Models of consumer choice and selection in health insurance markets typically focus on decisions within one market setting (e.g. the choice of plans offered by an employer). This paper focuses on selection and choice at the broader level of health care markets, comparing Medicaid, employer sponsored insurance, and insurance exchanges. I study cross-market adverse selection in the context of the Affordable Care Act, which simultaneously expanded Medicaid while creating health insurance exchanges. Comparing Medicaid expansion and non-expansion states, I find that the individual market in expansion stats has healthier enrollees, lower costs, and premiums which are 10% lower than in non-expansion states. Then, using variation in federal reinsurance payments as identification, I find that price increases on individual health insurance exchanges lead lower-income consumers to become uninsured, and higher income consumers switch to employer-sponsored coverage.
Selected Work in Progress
How do Health Insurance Premiums Affect Employment Among Adults with Expensive Health Conditions? with Kurt Lavetti
Is This Time Different? The Slowdown in Health Spending with Amitabh Chandra and Jonathan Skinner
Brookings Papers on Economic Activity, Vol 47, No. 2 (2013)
Large Increases In Spending On Postacute Care In Medicare Point To The Potential For Cost Savings In These Settings with Amitabh Chandra and Maurice Dalton
Health Affairs, Vol 32, No. 5 (2013)