Did Community Rating Induce an Adverse Selection Death Spiral? Evidencefrom New York, Pennsylvania and Connecticut

44 Pages Posted: 17 Feb 1999 Last revised: 11 Sep 2002

See all articles by Thomas C. Buchmueller

Thomas C. Buchmueller

University of California - Paul Merage School of Business - Economics/Health Care; University of Michigan, Stephen M. Ross School of Business; National Bureau of Economic Research (NBER)

John E. DiNardo

University of Michigan at Ann Arbor - Gerald R. Ford School of Public Policy; National Bureau of Economic Research (NBER)

Date Written: January 1999

Abstract

Using data from the 1987 to 1996 March Current Population Surveys we find no evidence for the conventional wisdom' that the imposition of pure community rating leads to an adverse selection death spiral.' Specifically, the percentage of individuals in small groups covered by health insurance did not fall in New York (which enacted community rating legislation in 1993) relative to either Pennsylvania (which enacted no insurance reform) or Connecticut (which enacted moderate insurance reform without imposing community rating). Consistent with the predictions of the simple Rothschild and Stiglitz (1975) framework, however, we find that the New York reforms appear to have had a significant impact on the structure of the New York insurance market. Specifically, New York has experienced a dramatic shift away from indemnity insurance toward HMOs. While this shift took place during a period of nationwide increases in the percentage with managed care, the increase in HMO penetration in New York's small group and individual markets was significantly greater than in Pennsylvania or Connecticut.

Suggested Citation

Buchmueller, Thomas C. and DiNardo, John, Did Community Rating Induce an Adverse Selection Death Spiral? Evidencefrom New York, Pennsylvania and Connecticut (January 1999). NBER Working Paper No. w6872. Available at SSRN: https://ssrn.com/abstract=145567

Thomas C. Buchmueller (Contact Author)

University of California - Paul Merage School of Business - Economics/Health Care ( email )

Irvine, CA 92697-3125
United States

HOME PAGE: http://web.gsm.uci.edu/~tbuchmu/

University of Michigan, Stephen M. Ross School of Business ( email )

701 Tappan Street
Ann Arbor, MI MI 48109
United States

National Bureau of Economic Research (NBER)

1050 Massachusetts Avenue
Cambridge, MA 02138
United States

John DiNardo

University of Michigan at Ann Arbor - Gerald R. Ford School of Public Policy ( email )

5238 Weill Hall
735 S. State St.
Ann Arbor, MI 48109-1220
734-647-7843 (Phone)

HOME PAGE: http://www-personal.umich.edu/~jdinardo/

National Bureau of Economic Research (NBER)

1050 Massachusetts Avenue
Cambridge, MA 02138
United States

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