Frean Molly, Gruber Jonathan, Sommers Benjamin D
Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Kresge 4th Floor, Boston, MA 02115, United States.
Massachusetts Institute of Technology and National Bureau of Economic Research, Department of Economics, E52-434, 77 Massachusetts Avenue, Cambridge, MA 02139, United States.
J Health Econ. 2017 May;53:72-86. doi: 10.1016/j.jhealeco.2017.02.004. Epub 2017 Mar 6.
Using premium subsidies for private coverage, an individual mandate, and Medicaid expansion, the Affordable Care Act (ACA) has increased insurance coverage. We provide the first comprehensive assessment of these provisions' effects, using the 2012-2015 American Community Survey and a triple-difference estimation strategy that exploits variation by income, geography, and time. Overall, our model explains 60% of the coverage gains in 2014-2015. We find that coverage was moderately responsive to price subsidies, with larger gains in state-based insurance exchanges than the federal exchange. The individual mandate's exemptions and penalties had little impact on coverage rates. The law increased Medicaid among individuals gaining eligibility under the ACA and among previously-eligible populations ("woodwork effect") even in non-expansion states, with no resulting reductions in private insurance. Overall, exchange premium subsidies produced 40% of the coverage gains explained by our ACA policy measures, and Medicaid the other 60%, of which 1/2 occurred among previously-eligible individuals.
通过对私人保险提供保费补贴、实施个人强制参保规定以及扩大医疗补助计划，《平价医疗法案》（ACA）提高了保险覆盖率。我们利用2012 - 2015年美国社区调查以及一种利用收入、地理位置和时间差异的三重差分估计策略，首次对这些条款的效果进行了全面评估。总体而言，我们的模型解释了2014 - 2015年保险覆盖率增长的60%。我们发现，保险覆盖率对价格补贴有适度反应，基于州的保险交易所的覆盖率增长幅度大于联邦交易所。个人强制参保规定的豁免和处罚对覆盖率的影响很小。该法案增加了根据ACA获得资格的个人以及之前符合资格人群（“隐藏效应”）的医疗补助，即使在未扩大医疗补助计划的州也是如此，且并未导致私人保险减少。总体而言，我们的ACA政策措施所解释的保险覆盖率增长中，40%是由交易所保费补贴带来的，60%是由医疗补助带来的，其中一半发生在之前符合资格的个人中。
