Comment on: The Early Impact of the Affordable Care Act::
This very interesting paper by Amanda Kowalski tells me that costs have risen by a lot in many places. I am surprised
That suggests to me that many of the previously uninsured were not low-value consumers, the kind who would not demand much health care, as we saw in the case in Massachusetts.
That foregone consumer surplus caused by not insuring the uninsured earlier has thus turned out to be very much bigger in the pre-ACA regime than I had thought. And so the potential positive social welfare effects of the ACA are significantly greater than I had believed likely.
Moreover, the paper seems to me to imply that the division of the surplus from subsidies between insurance companies on the one hand and consumers on the other is very different between the states that have aggressively pursued ACA enforcement and those that have not. In the passive and nonimplementing states--the nullification states--insurance companies appear to have grabbed a greater amount of the surplus. I wonder if that might explain some of the absence of a strong insurance lobby in nullification states for more aggressive implementation? Non-implementation means that insurance companies forego some of the potential subsidy pool. But it also means that the pressures in the ACA that would increase market competition are also largely absent.