8. The Perfect Market

This page contains additional references for Chapter 8 of Responding to Healthcare Reform: A Strategy Guide for Heatlhcare Leaders.  The most current additions are at the top of the page.  It also includes the annotated references from the book and their associated hyperlinks.

Current References

The Oregon Health Insurance Experiment: Evidence from the First Year, Amy Finkelstein, Sarah Taubman, Bill Wright, Mira Bernstein, Jonathan Gruber, Joseph P. Newhouse, Heidi Allen, Katherine Baicker, The Oregon Health Study Group, NBER Working Paper No. 17190, Issued in July 2011

Abstract: In 2008, a group of uninsured low-income adults in Oregon was selected by lottery to be given the chance to apply for Medicaid. This lottery provides a unique opportunity to gauge the effects of expanding access to public health insurance on the health care use, financial strain, and health of low-income adults using a randomized controlled design. In the year after random assignment, the treatment group selected by the lottery was about 25 percentage points more likely to have insurance than the control group that was not selected. We find that in this first year, the treatment group had substantively and statistically significantly higher health care utilization (including primary and preventive care as well as hospitalizations), lower out-of-pocket medical expenditures and medical debt (including fewer bills sent to collection), and better self-reported physical and mental health than the control group.

Massachusetts Connector:: https://www.mahealthconnector.org/portal/site/connector/


Kavita Patel and John McDonough. “From Massachusetts To 1600 Pennsylvania Avenue: Aboard The Health Reform ExpressHealth Affairs June 2010 29:1106-1111; doi:10.1377/hlthaff.2010.0429

Abstract: The journey of national health reform legislation from concept to President Barack Obama’s desk was long and winding, but not without important guideposts. Core elements of Massachusetts’ 2006 health reform—near-universal, affordable coverage; changes in the small-group and individual insurance markets; and an individual mandate to obtain insurance—provided a road map for policy makers charting national health reform. Our experience with the Massachusetts reform informed our work on the Senate Health, Education, Labor, and Pensions Committee in 2008 and 2009. We compare national and Massachusetts health reforms and analyze their implications for the future.


Sean D. Sullivan. “US health care reform: a work in progress. The European Journal of Health Economics Volume 11, Number 2, 117-118, DOI: 10.1007/s10198-010-0225-7

Intro: In January, the largest US health insurer, Wellpoint, announced that it would raise annual premiums by between 30 and 39% in 2010 for individual members in its Anthem Blue Cross plan of California. The rate increase comes just days after it announced earnings of $4.7 billion in 2009. The health insurer claims the bad economy and rising health care costs are to blame for the rate increases. The largest rate increase will be felt in the individual insurance markets—that is, for customers who purchase insurance directly rather than through an employer. Many of the 800,000 individual members in the California subsidiary will not be able to afford these increases and will likely join the 45 million Americans without health care coverage. Such stories give rich texture to the ongoing health care debate in the US.

Annotated References from Responding to Reform

Chollet, D., and S. Liu. 2005. “The Elephants in Your Back Yard: Monopolistic Pricing in Health Insurance Markets.” Abstacts AcademyHealth Meeting 22: (Abstract no. 3486).

Eibner, C., P. S. Hussey, and F. Girosi. 2010, “The Effects of the Affordable Care Act on Workers’ Health Insurance Coverage.” New England Journal of Medicine 363 (15): 1393-95.

Grier, P. 2010. “New Jolt for Healthcare Reform? Insurer Hikes Rates 39 Percent.” The Christian Science Monitor. [Online article; published 2/11/10.] www.csmonitor.com/USA/Politics/2010/0211/New-jolt-for-healthcare-reform-Insurer-hikes-rates-39-percent

Health Connector. 2010. www.mahealthconnector.org/portal/site/connector
The Massachusetts version of its health insurance exchange, called the “Health Connector.”

The Massachusetts health care insurance reform law, enacted in 2006, mandates that nearly every resident of Massachusetts obtain a state-government–regulated minimum level of healthcare insurance coverage and provides free healthcare insurance for residents earning less than 150 percent of the federal poverty level (FPL) who are not eligible for Mass Health (Medicaid). The law also partially-subsidizes healthcare insurance for those earning up to 300 percent of the FPL.

The number of people insured as of December 2009 was 5,473,000, not counting Medicare enrollees (see same report). Depending on population growth, about 4 percent of the population is uninsured

Wilper, A. P., S. Woolhandler, K. E. Lasser, D. McCormick, D. H. Bor, and D. U. Himmelstein. 2009. “Hypertension, Diabetes, and Elevated Cholesterol among Insured and Uninsured U.S. Adults.” Health Affairs 28 (6): w1151.


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