The Impact of Market Size and Composition on Health Insurance Premiums: Evidence from the First Year of the ACA

26 Pages Posted: 2 Feb 2015

See all articles by Michael Dickstein

Michael Dickstein

Stanford University

Mark Duggan

Stanford University - Department of Economics

Joe Orsini

Pietro Tebaldi

University of Chicago - Department of Economics

Date Written: January 2015

Abstract

Under the Affordable Care Act, individual states have discretion in how they define coverage regions, within which insurers must charge the same premium to buyers of the same age, family structure, and smoking status. We exploit variation in these definitions to investigate whether the size of the coverage region affects outcomes in the ACA marketplaces. We find large consequences for small and rural markets. When states combine small counties with neighboring urban areas into a single region, the included rural markets see .6 to .8 more active insurers, on average, and savings in annual premiums of between $200 and $300.

Suggested Citation

Dickstein, Michael and Duggan, Mark and Orsini, Joe and Tebaldi, Pietro, The Impact of Market Size and Composition on Health Insurance Premiums: Evidence from the First Year of the ACA (January 2015). NBER Working Paper No. w20907. Available at SSRN: https://ssrn.com/abstract=2558959

Michael Dickstein (Contact Author)

Stanford University ( email )

No Address Available

Mark Duggan

Stanford University - Department of Economics ( email )

Landau Economics Building
579 Serra Mall
Stanford, CA 94305-6072
United States

Pietro Tebaldi

University of Chicago - Department of Economics ( email )

1126 E. 59th St
Chicago, IL 60637
United States

No contact information is available for Joe Orsini

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