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Polarization, Participation, and Premiums: How Political Behavior Helps Explain Where the ACA Works, and Where It Doesn't

Polarization, Participation, and Premiums: How Political Behavior Helps Explain Where the ACA... Context: Political partisanship can influence whether individuals enroll in government programs. In particular, Republicans, ceteris paribus, are less likely to enroll in Affordable Care Act (ACA) individual marketplace insurance than Democrats. The logic of adverse selection suggests low uptake among Republicans would generally put upward pressure on marketplace premiums, especially in geographic areas with more Republican partisans. Methods: Using data from Healthcare.gov at the rating area level, this article examines the association between Republican vote share and growth in ACA marketplace premiums, being careful to account for potential confounding variables. Findings: Insurers have increased marketplace premiums at higher rates in areas with more Republican voters. In the preferred model specification, a 10-percentage-point difference in Republican vote share is associated with a 3.2-percentage-point increase in average premium growth for a standard plan. A variety of robustness and placebo checks suggest the relationship is driven by partisanship. Conclusions: Partisan polarization can threaten the successful implementation of policies that rely on high levels of citizen participation. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Health Politics, Policy and Law Duke University Press

Polarization, Participation, and Premiums: How Political Behavior Helps Explain Where the ACA Works, and Where It Doesn't

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Copyright
Copyright © 2019 by Duke University Press
ISSN
0361-6878
eISSN
1527-1927
DOI
10.1215/03616878-7785787
Publisher site
See Article on Publisher Site

Abstract

Context: Political partisanship can influence whether individuals enroll in government programs. In particular, Republicans, ceteris paribus, are less likely to enroll in Affordable Care Act (ACA) individual marketplace insurance than Democrats. The logic of adverse selection suggests low uptake among Republicans would generally put upward pressure on marketplace premiums, especially in geographic areas with more Republican partisans. Methods: Using data from Healthcare.gov at the rating area level, this article examines the association between Republican vote share and growth in ACA marketplace premiums, being careful to account for potential confounding variables. Findings: Insurers have increased marketplace premiums at higher rates in areas with more Republican voters. In the preferred model specification, a 10-percentage-point difference in Republican vote share is associated with a 3.2-percentage-point increase in average premium growth for a standard plan. A variety of robustness and placebo checks suggest the relationship is driven by partisanship. Conclusions: Partisan polarization can threaten the successful implementation of policies that rely on high levels of citizen participation.

Journal

Journal of Health Politics, Policy and Law – Duke University Press

Published: Dec 1, 2019

References

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    Diamond, Alexis Sekhon, Jasjeet S.
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    Lerman, Amy E. Sadin, Meredith L. Trachtman, Samuel
  • Assessing ACA Marketplace Enrollment.
    Levitt, Larry Claxton, Gary Damico, Anthony Cox, Cynthia
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    Montgomery, Jacob M. Nyhan, Brendan.
  • How Conditioning on Posttreatment Variables Can Ruin Your Experiment and What to Do About It
    Montgomery, Jacob M. Nyhan, Brendan Torres, Michelle
  • Early Assessment of Competition in the Health Insurance Marketplace.
    Morrisey, Michael A Nathan, Richard P. Brandt, Caitlin Rivlin, Alice
  • Implementing the Affordable Care Act: The Promise and Limits of Health Care Reform
    Oberlander, Jonathan
  • When Effect Becomes Cause: Policy Feedback and Political Change
    Pierson, Paul
  • Equilibrium in Competitive Insurance Markets: An Essay on the Economics of Imperfect Information
    Rothschild, Michael Stiglitz, Joseph
  • Is Trump's Debate Claim about Health Care Costs Rising True?
    Rovner, Julie
  • Matching to Remove Bias in Observational Studies
    Rubin, Donald B.
  • Who Participated in the ACA? Gains in Insurance Coverage by Political Partisanship
    Sances, Michael W. Clinton, Joshua D.
  • The Effect of Medicaid Expansion on Marketplace Premiums
    Sen, Aditi P. DeLeire, Thomas C.
  • From the Very Start, Sharp Partisan Divisions over Obamacare.
    Smith, Samantha
  • More Democrats Are Getting Health Insurance, Thanks to Obamacare. Why Are Republicans Staying Away?
    Tesler, Michael
  • Drivers of 2015 Health Insurance Premium Changes.
  • Drivers of 2017 Health Insurance Premium Changes.
  • The Rise of Negative Partisanship and the Nationalization of US Elections in the Twenty-First Century
    Abramowitz, Alan I. Webster, Steven.
  • Zeke Emanuel: Employer-Based Insurance Will Die Out by 2025.
  • The Future of the ACA's Exchanges.
    Antos, Joseph R. Capretta, James C.
  • US Uninsured Rate Edges up Slightly.
    Auter, Zac.
  • BCBS Health Index.
  • The Affordable Care Act in 2014: Significant Insurer Losses Despite Substantial Subsidies.
    Blase, Brian Badger, Doug Haislmaier, Edmund
  • The Three R's of Health Insurance.
    Blumenthal, David
  • Self-Interest, Social Security, and the Distinctive Participation Patterns of Senior Citizens
    Campbell, Andrea Louise
  • Voter Migration and the Geographic Sorting of the American Electorate
    Cho, Wendy K. Tam Gimpel, James G. Hui, Iris S.
  • March 31, 2016, HHS-Operated Risk Adjustment Methodology Meeting.
  • Explaining Health Care Reform: Risk Adjustment, Reinsurance, and Risk Corridors.
    Cox, Cynthia Semanskee, Ashley Claxton, Gary Levitt, Larry
  • Paying for Health Insurance: The Trade-Off between Competition and Adverse Selection
    Cutler, David M. Reber, Sarah J.
  • More Insurers Lower Premiums: Evidence from Initial Pricing in the Health Insurance Marketplaces
    Dafny, Leemore S. Gruber, Jonathan Ody, Christopher
  • Genetic Matching for Estimating Causal Effects: A General Multivariate Matching Method for Achieving Balance in Observational Studies
    Diamond, Alexis Sekhon, Jasjeet S.
  • The Affordable Care Act: An Experiment in Federalism?
    Dropp, Kyle A. Jackman, Molly C. Jackman, Saul P.
  • The Democrats' Misplaced Faith in Policy Feedback
    Galvin, Daniel J. Thurston, Chloe N.
  • Urban and Rural America Are Becoming Increasingly Polarized.
    Gamio, Lazaro
  • Generalized Additive Models.
    Hastie, Trevor Tibshirani, R.
  • Business Associations, Conservative Networks, and the Ongoing Republican War over Medicaid Expansion
    Hertel-Fernandez, Alexander Skocpol, Theda Lynch, Daniel
  • Covariate Balancing Propensity Score
    Imai, Kosuke Ratkovic, Marc
  • Fear and Loathing across Party Lines: New Evidence on Group Polarization
    Iyengar, Shanto Westwood, Sean J.
  • Pascal's Wager: Health Insurance Exchanges, Obamacare, and the Republican Dilemma
    Jones, David K. Bradley, Katharine W. V. Oberlander, Jonathan.
  • Total Marketplace Enrollment.
  • Is Obamacare Failing?
    Kliff, Sarah
  • Policy Uptake as Political Behavior: Evidence from the Affordable Care Act
    Lerman, Amy E. Sadin, Meredith L. Trachtman, Samuel
  • Assessing ACA Marketplace Enrollment.
    Levitt, Larry Claxton, Gary Damico, Anthony Cox, Cynthia
  • Bayesian Model Averaging: Theoretical Developments and Practical Applications
    Montgomery, Jacob M. Nyhan, Brendan.
  • How Conditioning on Posttreatment Variables Can Ruin Your Experiment and What to Do About It
    Montgomery, Jacob M. Nyhan, Brendan Torres, Michelle
  • Early Assessment of Competition in the Health Insurance Marketplace.
    Morrisey, Michael A Nathan, Richard P. Brandt, Caitlin Rivlin, Alice
  • Implementing the Affordable Care Act: The Promise and Limits of Health Care Reform
    Oberlander, Jonathan
  • When Effect Becomes Cause: Policy Feedback and Political Change
    Pierson, Paul
  • Equilibrium in Competitive Insurance Markets: An Essay on the Economics of Imperfect Information
    Rothschild, Michael Stiglitz, Joseph
  • Is Trump's Debate Claim about Health Care Costs Rising True?
    Rovner, Julie
  • Matching to Remove Bias in Observational Studies
    Rubin, Donald B.
  • Who Participated in the ACA? Gains in Insurance Coverage by Political Partisanship
    Sances, Michael W. Clinton, Joshua D.
  • The Effect of Medicaid Expansion on Marketplace Premiums
    Sen, Aditi P. DeLeire, Thomas C.
  • From the Very Start, Sharp Partisan Divisions over Obamacare.
    Smith, Samantha
  • More Democrats Are Getting Health Insurance, Thanks to Obamacare. Why Are Republicans Staying Away?
    Tesler, Michael