Mark Pauly, PhD

Effects of the ACA on Health Care Cost Containment

Issue Brief
Mar. 2, 2017

This brief reviews the evidence on how key ACA provisions have affected the growth of health care costs. Coverage expansions produced a predictable jump in health care spending, amidst a slowdown that began a decade ago. Although we have not returned to the double-digit increases of the past, the authors find little evidence that ACA cost containment provisions produced changes necessary to “bend the cost curve.” Cost control will likely play a prominent role in the next round of health reform and will be critical to sustaining coverage gains in the long term.

How to Save the Individual Insurance Market Post-ACA

Feb. 10, 2017

[cross-posted from the Health Cents blog on]

Just 6% of people under age 65 buy health insurance on the individual market (rather than getting it through their jobs), but the political debate about how to arrange insurance for them is causing great turmoil and has revived discussion of the individual mandate.

Exchanges Can Survive End of Individual Mandate

Jan. 23, 2017

One of the many scary trial balloons being floated by the Administration as part of its first 100 days is to abolish enforcement of the individual mandate. That mandate imposes a penalty of $695 per person, or 2.5% of income per family, for people who fail to obtain qualified health insurance. It isn’t much of a penalty because about half of the uninsured can get exemptions and the penalties are small relative to premiums.

Hospitals' Smoker Non-Hiring Debate

Aug. 6, 2013

The recent debate about the ethics of a health system's decision to refuse to hire new workers who smoke was understandably couched in the framework of ethics. But hiring a worker -- buying labor -- is an economic transaction that occurs in a market, and so it may be useful to discuss the economic framework as well.