This Essay examines the very fragile nature of the Patient Protection and Affordable Care Act's (ACA) approach to near-universal health insurance coverage, as accentuated by a variety of implementation hurdles and challenges. The ACA's vision for expanding insurance coverage was to build on our...

Subsidized health insurance markets use diagnosis-based risk adjustment to induce insurers to offer an equitable benefit to individuals of varying expected cost. I demonstrate that technological change after risk adjustment calibration -- new drug entry and the onset of generic competition --...

In the Affordable Care Act (ACA), Congress assumed that the private insurance sector will continue to underwrite health risks for most of the non-elderly population. But nothing requires private insurers to continue to do so. To the contrary, the burdensome nature of the ACA's provisions is...

Hospitals face an environment of declining real per-patient reimbursement from Medicare. Understanding the provider response to changing Medicare prices is critical for balancing the complex incentives of hospitals and patients with the fiscal and social objectives of the public insurance...

We consider whether hospital acquisitions of physicians lead to improved clinical outcomes for Medicare patients aged 65 and older. The analysis combines 2005-2012 Medicare fee-for-service and enrollment data with merger and physician affiliation information from the Levin Reports and SK&A,...

States with Section 1332 Waivers to operate high-risk pools (HRPs) or reinsurance programs can receive federal pass through funds equal to reductions in federal expenditures generated by the Waiver. Shifting financial responsibility for high-cost individuals out of the Health Insurance Exchange...

We present and empirically implement an equilibrium labor market search model where risk averse workers facing medical expenditure shocks are matched with firms making health insurance coverage decisions. Our model delivers a rich set of predictions that can account for a wide variety of...

I estimate demand for health insurance using consumer-level data from the California and Washington ACA exchanges. I use the demand estimates to simulate the impact of policies targeting adverse selection, including subsidies and the individual mandate. I find (1) own-premium elasticities of...

We use difference-in-difference methods and data from the 2008 Survey of Income and Program Participation to test whether the ACA dependent care provision is associated with family structure and public program participation among young adults. Findings indicate that implementation of the...

This study summarizes what we know and do not know, in both economic theory and empirical practice, about the potential to more closely approximate competitive markets in healthcare and insurance in ways that will do more good than harm to the current dysfunctional system. The alternatives to...