This morning I’m “attending” the virtual APPAM 2020 conference. My co-authors and I will be presenting three papers today at 11:00AM EST on the Affordable Care Act.
Paper 1: Zero-Price Effects in Health Insurance: Evidence from Colorado (Coleman Drake, Sih-Ting Cai, Dave Anderson, Dan Sacks –funded by NIHCM)
Paper 2: When All That Glitters is Gold: Dominated Plan Choice on Covered California for the 2018 Plan Year (Petra Rasmussen, Dave Anderson)
Paper 3: Changes in Marketplace Competition and Television Advertising by Insurers (Paul Shafer, Dave Anderson, Laura Baum, Erika Franklin-Fowler, Sarah Gollust)
These three papers have occupied a good chunk of my ACA related headspace for the past year. The first study is an extension of a study that Coleman and I published last January in Health Affairs where we had county level aggregate data for Healthcare.gov. This time we have household level data from Colorado to see what is actually happening at the actual choice level. We found interesting things.I’ll say more once we have the working paper out and about by the New Year.
We’ve talked a lot about dominated plan choice on the ACA marketplaces this year. I presented the initial version of the paper at Academy Health over the summer and we just sent back in a revised manuscript. I am hoping that the reviewers like what we did. We found a choice architecture problem that enabled inertia to place people in overly expensive plans. Individuals who bought plans in 2017 and did nothing in 2018 ended up spending a lot more in premiums for objectively worse plans. Individuals who had to make an active choice did a pretty good job but not a perfect job of avoiding objectively bad choices.
The third paper came out of a bullshitting session where we realized that this was an interesting, useful and answerable question. How do insurers change advertising when they become a monopolist? Do they increase advertising to scoop up marketshare? Do they decrease advertising because they are the only game in town? We used the Wesleyan Media Project’s data sets to poke at this question. I’ll say more once the reviewers get back to us on the recently resubmitted manuscript.
Most of my thinking this year on the ACA has been on the insurer/structural side of the marketplace and not too much on the consumer choice side. Even the dominated plan choice paper which has a consumer choice outcome (did you choose an objectively bad plan?) fundamentally engages with how the choice environment is set-up and regulated. Other work that I have cooking at the moment is mostly on the insurer or regulatory sides of the choice environment.
So we have an hour to talk about three papers I’m really happy to be a part of. Some of that happiness is that I think we are doing good, interesting , novel and policy relevant work. A lot is that these are co-authors are great co-authors. They are all wicked smart people who are also fundamentally kind people to work with. Writing with these folks makes going into work, or at least walking down to the spare bedroom/COVID office in the basement real easy.
So if you are at APPAM today, come and check our work out at 11:00AM EST.
lowtechcyclist
You’re presenting or co-presenting three papers at one conference? I’m surprised you had any headspace left lately for anything else besides food and sleep! I’m in a different field (statistics), but I think two in one year would be about my limit.
Hope your presentations all go well!
BruceFromOhio
Makes all the difference, doesn’t it?
Break a leg!
Zelma
I have loved reading your posts on health insurance even though I don’t understand half of them. I am particularly struck by the issue of inertia in consumer choice. It makes so much sense to me in health insurance (and just about everything else that we buy.) I chose a Medicare supplement plan 12 years ago for what were very good reasons at the time. My situation has changed and every year I wonder whether I could get a less expensive plan with better coverage if I went with an Advantage plan. And every year I decide it’s too much work to figure it out. Maybe this year but probably not.
David Anderson
@lowtechcyclist: Health policy is a high output field. Tenure expectations are ~20 publications including 7 1st authorships in 5 or 6 years.
I’m running ahead of that pace as I don’t have teaching or significant grant writing responsibilities.
2019 was 7 papers accepted (6 published in 2019)
2020 7 accepted (8 to be published)
2021 is looking to be a 7 to 10 paper year (3 R&Rs including 2 of the papers above and a huge bolus of funded work that will be submitted Q4 2020 or Q1 2021
Bodacious
All right, this will be the first year I’m jumping into the ACA marketplace (granted, I have a few more months to eke out with my COBRA), so working through your info – brick by brick. Feels like a ton of bricks now, but should provide somewhat of a safe landing, right? I carry that nervous excitement combined with cautious relief that the entire ACA will live on to see another year (premature thanks to SCOTUS – fingers crossed)
Thanks DA!
Bodacious
Also~ is there any secret to looking at your state’s available plans without being swamped with TEXT/CALLS/SPAM? I just want to look anonymously? I promise I won’t break anything! Otherwise, my phone just blows up.
David Anderson
@Bodacious: Use Health Plan Finder offered by CMS