Public Insurance Design
Public insurance programs in the U.S. increasingly rely on private insurers to deliver coverage, most notably through Medicare Advantage and Medicaid managed care. These programs are built around the idea of managed competition, in which insurers compete for enrollees under regulated payment, subsidy, and risk-adjustment schemes. A central question in this literature is whether competition in these settings benefits consumers or instead generates rents for insurers, depending on how program rules are designed.
One strand of this literature studies subsidy design, pass-through, and insurer incentives in public insurance markets. Empirical evidence from Medicare Advantage shows that poorly designed subsidies may be incompletely passed through to consumers, leading to higher insurer profits rather than lower premiums. These papers highlight the importance of benchmark rules, bidding incentives, and regulatory constraints in shaping equilibrium outcomes (Cabral, Geruso, and Mahoney (2018); V. Curto et al. (2021)).
A related strand examines public versus private provision of health insurance, reflecting growing interest in the consequences of privatization within public programs. As enrollment in Medicaid managed care and Medicare Advantage has expanded, researchers have studied how private provision affects costs, access, and consumer outcomes relative to traditional public insurance. This work emphasizes tradeoffs between efficiency, selection, and administrative complexity, and remains an active area of research (Layton et al. (2019); Macambira et al. (2022)).
Finally, recent work explores new directions in expanding access and affordability in health insurance markets, often motivated by ongoing policy debates. These papers evaluate reforms aimed at improving coverage and affordability, with a focus on welfare implications and distributional effects, and highlight open questions about how best to design insurance systems that balance access, cost, and efficiency (Geddes and Schnell (2023); V. E. Curto (2023)).
Potential papers for presentation today include
- Cabral, Geruso, and Mahoney (2018) — subsidies, pass-through, and insurer incentives in Medicare Advantage
- V. Curto et al. (2021) — competition and consumer outcomes in regulated insurance markets
- Layton et al. (2019) — public versus private provision in health insurance