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的“健康保险交易所”中的每个人都需要购买保险或支付罚款。个人强制保险可能是《平价医疗法案》中最具争议的部分。这项研究旨在回答关于这一定律的两个关键问题。首先，取消个人强制医保后，未参保率会增加多少？第二，拟议的替代法案能在多大程度上减轻提高保险覆盖面的负面影响？本研究开发了一个包含不对称信息和消费者动态的医疗保健交换的经济模型。它允许个人健康状况的异质性，使其能够捕捉到逆向选择——没有个人强制保险市场可能崩溃的主要原因。该模型是动态的，允许它捕捉消费者有远见的决策。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，因为这些替代方案都会惩罚那些目前没有保险的消费者，使他们在未来获得医疗保险的机会受到限制。利用该模型，研究人员考察了替代或改革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。该奖项反映了美国国家科学基金会的法定使命，并通过使用基金会的知识价值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.