Health Plan Choice and Insurance Take-Up in the ACA Health Insurance Marketplaces
The Affordable Care Act’s health insurance Marketplaces have significantly altered the market for individual health insurance in two ways – they create regulated markets for purchase of qualified health plans and they provide a mechanism for delivery of health insurance premium subsidies to income-eligible families. Goals of this policy reform are to enhance utility of health insurance for consumers (e.g., costs of coverage, access and quality), to reward higher value competitors with market share, and to make insurance more affordable and reduce uninsurance. Evidence on consumer decision-making and health insurance take-up is critical to understanding if these policy goals are being met. This panel presents three papers that evaluate consumer decision-making in ACA Marketplaces. The first paper presents results from a randomized experiment that evaluates whether inattention and information frictions may inhibit optimal consumer plan choices by testing whether delivery of salient information about plan premiums to re-enrolling consumers affects shopping behavior and plan choices. The second paper reports on the consumer preferences and shopping strategies employed by new enrollees in Marketplace health plans, and presents evidence on strategies, decision-support tools, choice architecture and consumer characteristics associated with “money-wasting” plan choices. The third paper evaluates the responsiveness of changes in insurance coverage to premium subsidies, in comparison to net premiums and the individual mandate penalty, while also testing for spillover effects of the policies in the labor market. These results have implications for models of consumer health insurance decision-making and for the efficiency of the ACA marketplaces.