact of that lift on coverage?This research develops an economic model of healthcare exchanges that incorporates asymmetric information and consumer dynamics. It allows for heterogeneity in health statuses of individuals, enabling it to capture adverse selection -- the main reason why the market could collapse without individual mandate. The model is dynamic, allowing it to capture consumers' foresighted decision making. This is crucial for evaluating the impact of the proposed replacements to individual mandate, which all penalize consumers who stay uninsured today with restricted access to health insurance in the future. Using the model, the investigators examine how different ways to replace or reform the ACA might affect the performance of the health insurance exchange and the consumer welfare.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.