The Impact of Market Size and Composition on Health Insurance Premiums: Evidence from the First Year of the Affordable Care Act
利用各州对保险覆盖区域定义的差异，研究发现将小县与邻近城市合并为一个区域，能使农村市场增加0.6至0.8家活跃保险公司，年保费节省200至300美元。
Under the Affordable Care Act, individual states have discretion in how they define coverage regions, within which insurers must charge the same premium to buyers of the same age, family structure, and smoking status. We exploit variation in these definitions to investigate whether the size of the coverage region affects outcomes in the ACA marketplaces. We find large consequences for small and rural markets. When states combine small counties with neighboring urban areas into a single region, the included rural markets see 0.6 to 0.8 more active insurers, on average, and savings in annual premiums of between $200 and $300.