Summary
The Affordable Care Act (ACA) introduced reforms to mitigate adverse selection into and within the individual insurance market. Authors examine the traits and predicted medical spending of enrollees in California post-ACA using 2,013 enrollees in individual market plans, on- and off-exchange, comparing actual versus potential participants using data from the 2014 California Health Interview Survey on respondents who were individually insured or uninsured.
Authors found the average predicted spending was similar for actual ($3,377) and potential participants ($3,257); however, some vulnerable subgroups were underrepresented. On- versus off-exchange enrollees differed in sociodemographic and health traits with modest differences in spending ($3,448 vs. $3,175). Authors found no evidence of selection into the overall insurance pool in 2014; however, differences by exchange status reflect the importance of including off-exchange enrollees in analyses and the pool for risk adjustment. California's post-ACA individual market has been a relative success, highlighting the importance of state policies and outreach efforts to encourage participation in the market.
Publication Authors:
- Vicki Fung
- et al