NATIONAL BUREAU OF ECONOMIC RESEARCH
NATIONAL BUREAU OF ECONOMIC RESEARCH

Going into the Affordable Care Act: Measuring the Size, Structure, and Performance of the Individual and Small Group Markets for Health Insurance

Pinar Karaca-Mandic, Jean M. Abraham, Kosali Simon, Roger Feldman

Chapter in NBER book Measuring and Modeling Health Care Costs (2018), Ana Aizcorbe, Colin Baker, Ernst Berndt, and David Cutler, editors (p. 419 - 456)
Conference held October 18-19, 2013
Published in February 2018 by University of Chicago Press
© 2018 by the National Bureau of Economic Research
in NBER Book Series Studies in Income and Wealth

The Affordable Care Act (ACA) will dramatically alter health insurance markets and the sources through which individuals obtain coverage. As the ACA is implemented, it is essential to monitor the intended and the unintended consequences of these regulations. To evaluate the changes in health insurance markets linked to the ACA, it is critical to consistently measure the size and structure of health insurance markets, as well as the performance of participating health insurers, prior to and post-ACA. In this paper we discuss challenges of describing the size, structure, and performance of the individual and small group markets. Next, we discuss improvements in data availability starting in 2010 to address some of these concerns. Finally, using data from the National Association of Insurance Commissioners (NAIC), we evaluate insurance market structure and performance during 2010-2012, focusing on enrollment, the number of participating insurers, premiums, claims spending, MLR, and administrative expenses.

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This chapter first appeared as NBER working paper w19719, Going into the Affordable Care Act: Measuring the Size, Structure and Performance of the Individual and Small Group Markets for Health Insurance, Pinar Karaca-Mandic, Jean M. Abraham, Kosali Simon, Roger Feldman
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