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Prof. Tom Baker engages students with health exchange research

April 11, 2013

This summer students working with Penn Law’s Tom Baker, the William Maul Measey Professor of Law and Health Sciences, will help lay the groundwork for a dispassionate answer to one of the most important and contentious policy questions in the country today: how well the health insurance exchanges that are the linchpin of Obamacare function.

Baker is a preeminent scholar in insurance law and a member of Penn’s Health Insurance Exchange (HIX) Research Group, a cross-disciplinary team of scholars working in health and policy-related fields.

With the assistance of six students, two from Penn Law and others from Villanova and Drexel, Baker this summer will compile a state-by-state database, which will be used by the HIX Research Group to analyze performance of the new health exchanges. 

“I am very excited to be working for him this summer, and especially on this project,” said Whitney Mayer L’15. “Although the research is not underway yet, I was very impressed with Prof. Baker’s willingness to potentially coordinate the research with the Masters of Public Health that I am dually receiving at Penn.  On the whole, he is concerned about developing his students to be lawyers who are engaged and give back to the community.”

The HIX Research Group, housed at Wharton’s Leonard Davis Institute of Health Economics (LDI), is studying the impact the new health insurance exchanges have on health care markets. The goal is to improve HIX performance, as measured by the accessibility, cost, and quality of health care delivered through health plans purchased on and off the exchanges.

Stephanie Hoffman, L ’11, a legal policy analyst at LDI, is project manager for the HIX Research Group. She has helped to organize a national conference April 11-12, designed to bring state exchange officials together with the research community and to coordinate ongoing research efforts across the country.

Under the Affordable Care Act, every state must have its health exchange website and phone operations up and running by October 1, when the first open-enrollment period for the purchase of health insurance plans under Obamacare begins.

The decisions individual states are making about how to implement the law, including whether to create their own exchanges or rely on one being created by the federal government, have recently captured national attention. With exchange implementation looming, Baker and his students are preparing to put the central feature of Obamacare – means-tested subsidies on competitive health insurance exchanges – under an empirical microscope.

“We have a list of what we think are the most important decisions that states are making around the exchanges, which the database will track,” Baker said. “Having coded all these states in all these different ways, we can then try to make some judgments about which choices were better. From a public policy perspective, that’s the most important thing we’re going to do.”

One of the first policy questions the database will answer is which exchange features helped states enroll people more quickly. That answer could come as early as next April, when the first open-enrollment period comes to an end.

The database will also help scholars understand, among other things, how different exchange structures impact such outcomes as the number of uninsured people in a given state, insurance premiums in that state, and the number of insurance companies in the marketplace. “At some point in the future, we’ll know which ones led to healthier populations, but that’s obviously a long time away,” Baker said.

Political scientists and other scholars will use the data to understand why particular states made the choices they did.

Much depends on the type of “choice architecture” the various exchanges employ. “These are complex decisions,” Baker said. “So you’ve got to tell people what’s a good choice. We’re strong believers in providing smart defaults. You want to pick what you think is the best choice for people, have that be ‘pre-checked,’ and then provide calculators and other methods so that people can see why that’s the right choice for them.  They can uncheck it if they want; it’s a free country.”

Once the health exchanges are in operation, the HIX Research Group will keep track of the decisions people make. “Some exchanges will work better than others,” Baker said. “Right now people are thinking that the states using what are called the ‘federally facilitated exchanges’ will eventually transition to running their own. But it’s quite possible that we will find that it’s not a bad thing for the federal government to run them, and perhaps states that are doing their own will decide to turn it over to the federal government. One thing we can be sure about is that there will be no shortage of research opportunities for people in this area.”