Losses (and Gains) from Health Reform for Non‐Medicaid Uninsureds

26 Pages Posted: 28 May 2020

See all articles by Mark Pauly

Mark Pauly

University of Pennsylvania

Adam Leive

University of Virginia

Scott E. Harrington

University of Pennsylvania - Wharton School

Date Written: March 2020

Abstract

This article examines how the Affordable Care Act (ACA) would change financial resources for and transfers to the previously uninsured if they were to purchase coverage in the ACA insurance exchanges (marketplaces) in 2014. The results suggest that the law provides gains to some, relative to their spending in the pre‐ACA period, particularly those in poor health and with very low incomes, but it also potentially imposes financial losses on many, again compared to their experience when uninsured. We estimate changes in expected payments—defined as premiums plus expected out‐of‐pocket costs—from purchasing coverage and paying cost sharing post‐ACA, relative to expected out‐of‐pocket payments when being uninsured pre‐ACA, across population subgroups characterized by income, age, and health status. We also estimate changes in expected transfers to the previously uninsured under alternative assumptions on how much health care spending increases after the ACA.

Suggested Citation

Pauly, Mark and Leive, Adam and Harrington, Scott E., Losses (and Gains) from Health Reform for Non‐Medicaid Uninsureds (March 2020). Journal of Risk and Insurance, Vol. 87, Issue 1, pp. 41-66, 2020, Available at SSRN: https://ssrn.com/abstract=3610301 or http://dx.doi.org/10.1111/jori.12255

Mark Pauly (Contact Author)

University of Pennsylvania ( email )

Adam Leive

University of Virginia ( email )

1400 University Ave
Charlottesville, VA 22903
United States

Scott E. Harrington

University of Pennsylvania - Wharton School ( email )

3641 Locust Walk
Colonial Penn Center
Philadelphia, PA 19104-6358
United States
215-898-9403 (Phone)
215-573-2157 (Fax)

HOME PAGE: http://scottharringtonphd.com/

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