In New England, Partisan Differences In ACA Marketplace Participation And Potential Financial Harm

Health Aff (Millwood). 2021 Sep;40(9):1420-1429. doi: 10.1377/hlthaff.2021.00624.


Political orientation can be a powerful motivator of certain health care decisions. This study examines how political orientation was associated with decisions to use the Affordable Care Act Marketplaces to enroll in nongroup health insurance plans and whether it was also associated with adverse financial consequences. We used administrative records and surveys of nongroup Marketplace enrollees from a large insurer in New England. Enrollees were categorized as Republican, Democrat, or independent through self-identification or were assigned to one of the political parties after responding to a political preference question. Republican enrollees were less likely than Democratic enrollees of comparable subsidy eligibility to enroll through the Marketplaces and receive subsidies. Among income-eligible enrollees, Republican subscribers received $66 per month less in premium subsidies than Democratic subscribers, equivalent to roughly $800 per year. However, this result varied by subgroups in the parties, and our results suggest that party effects on decision making may inversely relate to the magnitude of the financial consequence. Navigating the ongoing political polarization in the United States requires optimizing public policies, as well as the associated education and outreach, to ensure maximal efficacy regardless of political orientation.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Health Insurance Exchanges*
  • Humans
  • Insurance Carriers
  • Insurance Coverage
  • Insurance, Health
  • New England
  • Patient Protection and Affordable Care Act*
  • Politics
  • United States