Eligibility and Coverage: Recent Assessments of Medicaid and Marketplace Insurance
The Affordable Care Act’s (ACA) expansion of Medicaid eligibility and tax credits for Marketplace plans requires a renewed focus on patterns of insurance coverage and eligibility for publicly-financed programs. In a shifting landscape of insurance coverage, it is necessary both to understand historical responses to changes in eligibility and to develop more current estimates of economic behavior in this area. This session focuses on Medicaid and Marketplace eligibility and the effects of these programs on coverage. In “Changes in insurance coverage associated with healthcare reform…” the authors analyze impacts of the ACA expansion employing a difference-in-difference technique, and find that adults eligible for premium subsidies and cost sharing reductions experienced an 11 percentage point reduction in the uninsured rate. Using detailed data on premium subsidy eligibility in the Marketplaces, the author of “Effects of Marketplace Premiums on Uninsurance” is one of the first researchers to use 2014 data to estimate a take-up elasticity with respect to health insurance premiums. Finally, in “Medicaid enrollment, eligibility, and take-up during the Great Recession,” the authors examine recent trends in Medicaid coverage for adults, showing that the effects of the economic recovery on reducing Medicaid enrollment were roughly offset by pre-2014 ACA expansions in eligibility in some states. These closely-related papers enhance our understanding of how policy shapes coverage availability and how individuals respond to incentives when selecting coverage. They show both how Medicaid has filled coverage gaps during economic downturns, and how the recent ACA expansions are changing our understanding of coverage.