Brian Blase - Academia.edu (original) (raw)
Papers by Brian Blase
First, I acknowledge the economics faculty at George Mason University, particularly my dissertati... more First, I acknowledge the economics faculty at George Mason University, particularly my dissertation chair, Thomas Stratmann, as well as Alex Tabarrok and Bryan Caplan for teaching me about how to use economics to understand the world and think about public policy. The knowledge and skills that I have learned through George Mason University's economics program have been extremely valuable in my career as a policy analyst at the Heritage Foundation and now as the lead health care staffer for the House Committee on Oversight and Government Reform. I also acknowledge the valuable assistance and encouragement of Professor Stratmann as well as my dissertation advisors Professor Tabarrok, Len Nichols, and Robert Book which was necessary for the completion of my dissertation. I acknowledge the love, support, and encouragement of my parents. I also acknowledge the greatest gifts in my life-Evan, Spencer, and Andrewand I look forward to teaching them economics and especially about the law of unintended consequences. v
• The ACA significantly expanded insurance coverage between 2013 and 2017, but Americans' health ... more • The ACA significantly expanded insurance coverage between 2013 and 2017, but Americans' health worsened during this period as life expectancy declined for three consecutive years from 2014 to 2017. • States that did not adopt Medicaid expansion had favorable mortality trends from 2013 to 2017 compared with states that adopted the expansion, in part because they had fewer people die from opioid overdoses. • Medicaid expansion was associated with improvements in self-reported health and greater financial peace of mind, with mixed evidence on physical health benefits. It was associated with a decline in mortality for those near retirement age. • The bulk of the evidence suggests that targeted health programs, including those geared toward children, prove to be far better public investments than does a massive Medicaid expansion. • Large coverage expansions disappoint for several reasons: the uninsured receive nearly 80 percent as much care as similar insured people, the crowd-out of private coverage, and indirect effects on others such as longer wait times for care. 1 This study was peer-reviewed. 2 In 2013, the Congressional Budget Office (CBO) estimated there would be 25 million enrollees in the ACA exchanges in 2019. It turns out that there were fewer than 10 million (Congressional Budget Office 2020).
SSRN Electronic Journal, 2019
Enrollment in state-optional Medicaid expansions has significantly exceeded even the most optimis... more Enrollment in state-optional Medicaid expansions has significantly exceeded even the most optimistic forecasts. The open-ended federal financing of new adult Medicaid enrollees at elevated match rates-in excess of 90 percent-creates incentives for states and healthcare providers to improperly enroll new beneficiaries and inadequately monitor costs and eligibility. Several sources find that many states have done a poor job ensuring Medicaid enrollment only of those who meet eligibility requirements. First, several federal audits find massive problems with both incomplete and incompetent reviews and large-scale improper eligibility determinations. We summarize recent work that estimates causal effects of Medicaid expansions on enrollment. Using the publicly available American Community Survey, we demonstrate large increases in potentially improper enrollment from 2012 to 2017 in many expansion states across the United States. The evidence points to egregious eligibility errors in many states, including Arkansas,
SSRN Electronic Journal, 2018
One of the more controversial parts of the Affordable Care Act (ACA) is its expansion of Medicaid... more One of the more controversial parts of the Affordable Care Act (ACA) is its expansion of Medicaid. A new study from the Mercatus Center at George Mason University reviews Medicaid's longstanding problems, discusses the incentives states face as a result of the elevated federal reimbursement rate for the ACA Medicaid expansion population, and analyzes the impact of the expansion.
SSRN Electronic Journal, 2018
The ACA significantly altered the rules governing the individual insurance market, and the genera... more The ACA significantly altered the rules governing the individual insurance market, and the general effect was to lower premiums for older and less healthy people and raise premiums for younger and healthier people. To induce younger and healthier people to enroll, the law contained the individual mandate and subsidies for both buyers and, for the first few years of the program, sellers of insurance in the form of premium stabilization programs. This study analyzes data from HHS from 2014, the first year of the ACA's implementation, and finds that insurers suffered significant losses despite eventually receiving much larger payments from the law's reinsurance program (one of the premium stabilization programs) than they expected when setting their 2014 premiums. Given the same population and same utilization of services from that population, insurers would have had to price average premiums more than 25 percent higher to avoid losses in the absence of the reinsurance program. While insurers' performance varied significantly across carriers and states, the large overall losses in 2014 raise questions about the long-term stability of the changes made by the ACA, particularly after 2016 when the reinsurance and risk corridor programs end and premium revenue must be sufficient to cover expenses.
SSRN Electronic Journal, 2018
The Affordable Care Act (ACA) placed numerous requirements on insurance offered in both the indiv... more The Affordable Care Act (ACA) placed numerous requirements on insurance offered in both the individual and small group markets. This study presents data from the 174 insurers that offered qualified health plans (QHPs)-plans that satisfy the ACA requirements and are certified to be sold on exchanges-in both the individual and small group markets in 2014. QHPs in both markets are essentially the same and are governed by nearly identical regulations, making possible a better-controlled analysis of the performance of insurers participating in the two markets. Average medical claims for individual QHP enrollees were 24 percent higher than average medical claims for group QHP enrollees. Moreover, average medical claims for individual QHP enrollees were 93 percent higher than average medical claims for individual non-QHP enrollees. As a result, insurers made large losses on individual QHPs despite receiving premium income that was 45 percent higher for individual QHP enrollees than for individual non-QHP enrollees. These higher medical claims resulted in loss ratios for individual QHPs nearly 30 percentage points higher than loss ratios in other markets. Given that insurer performance selling individual QHPs worsened in 2015, these findings suggest that the ACA rules and regulations governing QHPs may be incompatible with a well-functioning insurance market even with subsidies to insurers and incentives for individuals to enroll in QHPs.
SSRN Electronic Journal, 2018
When the Patient Protection and Affordable Care Act (ACA) was signed into law in 2010, many group... more When the Patient Protection and Affordable Care Act (ACA) was signed into law in 2010, many groups projected how many people would enroll in health insurance plans satisfying the law's new rules and requirements (ACA plans). Nearly six years later, enrollment in health insurance exchange plans is far short of initial projections, particularly for people who earn too much to qualify for subsidies to reduce high ACA plan deductibles. The dearth of exchange enrollees with at least a middle-class income indicates that the individual mandate is not motivating as many people, particularly younger, healthier, and wealthier people, to purchase coverage as was originally expected. Large insurer losses on ACA plans show that the overall risk pool is sicker and much more costly than originally projected, and are an indication that the law may require significant revision in order to avoid causing an adverse-selection spiral.
ABSTRACT for their helpful research assistance.
SSRN Electronic Journal, 2018
The Mercatus Center gratefully acknowledges the financial support of the John Templeton Foundatio... more The Mercatus Center gratefully acknowledges the financial support of the John Templeton Foundation for research on healthcare policy in the United States.
First, I acknowledge the economics faculty at George Mason University, particularly my dissertati... more First, I acknowledge the economics faculty at George Mason University, particularly my dissertation chair, Thomas Stratmann, as well as Alex Tabarrok and Bryan Caplan for teaching me about how to use economics to understand the world and think about public policy. The knowledge and skills that I have learned through George Mason University's economics program have been extremely valuable in my career as a policy analyst at the Heritage Foundation and now as the lead health care staffer for the House Committee on Oversight and Government Reform. I also acknowledge the valuable assistance and encouragement of Professor Stratmann as well as my dissertation advisors Professor Tabarrok, Len Nichols, and Robert Book which was necessary for the completion of my dissertation. I acknowledge the love, support, and encouragement of my parents. I also acknowledge the greatest gifts in my life-Evan, Spencer, and Andrewand I look forward to teaching them economics and especially about the law of unintended consequences. v
• The ACA significantly expanded insurance coverage between 2013 and 2017, but Americans' health ... more • The ACA significantly expanded insurance coverage between 2013 and 2017, but Americans' health worsened during this period as life expectancy declined for three consecutive years from 2014 to 2017. • States that did not adopt Medicaid expansion had favorable mortality trends from 2013 to 2017 compared with states that adopted the expansion, in part because they had fewer people die from opioid overdoses. • Medicaid expansion was associated with improvements in self-reported health and greater financial peace of mind, with mixed evidence on physical health benefits. It was associated with a decline in mortality for those near retirement age. • The bulk of the evidence suggests that targeted health programs, including those geared toward children, prove to be far better public investments than does a massive Medicaid expansion. • Large coverage expansions disappoint for several reasons: the uninsured receive nearly 80 percent as much care as similar insured people, the crowd-out of private coverage, and indirect effects on others such as longer wait times for care. 1 This study was peer-reviewed. 2 In 2013, the Congressional Budget Office (CBO) estimated there would be 25 million enrollees in the ACA exchanges in 2019. It turns out that there were fewer than 10 million (Congressional Budget Office 2020).
SSRN Electronic Journal, 2019
Enrollment in state-optional Medicaid expansions has significantly exceeded even the most optimis... more Enrollment in state-optional Medicaid expansions has significantly exceeded even the most optimistic forecasts. The open-ended federal financing of new adult Medicaid enrollees at elevated match rates-in excess of 90 percent-creates incentives for states and healthcare providers to improperly enroll new beneficiaries and inadequately monitor costs and eligibility. Several sources find that many states have done a poor job ensuring Medicaid enrollment only of those who meet eligibility requirements. First, several federal audits find massive problems with both incomplete and incompetent reviews and large-scale improper eligibility determinations. We summarize recent work that estimates causal effects of Medicaid expansions on enrollment. Using the publicly available American Community Survey, we demonstrate large increases in potentially improper enrollment from 2012 to 2017 in many expansion states across the United States. The evidence points to egregious eligibility errors in many states, including Arkansas,
SSRN Electronic Journal, 2018
One of the more controversial parts of the Affordable Care Act (ACA) is its expansion of Medicaid... more One of the more controversial parts of the Affordable Care Act (ACA) is its expansion of Medicaid. A new study from the Mercatus Center at George Mason University reviews Medicaid's longstanding problems, discusses the incentives states face as a result of the elevated federal reimbursement rate for the ACA Medicaid expansion population, and analyzes the impact of the expansion.
SSRN Electronic Journal, 2018
The ACA significantly altered the rules governing the individual insurance market, and the genera... more The ACA significantly altered the rules governing the individual insurance market, and the general effect was to lower premiums for older and less healthy people and raise premiums for younger and healthier people. To induce younger and healthier people to enroll, the law contained the individual mandate and subsidies for both buyers and, for the first few years of the program, sellers of insurance in the form of premium stabilization programs. This study analyzes data from HHS from 2014, the first year of the ACA's implementation, and finds that insurers suffered significant losses despite eventually receiving much larger payments from the law's reinsurance program (one of the premium stabilization programs) than they expected when setting their 2014 premiums. Given the same population and same utilization of services from that population, insurers would have had to price average premiums more than 25 percent higher to avoid losses in the absence of the reinsurance program. While insurers' performance varied significantly across carriers and states, the large overall losses in 2014 raise questions about the long-term stability of the changes made by the ACA, particularly after 2016 when the reinsurance and risk corridor programs end and premium revenue must be sufficient to cover expenses.
SSRN Electronic Journal, 2018
The Affordable Care Act (ACA) placed numerous requirements on insurance offered in both the indiv... more The Affordable Care Act (ACA) placed numerous requirements on insurance offered in both the individual and small group markets. This study presents data from the 174 insurers that offered qualified health plans (QHPs)-plans that satisfy the ACA requirements and are certified to be sold on exchanges-in both the individual and small group markets in 2014. QHPs in both markets are essentially the same and are governed by nearly identical regulations, making possible a better-controlled analysis of the performance of insurers participating in the two markets. Average medical claims for individual QHP enrollees were 24 percent higher than average medical claims for group QHP enrollees. Moreover, average medical claims for individual QHP enrollees were 93 percent higher than average medical claims for individual non-QHP enrollees. As a result, insurers made large losses on individual QHPs despite receiving premium income that was 45 percent higher for individual QHP enrollees than for individual non-QHP enrollees. These higher medical claims resulted in loss ratios for individual QHPs nearly 30 percentage points higher than loss ratios in other markets. Given that insurer performance selling individual QHPs worsened in 2015, these findings suggest that the ACA rules and regulations governing QHPs may be incompatible with a well-functioning insurance market even with subsidies to insurers and incentives for individuals to enroll in QHPs.
SSRN Electronic Journal, 2018
When the Patient Protection and Affordable Care Act (ACA) was signed into law in 2010, many group... more When the Patient Protection and Affordable Care Act (ACA) was signed into law in 2010, many groups projected how many people would enroll in health insurance plans satisfying the law's new rules and requirements (ACA plans). Nearly six years later, enrollment in health insurance exchange plans is far short of initial projections, particularly for people who earn too much to qualify for subsidies to reduce high ACA plan deductibles. The dearth of exchange enrollees with at least a middle-class income indicates that the individual mandate is not motivating as many people, particularly younger, healthier, and wealthier people, to purchase coverage as was originally expected. Large insurer losses on ACA plans show that the overall risk pool is sicker and much more costly than originally projected, and are an indication that the law may require significant revision in order to avoid causing an adverse-selection spiral.
ABSTRACT for their helpful research assistance.
SSRN Electronic Journal, 2018
The Mercatus Center gratefully acknowledges the financial support of the John Templeton Foundatio... more The Mercatus Center gratefully acknowledges the financial support of the John Templeton Foundation for research on healthcare policy in the United States.