Incumbent regulation and adverse selection: You can keep your health plan, but at what cost?
Journal of Public Economics · 2021 · Sebastián Fleitas、Gautam Gowrisankaran、Anthony T. Lo Sasso
中文摘要
2010年《平价医疗法案》（ACA）在小团体市场中实施了在位者规制政策，现有健康计划可选择暂缓遵守ACA规定。这为预期医疗成本较低且不确定性较大的雇主提供了不立即遵守ACA规定的激励。我们使用了包含2013年至2017年间超过300,000个雇主-年份的独特全国数据。与这些激励一致，我们发现拥有更健康参保人的雇主以及人员流动率更高的雇主更可能不立即合规。这在ACA合规市场中造成了逆向选择，使其2014年的人均年度医疗成本增加了365美元。
Abstract
The 2010 Affordable Care Act (ACA) instituted incumbent regulation policies in the small group market, where existing health plans could choose to defer compliance with ACA regulations. This created incentives for employers with lower expected healthcare costs and greater uncertainty to not immediately become ACA compliant. We use unique national data with over 300,000 employer-years from 2013 to 2017. Consistent with these incentives, we find that employers with healthier enrollees and those with more turnover were more likely to not immediately comply. This created adverse selection in the ACA-compliant market, increasing its annual healthcare costs by $365 per individual in 2014.