Trish Erin, Herring Bradley
Assistant Research Professor, University of Southern California Price School of Public Policy, Schaeffer Center for Health Policy and Economics, Verna and Peter Dauterive Hall 412G, 635 Downey Way | Los Angeles, CA 90089, 213-821-6178.
Associate Professor of Health Economics, Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, 624 North Broadway, Room 408 | Baltimore, MD 21205, 410-614-5967.
J Risk Insur. 2018 Sep;85(3):607-633. doi: 10.1111/jori.12184. Epub 2016 Oct 3.
The Affordable Care Act (ACA) imposes adjusted community rating in the small group market, which employers can avoid by self-insuring, raising concerns about adverse selection. We evaluate the impact of limiting allowable rating variation on employer self-insurance across industries with varied health risk, using cross-state variation in pre-ACA rating regulations, the nationally-representative 2008-2013 KFF/HRET Employer Health Benefits survey, and a triple-difference regression approach. We find that lower-risk employers subject to laws limiting allowable premium rating variation have a predicted probability of self-insurance that is about 18 percentage points higher than otherwise-similar higher-risk employers, suggesting that these selection concerns are warranted.
《平价医疗法案》（ACA）在小团体市场实施调整后的社区费率，雇主可通过自我保险来避免这种情况，这引发了对逆向选择的担忧。我们利用ACA实施前费率监管的州际差异、具有全国代表性的2008 - 2013年凯泽家庭基金会/健康研究与教育信托基金雇主健康福利调查，以及三重差分回归方法，评估限制允许的费率变化对不同健康风险行业雇主自我保险的影响。我们发现，受法律限制允许的保费费率变化影响的低风险雇主，其自我保险的预测概率比其他类似的高风险雇主高出约18个百分点，这表明这些对选择的担忧是有道理的。
