Dissertation
Three essays on the effects of the Affordable Care Act on insurance coverage, health, and cost of coverage
University of Iowa
Doctor of Philosophy (PhD), University of Iowa
Autumn 2022
DOI: 10.25820/etd.006663
Abstract
One of the goals of the Patient Protection Affordable Care Act was to improve access to affordable coverage by creating the HIMs, mandating coverage, and expanding Medicaid eligibility. However, federal legislative and regulatory changes have led to rising premiums, insurer exit, and disenrollment from the health insurance marketplaces (HIM). Public health and economic crises during the pandemic may have reversed the health gains through Medicaid expansion. In this dissertation, I empirically examine factors that may have contributed to declining enrollment, health, and affordability of coverage. Specifically, in the first study, I employ a difference-differences and synthetic control methods model to examine the effect of the state-based individual mandate on insurance coverage and enrollment. In the second study, I assess the protective effects of the Medicaid expansion on adverse mental health during the pandemic using a difference-in-differences model. In the third paper, I use a difference-in-differences and synthetic control method to examine the effect of the section 1332 reinsurance program on premiums and insurer participation.
Details
- Title: Subtitle
- Three essays on the effects of the Affordable Care Act on insurance coverage, health, and cost of coverage
- Creators
- Onyinye Oyeka
- Contributors
- George L Wehby (Advisor)Dan Shane (Committee Member)Kanika Arora (Committee Member)Hari Sharma (Committee Member)Keith Mueller (Committee Member)
- Resource Type
- Dissertation
- Degree Awarded
- Doctor of Philosophy (PhD), University of Iowa
- Degree in
- Health Services and Policy
- Date degree season
- Autumn 2022
- DOI
- 10.25820/etd.006663
- Publisher
- University of Iowa
- Number of pages
- xii, 159 pages
- Copyright
- Copyright 2022 Onyinye Oyeka
- Language
- English
- Description illustrations
- illustrations, graphs, tables
- Description bibliographic
- Includes bibliographical references (pages 89-104).
- Public Abstract (ETD)
The Patient Protection and Affordable Care Act (ACA) introduced dramatic changes to the health insurance industry with the primary goal of increasing access to affordable coverage and improving access to health care. To accomplish this goal, the law implemented health insurance market reforms to both induce demand for health coverage and supply of health insurance. Though health insurance market reforms have reduced the number of uninsured non-elderly Americans, plan affordability in the health insurance marketplaces remains a key area of concern for enrollees and policymakers. Similarly, realized health benefits as a result of Medicaid expansion may have been undone given the recent COVID-19 pandemic.
Using national datasets and a combination of models aimed at causal inference, this dissertation will provide evidence on the effects of policy changes related to insurance on enrollment, health, and cost of coverage. The dissertation has three aims. The first aim of this dissertation is to examine the effects of repealing the federal individual mandate penalty in 2019 on private health insurance coverage and marketplace enrollment by leveraging state-based mandates in Massachusetts and New Jersey. The second aim investigates the effect of Medicaid expansion on self-reported mental health during the first year of the pandemic in 2020. The last aim evaluates the effect of the state-based reinsurance program on coverage affordability and insurer participation.
- Academic Unit
- Health Management and Policy
- Record Identifier
- 9984362857302771
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