Hill Steven C, Jacobs Paul D
Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, 5600 Fishers Lane, Mail Stop 07W41A, Rockville, MD 20857, United States.
Health Aff Sch. 2024 Dec 10;3(1):qxae169. doi: 10.1093/haschl/qxae169. eCollection 2025 Jan.
The Affordable Care Act (ACA) transformed the market for individual insurance. Using the 2-year panels of the Household Component of the Medical Expenditure Panel Survey covering the 2002-2022 period and controlling for the business cycle and other factors, we find the share of nonelderly adults enrolled in individual insurance doubled under the ACA. The percentage of adults covered by individual insurance 1-23 months more than doubled, and the percentage with at least 24 months rose 80% in states that did not expand Medicaid. Nearly all the gain came from adults who were uninsured immediately prior to enrolling. The prevalence of short individual market spells (<5 months) remained low after ACA implementation, and the ACA primarily helped cover individuals for longer spells. Individual insurance has always played a meaningful role in providing coverage for individuals ineligible for public programs and by bridging gaps between other forms of insurance. Because individual insurance is often temporary, more people may rely on individual insurance in their lifetimes than rely on it at a point in time. We document increases in individual coverage that suggest a strengthened role for this market after ACA implementation.
《平价医疗法案》（ACA）改变了个人保险市场。利用医疗支出面板调查家庭部分涵盖2002 - 2022年期间的两年期样本，并控制商业周期和其他因素，我们发现，在《平价医疗法案》实施后，参加个人保险的非老年成年人比例翻了一番。在未扩大医疗补助计划的州，参加个人保险1至23个月的成年人比例增加了一倍多，参加至少24个月个人保险的成年人比例上升了80%。几乎所有的增长都来自参保前即刻未参保的成年人。《平价医疗法案》实施后，个人保险市场短期保单（<5个月）的比例仍然很低，而且《平价医疗法案》主要帮助人们获得更长时间的保险覆盖。个人保险在为无资格参加公共项目的个人提供保险以及弥合其他形式保险之间的差距方面一直发挥着重要作用。由于个人保险通常是临时性的，一生中依赖个人保险的人可能比某一时刻依赖它的人更多。我们记录了个人保险覆盖范围的增加，这表明《平价医疗法案》实施后该市场的作用得到了加强。
