Collaborative Research: Evaluation of ACA Reform

“平价医疗法案”(ACA)的核心是“个人强制”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。个人强制令可能是ACA中最具争议的部分。这项研究旨在回答关于这一法律的两个关键问题。首先，取消个人强制令后，未参保率会增加多少？其次，拟议中的对该法律的替代能在多大程度上缓解这种提升对覆盖范围的负面影响？这项研究开发了一个医疗保健交易所的经济模型，该模型融合了不对称信息和消费者动态。它允许个人健康状况的异质性，使其能够捕捉逆向选择--这是市场可能在没有个人强制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令替代措施的影响至关重要，个人强制令都会惩罚今天没有保险、未来获得医疗保险受限的消费者。使用该模型，调查人员检查了取代或改革ACA的不同方式可能如何影响健康保险交易所和消费者福利的表现。这一裁决反映了NSF的法定使命，并通过使用基金会的智力优势和更广泛的影响审查标准进行评估，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.