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

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.

Association of Medicaid Expansion Under the Patient Protection and Affordable Care Act With Use of Long-term Care

“…In addition, our results could have combined ACA Medicaid expansion with other unobserved policy feedback loops. 24 To minimize bias from the possibility of unobserved policy feedback loops, the models included time and state-level fixed effects.…”

Polarization and public health: Partisan differences in social distancing during the coronavirus pandemic

“…Differences in risk aversion would not explain the differences in beliefs we find in Section 5, but are a possible complementary explanation for the observed partisan gap in social distancing. Trachtman 2019;Krupenkin 2018;Suryadevara et al 2019;Long et al 2019).…”

Competing Public and Private Television Advertising Campaigns and Marketplace Enrollment for 2015 to 2018

“…Thus, we cannot distinguish among enrollees who identify as Republican who are exposed to anti-ACA political messaging and who enroll despite the counter message, those of any political orientation who are simply reminded of health insurance options regardless of its political rhetoric, or enrollees who identify as Democrats who enroll in a sort of backlash to the political messaging (or for anyone, regardless of partisanship, who enroll out of concern of the potential for later repeal). We know from other research that Republicans' uptake of Marketplace plans may have been lower than Democrats', which is challenging to square with our findings without knowledge of individual partisanship in our study (Lerman, Sadin, and Trachtman 2017;Trachtman 2019). Future work is needed to replicate these findings and continue to examine how the polarized information environment competes in shaping consumers' health insurance behavior.…”