Health Economics Commons^™

Debt And The Medicare Eligibility Discontinuity: Disparate Effects Across Households, Olivia Falck

Honors Theses

Public health insurance programs like Medicare and Medicaid have been shown to help reduce household debt caused by healthcare costs. The impact of health insurance literacy makes the relationship between public health programs and debt more ambiguous. The increasing complexity of Medicare raises the question of whether cost savings associated with enrollment might be mitigated by the complexity of choosing the ideal plan for those with low health insurance literacy. In this study, I utilize the Medicare eligibility cutoff at age 65 to implement a regression discontinuity design that analyzes the impact of Medicare eligibility on household debt and out …

Health Insurance And Subjective Well-Being: Evidence From Two Healthcare Reforms In The United States, Seonghoon Kim

Research Collection School Of Economics

We study the role of access to health insurance coverage as a determinant of individuals' subjective well-being (SWB) by analyzing large-scale healthcare reforms in the United States. Using data from the Behavioral Risk Factor Surveillance System and Panel Study of Income Dynamics, we find that the 2006 Massachusetts reform and 2014 Affordable Care Act Medicaid expansion improved the overall life satisfaction of Massachusetts residents and low-income adults in Medicaid expansion states, respectively. The results are robust to various sensitivity and falsification tests. Our findings imply that access to health insurance plays an important role in improving SWB. Without considering psychological …

An Examination Of Types Of Health Insurance And The Reported Prevalence Of Autism In The United States, Jennifer L. Thompson

Dissertations

The prevalence of Autism Spectrum Disorders continues to rise despite barriers of changes to diagnostic criteria and lack of insurance coverage. Increases in prevalence affect costs associated with a disorder since cost of health care services are often estimated based on utilization of services. This can also affect an individual’s ability to access to health care services. To equitably distribute autism services to individuals an accurate estimation of the true prevalence of autism is needed.

Access to health care can be influenced by the type of insurance coverage a person holds. Other factors, such as socio-economic status, ethnicity, location of …

Health Insurance Plan Design And Chronic Disease Management, Daniel E. Feldman

Electronic Theses and Dissertations

Each year, Americans spend more money on health care than any other industrialized nation, despite comparable mortality rates for people with risk factors for heart disease. The reasons for this lack of health care value in the US are numerous and complex – including market distortions like supplier-inflated pricing and regulatory structures that enable consumers to utilize ubiquitous, high-cost medical technologies that yield uncertain benefits. Health insurance, once thought to be an insignificant contributor to rising health spending, has changed considerably in the past few decades in ways that make it more accessible and more generous in coverage. Health insurance …

The Full Impact Of The Affordable Care Act On Political Participation, Charles J. Courtemanche, James Marton, Aaron Yelowitz

Economics Faculty Publications

This article examines the impact of both the Medicaid expansion and the private insurance-related components of the Affordable Care Act (ACA) on voter turnout and registration. We employ a difference-in-difference-in-differences identification strategy exploiting variation over time, state Medicaid expansion status, and within-state local area pre-ACA uninsured rates. Using data between 2006 and 2016 from the November Current Population Survey and the Census Bureau's Small Area Health Insurance Estimates, our results suggest little effect of the ACA on voter turnout or registration.

Welfare Consequences Of Access To Health Insurance For Rural Households: Evidence From The New Cooperative Medical Scheme In China, Jessica Ya Sun

Research Collection School Of Economics

This study evaluates the welfare benefits of the New Cooperative Medical Scheme (NCMS), the main public health insurance plan for the rural population in China. The findings show that the value of the NCMS to recipients is slightly lower than the government's costs of implementation, ranging from 0.79 to 0.97 per RMB of the resource cost of the NCMS. The estimated moral hazard costs are low compared with the total benefits. It is also estimated that the benefits originating from the NCMS's insurance function only constitute 20% of the total benefits, suggesting a need for higher generosity levels among rural …

The Effect Of Health Insurance On Crime: Evidence From The Affordable Care Act Medicaid Expansion, Qiwei He, Scott Barkowski

Publications

Little evidence exists on the effect of the Affordable Care Act (ACA) on criminal behavior, a gap in the literature that this paper seeks to address. Using a simple model, we argue we should anticipate a decrease in time devoted to criminal activities in response to the expansion, because the availability of the ACA Medicaid coverage raises the opportunity cost of crime. This prediction is particularly relevant for the ACA expansion because it primarily affects childless adults, a population likely to contain individuals who engage in criminal behavior. We validate this forecast empirically using a difference‐in‐differences framework, estimating the expansion's …

The Effects Of The Affordable Care Act Medicaid Expansion On Breast And Cervical Cancer Screening Rates On Low-Income Childless Women, Michelle Raissa Kobou Wafo

Economics

In 2010, the Obama administration passed the Patient Protection and Affordable Care Act (ACA) commonly known as Obamacare. However, it is in 2014 that several key parts of the ACA went into effect. Among those key parts is the Medicaid expansion program. States that chose to adopt the policy, expanded Medicaid access to everyone under 138 percent of the federal poverty line. This extension had the largest impact on childless adults who previously were not covered by the program. Moreover, ACA made it mandatory for all health plans (private and public) to include the ten essential health benefits in their …

A Framework For Learning During An Honors Internship: Embold Health Inc., Haley Haldeman

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Embold Health Inc. is a health care analytics start-up company that identifies top performing providers using large data sets and clinically nuanced measurement. A comprehensive assessment of quality, appropriateness, and cost is what Embold Health delivers. Embold allows payers more control in choosing providers within their region. Being able to identify top provider behaviors through rigorous data driven measurement is significant both clinically and commercially; it provides the opportunity to increase value of care, decrease waste, and drive down cost.

Over the past year as an intern, I’ve had a first-hand look into the complexity that surrounds data driven health …

Does Health Insurance Make People Happier? Evidence From Massachusetts’ Healthcare Reform, Seonghoon Kim, Kanghyock Koh

Research Collection School Of Economics

We study the effects of Massachusetts' healthcare reform on individuals' subjective well-being. Using data from the Behavioral Risk Factor Surveillance System, we find that the reform significantly improved Massachusetts residents' overall life-satisfaction. This result is robust to various sensitivity checks and a falsification test. We also find that the reform improved mental health. An additional analysis on the Tennessee healthcare reform supports our findings' external validity. Using the reform as an instrument for health insurance coverage, we estimate its large impact on overall life-satisfaction. Our results provide novel evidence on the psychological consequences of Massachusetts' healthcare reform.

Effects Of The Affordable Care Act On Health Care Access And Self-Assessed Health After 3 Years, Charles J. Courtemanche, James Marton, Benjamin Ukert, Aaron Yelowitz, Daniela Zapata

Economics Faculty Publications

Using data from the Behavioral Risk Factor Surveillance System, we examine the causal impact of the Affordable Care Act on health-related outcomes after 3 years. We estimate difference-in-difference-in-differences models that exploit variation in treatment intensity from 2 sources: (1) local area prereform uninsured rates from 2013 and (2) state participation in the Medicaid expansion. Including the third postreform year leads to 2 important insights. First, gains in health insurance coverage and access to care from the policy continued to increase in the third year. Second, an improvement in the probability of reporting excellent health emerged in the third year, with …

Essays On The Market Structure Of The U.S. Health Care System, Ayse S. Diebel

Dissertations, Theses, and Capstone Projects

This dissertation examines the welfare implications of vertical restraints in the U.S. health care market. I focus on two phenomena that influence vertical relationships between hospitals and insurers: vertical integration and vertical bundling. Both of these practices have potential efficiency-inducing and anti-competitive effects from a theoretical standpoint, making welfare implications ambiguous. I analyze their impact on welfare in an empirical setting. This task requires structurally modeling the market by using data on hospitals, insurers, and consumers, and simulating counterfactual worlds free of vertical restraints.

I construct my dataset by combining data from multiple sources. Hospital characteristics come from the American …

Impacts Of Antepartum Health Status And Health Insurance Coverage, Anjelica Gangaram

Theses and Dissertations

This paper examines how a woman's antepartum health and health insurance status affect her likelihood of experiencing postpartum maternal morbidity complications.

The Pricing Impact Of Decreasing Competitiveness Of The Health Insurance Market, Lauren N. Patterson

Chancellor’s Honors Program Projects

No abstract provided.

Effects Of The Affordable Care Act On Health Behaviors After Three Years, Charles J. Courtemanche, James Marton, Benjamin Ukert, Aaron Yelowitz, Daniela Zapata

Institute for the Study of Free Enterprise Working Papers

This paper examines the impacts of the Affordable Care Act (ACA) – which substantially increased insurance coverage through regulations, mandates, subsidies, and Medicaid expansions – on behaviors related to future health risks after three years. Using data from the Behavioral Risk Factor Surveillance System and an identification strategy that leverages variation in pre-ACA uninsured rates and state Medicaid expansion decisions, we show that the ACA increased preventive care utilization along several dimensions, but also increased risky drinking. These results are driven by the private portions of the law, as opposed to the Medicaid expansion. We also conduct subsample analyses by …

Three Essays On Social Insurance, Jessica Ya Sun

Dissertations and Theses Collection (Open Access)

This dissertation consists of three chapters on the economics of social insurance. Each chapter explores an aspect of the evaluation and design of social insurance in terms of nutrition, healthcare and unemployment.

The first chapter, Kim, Fleisher and Sun (2016) report evidence of long-term adverse health impacts of fetal malnutrition exposure of middle-aged survivors of the 1959-1961 China Famine using data from the China Health and Retirement Longitudinal Study. We find that fetal exposure to malnutrition has large and long lasting impacts on both physical health and cognitive abilities, including the risks of suffering a stroke, physical disabilities in speech, …

Imperfect Synthetic Controls: Did The Massachusetts Health Care Reform Save Lives?, David Powell

David Powell

The Effect Of Paid Sick Leave Mandates On Access To Paid Leave And Work Absences, Kevin Callison, Michael F. Pesko

Upjohn Institute Working Papers

We evaluate the impact of paid sick leave (PSL) mandates on access to PSL and work absences for private sector workers in the U.S. By exploiting geographic and temporal variation in PSL mandate enactment, we compare changes in outcomes for workers in counties affected by a PSL mandate to changes for those in counties with no mandate. Additionally, we rely on within-county variation in the propensity to gain PSL following a mandate to estimate policy effects for workers most likely to acquire coverage. Results indicate that PSL mandates lead to increased access to PSL benefits, especially for women and those …

Early Effects Of The Affordable Care Act On Health Care Access, Risky Health Behaviors, And Self-Assessed Health, Charles J. Courtemanche, James Marton, Benjamin Ukert, Aaron Yelowitz, Daniela Zapata

Institute for the Study of Free Enterprise Working Papers

The goal of the Affordable Care Act (ACA) was to achieve nearly universal health insurance coverage through a combination of mandates, subsidies, marketplaces, and Medicaid expansions, most of which took effect in 2014. We use data from the Behavioral Risk Factor Surveillance System to examine the impacts of the ACA on health care access, risky health behaviors, and self-assessed health after two years. We estimate difference-in-difference-in-differences models that exploit variation in treatment intensity from state participation in the Medicaid expansion and pre-ACA uninsured rates. Results suggest that the ACA led to sizeable improvements in access to health care in both …

Does Increased Access To Health Insurance Impact Claims For Workers' Compensation? Evidence From Massachusetts Health Care Reform, Erin Todd Bronchetti, Melissa Mcinerney

Upjohn Institute Working Papers

We study over 20 million emergency room (ER) discharges in Massachusetts and three comparison states to estimate the impact of Massachusetts health care reform on claims for Workers’ Compensation (WC). Prior evidence on the relationship between health insurance and WC claiming behavior is mixed. We find that the reform caused a significant decrease in the number of per-capita ER discharges billed to WC. This result is driven by larger decreases in WC discharges for conditions for which there is greater scope to change the payer or the location of care. Conversely, we estimate smaller impacts for weekend versus weekday admissions …

Medicaid, Family Spending, And The Financial Implications Of Crowd-Out, Marcus O. Dillender

Upjohn Institute Working Papers

A primary purpose of health insurance is to protect families from medical expenditure risk. Despite this goal and despite the fact that research has found that Medicaid can crowd out private coverage, little is known about the effect of Medicaid on families' spending patterns. This paper implements a simulated instrumental variables strategy with data from the Consumer Expenditure Survey to estimate the effect of an additional family member becoming eligible from Medicaid on family-level health insurance coverage and spending. The results indicate that an additional family member becoming eligible for Medicaid increases the number of people in the family with …

Social Health Insurance Coverage And Financial Protection Among Rural-To-Urban Internal Migrants In China: Evidence From A Nationally Representative Cross-Sectional Study, Wen Chen, Qi Zhang, Andre M. N. Renzaho, Fangjing Zhou, Hui Zhang, Li Ling

Community & Environmental Health Faculty Publications

INTRODUCTION: Migrants are a vulnerable population and could experience various challenges and barriers to accessing health insurance. Health insurance coverage protects migrants from financial loss related to illness and death. We assessed social health insurance (SHI) coverage and its financial protection effect among rural-to-urban internal migrants (IMs) in China.

METHODS: Data from the '2014 National Internal Migrant Dynamic Monitoring Survey' were used. We categorised 170 904 rural-to-urban IMs according to their SHI status, namely uninsured by SHI, insured by the rural SHI scheme (new rural cooperative medical scheme (NCMS)) or the urban SHI schemes (urban employee-based basic medical insurance (UEBMI)/urban …

Effects Of The Affordable Care Act On Part-Time Employment: Early Evidence, Marcus Dillender, Carolyn Heinrich, Susan Houseman (Corresponding Author)

Susan N. Houseman

The Affordable Care Act (ACA) requires employers with at least 50 full-time-equivalent employees to offer “affordable” health insurance to employees working 30 or more hours per week. If employers do not comply with the mandate, they may face substantial financial penalties. Employers can potentially circumvent the mandate by reducing weekly hours below the 30-hour threshold or by using other nonstandard employment arrangements (direct-hire temporaries, agency temporaries, small contractors, and independent contractors). We examine the effects of the ACA on short-hours, part-time employment. Using monthly CPS data, we estimate that the ACA resulted in an increase in low-hours, involuntary part-time employment …

Effects Of The Affordable Care Act On Part-Time Employment: Early Evidence, Marcus O. Dillender, Carolyn J. Heinrich, Susan N. Houseman (Corresponding Author)

Upjohn Institute Working Papers

The Affordable Care Act (ACA) requires employers with at least 50 full-time-equivalent employees to offer “affordable” health insurance to employees working 30 or more hours per week. If employers do not comply with the mandate, they may face substantial financial penalties. Employers can potentially circumvent the mandate by reducing weekly hours below the 30-hour threshold or by using other nonstandard employment arrangements (direct-hire temporaries, agency temporaries, small contractors, and independent contractors). We examine the effects of the ACA on short-hours, part-time employment. Using monthly CPS data, we estimate that the ACA resulted in an increase in low-hours, involuntary part-time employment …

Evaluating The Causal Effect Of Insurance Access On Labor Market Outcomes Among Young Adults, Eden Volkov

Theses and Dissertations

The ACA youth coverage mandate took effect in 2010. Under this provision, individuals through age 26 can remain on their parent's health insurance plan. This provision increased insurance coverage. This has led to 22-29 year olds being more likely to be self-employed, to not work, and to work part time.

The Economics Of Health, Donald J. Meyer Editor

Upjohn Press

Donald J. Meyer leads a group of notable health economists who explore critical issues—and their economic impacts—facing the nation's healthcare system today. These include lifestyle choices and their health impacts, decisions on medical care and self-care, the fee-for-service payment model, disability and workers’ compensation insurance claims, long-term care, and how various aspects of the Patient Protection and Affordable Care Act (ACA) impact the nation’s healthcare system. Contributors include M. Kate Bundorf, Marcus Dillender, John H. Goddeeris, Donald J. Meyer, Edward C. Norton, and Charles E. Phelps.

Eligibility Recertification And Dynamic Opt-In Incentives In Income-Tested Social Programs: Evidence From Medicaid/Chip, Zhuan Pei

Upjohn Institute Working Papers

Conventional labor supply studies assume constant eligibility monitoring of income-tested program participants, but this is not true for most programs. For example, states can allow children to enroll in Medicaid/CHIP for 12 months regardless of family income changes. A long recertification period reduces monitoring costs but is predicted to induce program participation by temporary income adjustments. However, I find little evidence of strategic behavior from the 2001 and 2004 Survey of Income and Program Participation. Given the lack of dynamic responses, I propose a framework to compute the optimal recertification period and find 12 months to be its lower bound.

The Effect Of Health Insurance On Workers' Compensation Filing: Evidence From The Affordable Care Act's Age-Based Threshold For Dependent Coverage, Marcus O. Dillender

Upjohn Institute Working Papers

This paper identifies the effect of health insurance on workers' compensation (WC) filing for young adults by implementing a regression discontinuity design using WC medical claims data from Texas. The results suggest health insurance factors into the decision to have WC pay for discretionary care. The implied instrumental variables estimates suggest a 10 percentage point decrease in health insurance coverage increases WC bills by 15.3 percent. Despite the large impact of health insurance on the number of WC bills, the additional cost to WC at age 26 appears to be small as most of the increase comes from small bills.

The Potential Effects Of Federal Health Insurance Reforms On Employment Arrangements And Compensation, Marcus O. Dillender, Carolyn J. Heinrich, Susan N. Houseman

Upjohn Institute Working Papers

The Affordable Care Act (ACA) presents an opportunity to significantly improve compensation for American workers. A potential concern, though, is that employers will circumvent the employer mandate by increasing their use of workers in staffing arrangements that are not covered by the mandate: workers averaging less than 30 hours per week, working on a temporary basis, or working in organizations with fewer than 50 full-time employees. In this paper, we shed light on the likely effects that the ACA will have on employment arrangements. We first examine how part-time employment in Massachusetts changed after its health insurance reform, which is …

Health Care Use, Out-Of-Pocket Expenditure, And Macroeconomic Conditions During The Great Recession, Juan Du, Takeshi Yagihashi

Economics Faculty Publications

We study how macroeconomic conditions during the Great Recession affected health care utilization and out-of-pocket expenditures of American households. We use two data sources: the Consumer Expenditure (CE) Survey and the Survey of Income and Program Participation (SIPP); each has its own advantages. The CE contains quarterly frequency variables, and the SIPP provides panel data at the individual level. Consistent evidence across the two datasets shows that utilization of routine medical care was counter-cyclical, whereas hospital care was pro-cyclical during the Great Recession. When we examine the pre-recession period, the relationship between macroeconomic conditions and health care use was either …