The Affordable Care Act after a Decade: Industrial Organization of the Insurance Exchanges

43 Pages Posted: 23 Aug 2021 Last revised: 22 Sep 2024

See all articles by Benjamin Handel

Benjamin Handel

University of California, Berkeley; National Bureau of Economic Research (NBER)

Jonathan Kolstad

University of California, Berkeley - Haas School of Business; National Bureau of Economic Research (NBER)

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Date Written: August 2021

Abstract

The regulated insurance exchanges set up in the Affordable Care Act (ACA) were designed to deliver affordable, efficient health coverage through private insurers. It is crucial to study the complex industrial organization (IO) of these exchanges in order to assess their impacts to date, during the first decade of the ACA, and in order to project their impacts going forward. We revisit the inherent market failures in health care markets that necessitate key ACA exchange regulations and investigate whether they have succeeded in their goals of expanding coverage, creating robust marketplaces, providing product variety, and generating innovation in health care delivery. We discuss empirical IO research to date and also highlight shortcomings in the existing research that can be addressed moving forward. We conclude with a discussion of IO research-based policy lessons for the ACA exchanges and, more generally, for managed competition of private insurance in health care.

Suggested Citation

Handel, Benjamin and Kolstad, Jonathan, The Affordable Care Act after a Decade: Industrial Organization of the Insurance Exchanges (August 2021). NBER Working Paper No. w29178, Available at SSRN: https://ssrn.com/abstract=3909623

Benjamin Handel (Contact Author)

University of California, Berkeley ( email )

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National Bureau of Economic Research (NBER)

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Jonathan Kolstad

University of California, Berkeley - Haas School of Business ( email )

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2220 Piedmont Avenue
Berkeley, CA 94720
United States

National Bureau of Economic Research (NBER)

1050 Massachusetts Avenue
Cambridge, MA 02138
United States

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