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Thesis/Dissertation
Date
2024-08
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Economics
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DOI
http://dx.doi.org/10.34944/dspace/10580
Abstract
The Patient Protection and Affordable Care Act of 2010 established the existence of the individual health insurance marketplaces where consumers could more easily compare different health insurance policies. The states were given freedom to decide who and how the markets would be managed and regulated. Despite these known differences, little is known about how the various types of marketplaces compare to one another. In Chapter 1, I estimate an equilibrium model of individual insurance to recover demand- and supply-side parameters and estimate consumer welfare and marginal costs for each marketplace type. In addition, I simulate multiple counterfactual exercises that alter key aspects of the individual marketplaces. I find that results from expanding consumer subsidies and standardizing insurance plans lead to increases in consumer surplus between $45 and $229. In addition, I find evidence that if states were to transition from federally-run marketplaces to state-run marketplaces consumers could see gains in surplus up to $291 and issuers could see reductions in marginal costs up to $384.The implementation of Balanced Budget Act of 1997 was responsible for the creation of critical access hospitals. This designation provided financial aid to small, rural hospitals in the hopes of preventing closure. While the program preserves access to care, previous research indicates that the critical access hospital program may be an inefficient allocation of resources. Conversely, my study in Chapter 2 finds that the reimbursement increases associated with an extension of program may efficiently improve patient outcomes. I utilize a differences-in-differences model that exploits the enactment of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to examine the county-level effects of increased hospital reimbursements on inpatient deaths. I find an average decline between 1.8 and 3.5 percent in county-level inpatient deaths and find evidence of medium-run impacts of this policy.
My work in Chapter 1 on the individual insurance market reveals that federally-run insurance markets could benefit from transitioning to a state-based approach. Further, results indicate that in federally-run insurance marketplaces where the states engage in plan management activities premiums and marginal costs are higher. In Chapter 3, I utilize a reduced-form approach to estimate the medium- to long-run impacts of marketplaces opting to transition from fully-federally run to either a “hybrid" approach where the state engages in plan management activities or to a fully state-based marketplace. Using data from 2015-2022 and synthetic differences-in-differences I estimate that transitioning to a “hybrid' approach leads to increases in premiums and deductibles for consumers equal to approximately $28 and $358 on average. These increases are sustained up to five years post transition. I also find evidence that transitioning to a fully state-based marketplace may reduce deductibles and increase maximum out-of-pocket payments for one of the states that transitioned.
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