NBER Working Papers by Anna Sinaiko

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Working Papers

September 2014Risk Corridors and Reinsurance in Health Insurance Marketplaces: Insurance for Insurers
with Timothy J. Layton, Thomas G. McGuire: w20515
In order to encourage entry and lower prices, most regulated markets for health insurance include policies that seek to reduce the uncertainty faced by insurers. In addition to risk adjustment of premiums paid to plans, the Health Insurance Marketplaces established by the Affordable Care Act implement reinsurance and risk corridors. Reinsurance limits insurer costs associated with specific individuals, while risk corridors protect against aggregate losses. Both tighten the insurer's distribution of expected costs. This paper considers the economic costs and consequences of reinsurance and risk corridors. Drawing a parallel to individual insurance principles first described by Arrow (1963) and Zeckhauser (1970), we first discuss the optimal insurance policy for insurers. Then, we simulate ...

Published: Timothy J. Layton & Thomas G. McGuire & Anna D. Sinaiko, 2016. "Risk Corridors and Reinsurance in Health Insurance Marketplaces: Insurance for Insurers," American Journal of Health Economics, vol 2(1), pages 66-95. citation courtesy of

May 2014Dominated Choices and Medicare Advantage Enrollment
with Christopher Afendulis, Richard Frank: w20181
Research in behavioral economics suggests that certain circumstances, such as large numbers of complex options or revisiting prior choices, can lead to decision errors. This paper explores the enrollment decisions of Medicare beneficiaries in the Medicare Advantage (MA) program. During the time period we study (2007-2010), private fee-for-service (PFFS) plans offered enhanced benefits beyond those of traditional Medicare (TM) without any restrictions on physician networks or additional cost, making TM a dominated choice relative to PFFS. Yet more than three quarters of Medicare beneficiaries remained in TM during our study period. We explore two possible explanations for this behavior: status quo bias and choice overload. Our results suggest that status quo bias plays an important rol...

Published: Christopher C. Afendulis & Anna D. Sinaiko & Richard G. Frank, 2015. "Dominated choices and Medicare Advantage enrollment," Journal of Economic Behavior & Organization, vol 119, pages 72-83.

November 2013Enrollment in Medicare Advantage Plans in Miami-Dade County: Evidence of Status Quo Bias?
with Christopher C. Afendulis, Richard G. Frank: w19639
Evidence from behavioral economics reveals that decision-making in health care settings can be affected by circumstances and choice architecture. This paper conducts an analysis of choice of private Medicare plans (Medicare Advantage plans) in Miami-Dade County. We provide a detailed description of the choice of MA plans available in Miami over much of the program's history and the composition of Medicare beneficiaries in Miami over the 2000s. Our analysis suggests that first becoming eligible for Medicare is the key transition point for MA, and that there is significant status quo bias in the MA market. This consumer behavior has important implications for policy that regulates the MA market.

Published: Enrollment in Medicare Advantage Plans in Miami-Dade County Evidence of Status Quo Bias? Anna D. Sinaiko, PhD, MPP1 Christopher C. Afendulis, PhD2 Richard G. Frank, PhD2 INQUIRY August 2013 vol. 50 no. 3 202-215

June 2008State and Federal Approaches to Health Reform: What Works for the Working Poor?
with Ellen Meara, Meredith Rosenthal, Katherine Baicker: w14125
We compare and contrast the labor market and distributional impact of three common approaches to state and federal health insurance expansion: public insurance expansions, refundable tax credits for low income people, and employer and individual mandates. We draw on existing estimates from the literature and individual-level data on the non-institutionalized population aged 64 and younger from the 2005 Current Population Survey to estimate how each approach affects (1) the number of people insured; (2) private and public health spending; (3) employment and wages; and (4) the distribution of subsidies across families based on income in relation to the federal poverty level and work status of adult family members. Employer mandates expand coverage to the largest number of previously insured ...


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