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CHAPTER 2. HEALTH PLAN CHOICE 99 the employer level. One important point about risk-rated premiums in health insurance is that coverage is typically purchased on an annual basis. While risk-rating might increase static efficiency, it exposes households to reclassification risk as their health status changes over time. This is one argument for community rating or nondiscrimation in employer contributions. It is interesting to ask whether there are ways to promote static efficiency that nevertheless mitigate reclassification risk. One natural approach is to ensure that consumers have a baseline option whose price is independent of risk, and allow incremental purchases to be risk-rated. An alternative would be longer- term contracts that provide dynamic insurance (e.g., ?). Understanding the dynamic aspects of health insurance are an important challenge for future empirical work. 2.7 Appendix to Chapter 2 This Appendix compares our demand estimates to the broader literature on health plan choice, and discusses alternative specifications of the consumer demand model. 2.7.1 Comparison to Demand Estimates in Other Settings As reported in Table 2.4, we find that on average a $100 dollar increase in the annual enrollee contribution decreases market share by 7 to 9 percent. Studies in similar settings vary in their method for reporting elasticities. Following ?, we reconcile the estimates of price elasticity across studies by converting them to semi-elastiticies (calculated as the percent change in market share in response to a $100 increase in the employee contribution). Because the studies cover different time periods, we adjust the change in the employee contribution for inflation. After making these adjustments, most studies estimate semi- elastiticities in the range of -1.5 to -4.3 for the main specifications (????). Estimates from ? are somewhat higher (ranging from -2.4 to -9.6 for the main specifications and even higher in some models). Similarly, ?, who analyze retirees, have an estimate that implies a semi-elastiticity of -9.0.
CHAPTER 2. HEALTH PLAN CHOICE 100 2.7.2 Alternative Specifications of the Demand Model As we discuss in the main text, the estimates of risk and price elasticity are key parameters for our welfare calculations. Table 2.9 provides additional estimates of the demand model to examine the sensitivity of these parameters. Column 1 of Ta- ble 2.9 repeats the first specification of Table 2.4 as a baseline. This specification pools data from enrollees in different coverage tiers, increasing the sample size and generating additional variation in plan contributions due to the higher pass-through rates for dependent coverage tiers, but requires us to make assumptions about household aggregation. We test whether our estimates are sensitive to these assumptions by restricting the sample to employees purchasing employee-only coverage (Column 2) and controlling for family structure in our full-sample specification (Column 3). Both variations give similar results to our baseline specification (Column 1). While the estimate of the effect of being a high risk individual on demand for the network PPO is smaller in magnitude in the employee-only sample (Column 2), the estimate is imprecise likely because it is identified by a small number of enrollees. When we include controls for family structure in the model estimated on the full sample, we find that families with a spouse seem to prefer the PPO relative to the average household (Column 3). As discussed in Section 2.5.4 , we develop different instruments to exploit alternative sources of identifying variation in employee contributions, testing the robustness of our estimates to different exogeneity assumptions. In Table 2.4 (Columns 2 and 3), we demonstrate that the estimate of the price effect is robust to across-plan variation in employer contribution setting. To address the concern that employer contribution rates may be systematically influenced by employee preferences, we instrument for employee contributions with a variant of the contribution model in which the the pass-through coefficients are restricted to be identical across firms (Column 4). We view the concern that insurer bids are correlated with household preferences to be diminished because of the limited information insurers have in our setting. Never- theless we report a specification where we include predicted bids in the contribution model (Column 5). The results from both these specifications are similar although with larger standard errors.
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ESSAYS IN PUBLIC FINANCE AND INDUST
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I certify that I have read this dis
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insurance choice. Among other thing
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Acknowledgements I am deeply thankf
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Contents Preface iv Acknowledgement
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2.5.3 The Value of Plan Choice ....
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List of Tables 1.1 Asset Exemption
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4.9 First Week Contract Spending fo
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4.3 I.T. Contracting by Week ......
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CHAPTER 1. BANKRUPTCY 2 of the dead
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CHAPTER 1. BANKRUPTCY 4 relevant le
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CHAPTER 1. BANKRUPTCY 12 newly edit
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CHAPTER 1. BANKRUPTCY 28 to seizabl
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CHAPTER 1. BANKRUPTCY 31 CARA utili
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CHAPTER 1. BANKRUPTCY 33 Puzzle 3:
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CHAPTER 1. BANKRUPTCY 35 of income
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CHAPTER 1. BANKRUPTCY 40 TaxSim pro
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Payments CHAPTER 1. BANKRUPTCY 42 $
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OOP payments CHAPTER 1. BANKRUPTCY
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ln(seizable sssets) CHAPTER 1. BANK
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