Last December, the Journal of Health Politics, Policy and Law published a fascinating article by Sam Trachtman.** He looked at a relevant policy-politics feedback loop. What did ACA premiums look like for non-subsidized individuals in Republican and Democratic leaning counties?
Insurers have increased marketplace premiums at higher rates in areas with more Republican voters. In the preferred model specification, a 10-percentage-point difference in Republican vote share is associated with a 3.2-percentage-point increase in average premium growth for a standard plan….
One way to investigate this dynamic is to look at geographic variation in premiums. In particular, premiums would be expected to be higher in areas with more Republican partisans. Figure 1 demonstrates that in 2017, there was a strong positive relationship between county-level Republican voting and individual marketplace premiums, while this relationship was slightly negative in 2014. This suggests that insurers systematically underestimated health spending in Republican-leaning areas relative to Democratic-leaning areas, a pattern that could be attributable to the interaction between partisanship-motivated enrollment and adverse selection….
Recent scholarship indicates that the uptake decisions that individuals make with respect to the ACA are driven in part by their political partisanship. Using individual-level survey data from Kaiser Health Tracking polls, Lerman, Sadin, and Trachtman (2017) estimate that, ceteris paribus, Republicans are 6 percentage points more likely to forgo coverage than Democrats, 12 percentage points less likely to use the ACA marketplaces, and 7 percentage points more likely than Democrats to purchase plans off-marketplace. Analysis of Cooperative Congressional Election Study (CCES) data yields similar conclusions (Tesler 2015).
People process information through subjective lenses. Partisanship is a major lens through which health and health insurance information has been processed over the past decade.
** Samuel Trachtman; Polarization, Participation, and Premiums: How Political Behavior Helps Explain Where the ACA Works, and Where It Doesn’t. J Health Polit Policy Law 1 December 2019; 44 (6): 855–884. doi: https://doi.org/10.1215/03616878-7785787