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Moral hazard induced unraveling: Theory and evidence from the Affordable Care Act
Journal article   Open access   Peer reviewed

Moral hazard induced unraveling: Theory and evidence from the Affordable Care Act

Cameron M. Ellis, Meghan I. Esson and Eli Liebman
The Journal of risk and insurance
08/21/2026
DOI: 10.1111/jori.70075
url
https://doi.org/10.1111/jori.70075View
Published (Version of record) Open Access

Abstract

We identify and quantify a new form of welfare loss in insurance markets. We first show theoretically that moral hazard from subsidies for cost‐sharing combined with community rating mimics adverse selection and can unravel insurance markets. To quantify the potential welfare loss, we use exogenous variation in the number of subsidized enrollees on the ACA exchanges. We find that subsidy‐induced moral hazard led to higher premiums, which has lowered enrollment among the unsubsidized by 6.2 percentage points. We estimate the welfare costs of this “moral hazard induced unraveling” to be around 25% of the total welfare loss.
asymmetric information insurance market failure moral hazard unraveling

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