Polarisation and Public Policy: Political Adverse Selection under Obamacare

• 成果类型: Article; Early Access
• 署名作者: Bursztyn, Leonardo; Kolstad, Jonathan; Rao, Aakaash; Tebaldi, Pietro; Yuchtman, Noam
• 署名单位: University of Chicago; National Bureau of Economic Research; University of California System; University of California Berkeley; Harvard University; Columbia University; University of London; London School Economics & Political Science; Centre for Economic Policy Research - UK
• 刊物名称: ECONOMIC JOURNAL
• ISSN/ISSBN: 0013-0133
• DOI: 10.1093/ej/ueaf079
• 发表日期: 2026
• 关键词: health-insurance; CONSEQUENCES; partisanship; COMPETITION; PRIVATE

摘要

Politicising policies designed to address market failures can diminish their effectiveness. We document a pattern of 'political adverse selection' in the health insurance exchanges established under the Affordable Care Act (colloquially, 'Obamacare'): Republicans enrolled at lower rates than Democrats and independents, a gap driven by healthier Republicans. This selection raised public subsidy spending by approximately $155 per enrollee annually (3.2% of average cost). We fielded a survey to show that this selection does not exist for other insurance products. Lower enrolment and higher costs are concentrated in more Republican areas, potentially contributing to polarised views of the policy.