Publications

2021
Adrianna McIntyre, Mark Shepard, and Myles Wagner. 2021. “Can Automatic Retention Improve Health Insurance Market Outcomes?” AEA Papers and Proceedings.Abstract
There is growing interest in market design using default rules and other "choice architecture" principles to steer consumers toward desirable outcomes. Using data from Massachusetts's health insurance exchange, we study an "automatic retention" policy intended to prevent coverage interruptions among low-income enrollees. Rather than disenroll people who lapse in paying premiums, the policy automatically switches them to an available free plan until they actively cancel or lose eligibility. We find that automatic retention has a sizable impact, switching 14 percent of consumers annually and differentially retaining healthy, low-cost individuals. The results illustrate the power of defaults to shape insurance coverage outcomes.
2020
Adrianna McIntyre, Matthew W. Brault, and Benjamin D. Sommers. 10/26/2020. “Measuring Coverage Rates in a Pandemic: Policy and Research Challenges.” JAMA Health Forum. Publisher's VersionAbstract
The historic job losses accompanying the coronavirus disease 2019 (COVID-19) pandemic have raised concerns that the number of uninsured US residents will increase substantially in 2020—but there are no official real-time mechanisms for tracking the nation’s uninsured rate. Unlike assessing unemployment claims or Medicaid enrollment, measuring the overall share of people without insurance relies on time-consuming and imperfect household surveys. Understanding the limitations of the available data is especially critical during a fast-changing health and economic crisis like the current one.
Adrianna McIntyre, Robert J. Blendon, John M. Benson, Mary G. Findling, and Eric C. Schneider. 2020. “The Affordable Care Act's Missing Consensus: Values, Attitudes, and Experiences Associated with Competing Health Reform Preferences.” Journal of Health Politics, Policy, and Law, 45, 5, Pp. 729–755. Publisher's VersionAbstract
Ten years after its enactment, public support for the Affordable Care Act (ACA) still only reaches a scant majority. Candidates for the presidency—and the sitting president—have endorsed health reforms that would radically transition US health care away from the current system upon which the ACA was built. Few opinion surveys to date have captured dominant preferences among alternative health reform policies or characterized attitudes and experiences that might be associated with policy preferences. Using a 2019 nationally representative telephone survey, this article considers how variations in political values, attitudes toward government, and experiences with the health care system relate to competing health reform preferences. Differences between those who favor Medicare for All over building on the ACA largely reflect different levels of satisfaction with the status quo and views of private health insurance. By contrast, differences between ACA supporters and those who would favor replacing it with a state-based alternative reflect sharply different political values and attitudes. Key differences remain significant after controlling for demographic, health, and political characteristics. Overwhelming public support still eludes the ACA, and reaching consensus on future directions for health reform will remain challenging given differences in underlying beliefs.
2019
Adrianna McIntyre and Zirui Song. 2/26/2019. “The US Affordable Care Act: Reflections and directions at the close of a decade.” PLOS Medicine, 16, 2. Publisher's VersionAbstract
Nearly nine years after its passage, the Affordable Care Act (ACA) remains at the forefront of public policy debate. The law is persistently contentious as a matter of public opinion, but represents a historic achievement in United States healthcare reform. While it was incremental in many respects—health insurance plans for the vast majority of Americans were relatively unchanged—the ACA left an indelible mark on the healthcare system through its expansion of insurance coverage and efforts to improve the healthcare delivery system. In the past decade, the country has witnessed a substantial decline in the number of uninsured individuals, while other elements of the law have sought to make inroads into affecting the cost and quality of care. Yet looking forward, the ACA continues to face challenges that make its abiding impact and legacy uncertain.
2017
Adrianna McIntyre, Allan M. Joseph, and Nicholas Bagley. 9/14/2017. “Small Change, Big Consequences — Partial Medicaid Expansions under the ACA.” New England Journal of Medicine, 377, Pp. 1004-1006. Publisher's VersionAbstract
The Trump administration may decide to permit states to partially expand their Medicaid programs to cover people with incomes up to 100% of the federal poverty level. Arkansas has requested a waiver to do so, and if it is granted, other states may follow suit.
Adrianna McIntyre, Nicholas Bagley, Austin Frakt, and Aaron Carroll. 2017. “The Dubious Empirical and Legal Foundations of Wellness Programs.” Health Matrix: The Journal of Law-Medicine, 27, 1. Publisher's VersionAbstract
The article offers information on the dubious empirical and legal foundations of workplace wellness programs in the U.S. Topics discussed include enactment of Affordable Care Act for expanding the scope of incentives availas; analysis of financial incentives offered to the employees for encouraging their participation in wellness programs; and targeting incentives specifically toward individuals diagnosed with chronic diseases.