Health insurance

Anticompetitive behavior, such as consolidation, in the health-insurance industry has allowed a small group of insurers to dominate the market. One of the main drivers of this behavior is “adverse selection,” where individuals know more about how sick they are than insurance companies do. To mitigate the risk of paying out more claims than they can cover, insurers often raise their premiums. Kellogg’s Amanda Starc and her colleague argue that, to create a truly healthy health-insurance marketplace, regulators and policymakers need a framework for rethinking the complex interactions between adverse selection and regulatory guardrails.

In February, the Federal Trade Commission settled with pharmaceutical benefits manager (PBM) Express Scripts. The FTC had sued Express Scripts and two other large PBMs under the long dormant Section 5 of the FTC Act, which targets “unfair methods of competition.” The settlement suggests that the FTC may succeed in addressing the convoluted contracts between PBMs, drug manufacturers, health insurers, and employers that drive up drug prices for Americans. It also opens unchartered territory for antitrust enforcement and the limits of Section 5, argue Fiona Scott Morton and Mariah Smith.

Solutions to expanding heath care coverage in the U.S. are often incremental and focus on mitigating market failures. In new research, Katherine Baicker, Amitabh...

A new paper explores the resources consumed by the complicated billing process in health care and the process’ impact on patients’ access to care. Health...