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Take-Up, Drop-Out, and Spending in ACA Marketplaces
National Bureau of Economic Research [NBER]; purchase required for full document Link to more items from this source
June 4, 2018
"Enrollees who drop out re-time health spending to the months of insurance coverage. This drop-out behavior generates a new type of adverse selection: insurers face high costs relative to the premiums collected when they enroll strategic consumers.... [T]he pattern of attrition undermines market stability and can drive insurers to exit, even absent differences in enrollees' underlying health risks.... [I]nsurers largely shift the costs of attrition to non-drop-out enrollees, whose inertia generates low price sensitivity."

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