Duke University.
University of North Carolina at Chapel Hill.
J Health Polit Policy Law. 2019 Oct 1;44(5):715-736. doi: 10.1215/03616878-7611623.
On January 20, 2017, President Donald Trump penned his first executive order, which aimed to "minimiz[e] the economic burden" of the Affordable Care Act, signaling his intent to make good on promises to repeal and replace the law. This executive order, along with concurrent changes in political messaging associated with the transition in power and reductions in HealthCare.gov advertising, lowered Health Insurance Marketplace enrollment at the end of the 2017 open enrollment period.
The authors used difference-in-differences and event-study models with weekly county-level Marketplace application data from 1,476 counties in 37 states to estimate the incremental enrollment loss in the postinauguration period.
Estimates indicate a population-weighted decline of over 700 applications per county-week during the final 2 weeks of the 2017 open enrollment period relative to 2016, corresponding to a nearly 30% decline in applications submitted. A more flexible event-study approach that better accounts for time shifting of enrollment across open enrollment periods found a similar decline of approximately 660 applications per county-week associated with the postinauguration period (-24%).
The lack of political support for the law by the incoming administration seemingly had an immediate and significant downward effect on Marketplace enrollment nationwide.
2017 年 1 月 20 日，唐纳德·特朗普总统签署了他的第一份行政命令，该命令旨在“最小化”《平价医疗法案》的经济负担，这表明他有意兑现废除和取代该法律的承诺。该行政命令，以及权力交接期间与医疗保健市场广告相关的同时发生的政治信息变化，导致在 2017 年开放注册期结束时，医疗保健市场的注册人数减少。
作者使用了差异法和事件研究法，使用来自 37 个州的 1476 个县的每周县级市场应用数据，以估计就职后时期的增量注册损失。
估计表明，与 2016 年相比，在 2017 年开放注册期的最后两周，每县每周的人口加权注册申请下降了 700 多个，这对应于提交申请数量下降了近 30%。一种更灵活的事件研究方法更好地考虑了开放注册期之间的注册时间转移，发现与就职后时期相关的注册申请下降了约 660 个，每县每周下降了 24%。
即将上任的政府对该法律缺乏政治支持，这似乎对全国医疗保健市场的注册人数产生了直接而重大的负面影响。
