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Dissertation Defense: Bradley Finnegan

Title: Consumer Choice in the Affordable Care Act’s Health Insurance Marketplaces  | Date: Wednesday, July 5  |  Time: 1-4pm  |  Location: 6th Fl. Conf. Rm. – 950 NH Ave.  |  Committee: Leighton Ku, PhD. (Chair, TSPPPA and Dept. of Health Policy and Management), Sara Rosenbaum, JD (TSPPPA and Dept. of Health Policy and Management), Lorens A. Helmchen, PhD (Dept. of Health Policy and Management)

Abstract: The Patient Protection and Affordable Care Act (ACA) expanded access to both public and private health insurance.  Access to private health insurance was expanded via state insurance exchanges and the federally-facilitated marketplace where customers can compare and purchase private health insurance plans.  The ACA substantially altered how commercial health insurance is sold by prohibiting price variations based on health status and minimizing the factors that drive health insurance pricing.  The exchanges empower customers to choose between health plans based on plan benefits and costs, providing transparent information regarding plan features and facilitating side-by-side comparisons.  This dissertation explores the key health plan characteristics and customer demographics that drive health plan choice.  Data from the Washington Health Benefit Exchange are used to estimate the effects each of these factors have on health plan choice.  The results from this three-essay dissertation suggest that out-of-pocket maximum is key factor health plan choice.  In addition, lower income customers eligible for cost-sharing reductions are choosing health plans that do not offer this enhanced savings. In addition, households with mixed eligibility between Medicaid and tax credits are selecting commercial plans offered by traditional Medicaid MCOs rather than commercial insurers. These results suggest consumer protections such as those within the ACA should be central to future health care reform efforts and should encourage exchanges to improve decision-support tools to facilitate health plan choice. Finally, states should explore policies that can capitalize on the enhanced market position of commercial plans offered by Medicaid MCOs.


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