Health Economics Commons^™

Retroactive Eligibility Waivers: Innovative Or Ineffective?, Mohamed Kacem Benyamine

Theses and Dissertations

Medicaid’s retroactive eligibility provision covers medical expenses for beneficiaries up to 90 days before the application date. Retroactive eligibility insulates uninsured, low-income households from expensive healthcare emergencies. New Hampshire, Arkansas, and Iowa recently obtained waivers to end retroactive coverage. Using a difference-in-differences design and data from the Behavioral Risk Factor Surveillance System, I evaluate whether changes in retroactive coverage affect enrollment rates and self-reported health. Removing retroactive eligibility has no statistically significant effects on insurance enrollment or self-reported health. However, it does increase rates of access to a doctor by 1.0% overall and by 1.6% for women. Removing retroactive eligibility …

Behavioral Responses To The Medicare Part D Coverage Gap And Its Closure, Selene Urbatsch

Theses and Dissertations

The author examines how exposure to the Medicare Part D coverage gap affects future prescription drug use and whether the closure of the gap under the Affordable Care Act (ACA) altered beneficiary behavior. Using 2007–2019 MEPS data, the analysis compares Part D enrollees to similarly aged, privately insured individuals, producing first-differences and difference-in-differences estimates. Before the ACA, exposure to the gap was associated with 4.9 fewer prescription fills relative to comparable non-Part D individuals. After the ACA, the effect fell to a reduction of 2.2 generic fills, with no significant decline in branded use. Sudden out-of-pocket cost increases prompted sharp …

Assessing The Impact Of Medicaid Expansion On The Labor Market, Healthcare Access, And Health Outcomes During The Covid-19 Pandemic, Kaavya Narayan

CMC Senior Theses

This thesis examines the impact of Medicaid expansion status on labor market outcomes, healthcare access, and health outcomes during COVID-19. Using data from the CDC’s Behavioral Risk Factor Surveillance System and a Difference-in-Differences (DiD) model, I estimate the effects of Medicaid expansion on unemployment, financial barriers to care, obesity, and poor health before and after the pandemic. The analysis also accounts for state-level political and demographic characteristics, gender, marital status, and education level. My results show that non-expansion states, relative to expansion states of similar political and demographic breakdowns, are significantly more disadvantaged in terms of obesity, poor health, financial …

Medical Expenditures And The Measurement Of Poverty In The United States, Luke Petach, David Wyant

Faculty Scholarship

Using data from the Medical Expenditure Panel Survey (MEPS) we estimate the fraction of the US population that is health poor. A person is health poor if their income prior to paying health insurance premiums and out-of-pocket healthcare costs is above the poverty line, but their income net-of-premiums and out-of-pocket healthcare costs is below the poverty line. Because resources used to finance health insurance premiums and out-of-pocket costs are (A) lexicographically preferred and (B) cannot be used to maintain an individual’s standard of living, they should be excluded from official poverty estimates. Approximately 1% to 2% of the US population …

Medical Expenditures And The Measurement Of Poverty In The United States, Luke Petach, David K. Wyant

Funded Scholarship

Using data from the Medical Expenditure Panel Survey (MEPS) we estimate the fraction of the US population that is health poor. A person is health poor if their income prior to paying health insurance premiums and out-of-pocket healthcare costs is above the poverty line, but their income net-of-premiums and out-of-pocket healthcare costs is below the poverty line. Because resources used to finance health insurance premiums and out-of-pocket costs are (A) lexicographically preferred and (B) cannot be used to maintain an individual’s standard of living, they should be excluded from official poverty estimates. Approximately 1% to 2% of the US population …

Three Essays In Healthcare Economics And Policy Analysis, Tuyen Pham

Graduate Theses, Dissertations, and Problem Reports (ETD)

This dissertation research consists of three essays on healthcare economics and policy analysis. Chapter 1 investigates and explains the failure of a proposition on limiting dialysis clinic profits in California in 2018. The proposition would have required dialysis clinics to issue refunds to patients or their payers for revenue that exceeds 115% of the direct cost of treatment. In this chapter, a conceptual framework of how voters weigh costs and benefits is developed and two different empirical approaches, simple OLS and Double Post LASSO, are employed to identify key determinants of the voting outcome. The empirical results suggest that counties …

The Affordable Care Act And Entrepreneurship Lock: An Updated Examination Of Employer-Based Healthcare’S Effect On Self-Employment By Demographic Group, Sean Ruddy

Undergraduate Economic Review

This paper capitalizes on a natural experiment created by differences in Medicaid expansion under The Patient Protection and Affordable Care Act (ACA). A difference and difference model comparing states that did and did not expand Medicaid is conducted to investigate if providing an alternative and low-cost source of health insurance affects self-employment rates overall and across different demographic groups. The results suggest that living in a state that expanded Medicaid was associated with a 1.4 percent increase in the likelihood that an individual will be self-employed and that this effect is heterogeneous across different demographics, being largest among African Americans.

Effect Of The Affordable Care Act Medicaid Expansion On Labor Participation Of Female Registered Nurses In Outpatient Care, Deborah R. Weissner

Theses and Dissertations

Medicaid expansions were used to examine the effects of a surge in demand for primary care on the labor participation of registered nurses (RN) in outpatient settings relative to hospitals. Using difference-in-differences and two-way fixed effects with the American Community Survey Public Use Microdata Sample single-year 2010 through 2017 files, I find an increase in the probability of an RN working in an outpatient setting among (1) young, unmarried RNs with a maximum household income of 501 percent of the federal poverty level and (2) young unmarried RNs who have at least one child under age 6. These results are …

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.

Effects Of Innovations In Health Care Provision And Financing, Hoda Nouri Khajavi

Dissertations, Theses, and Capstone Projects

This dissertation consists of four chapters that study the impacts of innovations in health care provision and financing. The relentless rise in US health care costs has led the Centers for Medicare and Medicaid Services to launch various pilot programs to create financial incentives for health care providers, suppliers, and local communities to improve the efficiency of the health care system. The fist chapter of this manuscript reviews the main pilot programs implemented and/or funded by the Centers for Medicare and Medicaid Services since the 111th United States Congress passed the Patient Protection and Affordable Care Act, also known as …

Medicaid Coverage Across The Income Distribution Under The Affordable Care Act, Charles J. Courtemanche, James Marton, Aaron Yelowitz

Institute for the Study of Free Enterprise Working Papers

This chapter examines trends in Medicaid enrollment across the income distribution after the ACA’s Medicaid expansion.Using data from the American Community Survey between 2012and 2017, we compare Medicaid coverage over time in 9 states that expanded Medicaid in 2014 with no previous expansion for able-bodied, working-age adults with 12 states that had not expanded Medicaid by 2019 and also had no previous expansion for such adults. A difference-in-differences model is used to formalize this comparison. Similar to many previous studies, we find that Medicaid coverage increased dramatically for income-eligible adults under 138% of the federal poverty level (FPL). In addition, …

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 …

The Three-Year Impact Of The Affordable Care Act On Disparities In Insurance Coverage, Charles J. Courtemanche, James Marton, Benjamin Ukert, Aaron Yelowitz, Daniela Zapata, Ishtiaque Fazlul

Economics Faculty Publications

Objective
To estimate the impact of the major components of the ACA (Medicaid expansion, subsidized Marketplace plans, and insurance market reforms) on disparities in insurance coverage after three years.

Data Source
The 2011-2016 waves of the American Community Survey (ACS), with the sample restricted to nonelderly adults.

Design
We estimate a difference-in-difference-in-differences model to separately identify the effects of the nationwide and Medicaid expansion portions of the ACA using the methodology developed in the recent ACA literature. The differences come from time, state Medicaid expansion status, and local area pre-ACA uninsured rates. In order to focus on access disparities, we …

The Effect Of The Dependent Coverage Provision Of The Affordable Care Act On Opioid Use And Abuse, Christian Carrillo

Theses and Dissertations

The non-medical use of prescription opioids has become the fastest growing drug problem in the United States. This paper examines the effect of the ACA's dependent coverage provision on the prevalence of prescription opioid misuse and abuse along with the mechanism driving the results.

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 …

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 …

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 …

The Effect Of Health Insurance On Young Adults' Labor Market Outcomes: Evidence From The Affordable Care Act's Dependent Coverage Expansion, Quazi Hassan

Theses and Dissertations

The Affordable Care Act’s dependent coverage mandate extended young adults’ parental coverage to age 26. I study the expansion’s impact on young adults’ labor market outcomes using a control function method. Following the expansion, I find dependent coverage lowered labor force participation, lowered incomes, and mixed evidence regarding labor supply.

How Did The Aca Affect Health Insurance Coverage In Kentucky?, Aaron Yelowitz

Institute for the Study of Free Enterprise Working Papers

The major components of the Affordable Care Act (ACA) were implemented in 2014, including the rollout of the Health Insurance Marketplace, Medicaid expansions, and the individual mandate. Kentucky stands out as one of the few southern states to expand Medicaid, and earlier work has demonstrated that Kentucky experienced some of the largest gains in health insurance coverage. The goal of the current study is to further explore the sources that individuals used to gain coverage in Kentucky using a large, publicly available dataset, the American Community Survey (ACS). Several findings emerge. First, overall health insurance coverage increased by 5.7 percentage …

Effects Of The Affordable Care Act On Part-Time Employment: Early Evidence, Marcus 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 …

The Effect Of Health Insurance On Out Of Pocket Expenditure, Andrew M. Bean

Theses and Dissertations

The dependent care provision of the Affordable Care Act went into effect September 2010. This change in insurance policy can be used as a natural experiment to examine the effect of health insurance on healthcare expenditures using a control function two-part model to address endogeneity.

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.

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

Medicaid And The Labor Supply Of Single Mothers: Implications For Health Care Reform, Vincent Pohl

Upjohn Institute Working Papers

The Patient Protection and Affordable Care Act expands Medicaid and introduces health insurance subsidies, thereby changing work incentives for single mothers. To undertake an ex ante policy evaluation of the employment effects of the PPACA, I structurally estimate a model of labor supply and health insurance choice exploiting existing variation in Medicaid policies. Simulations show that single mothers increase their labor supply at the extensive and the intensive margin by six and five percent, respectively. The PPACA leads to crowding-out of employer-sponsored health insurance of about 40 percent and increases single mothers' welfare by about $190 per month.

Mandate-Based Health Reform And The Labor Market: Evidence From The Massachusetts Reform, Jonathan T. Kolstad, Amanda E. Kowalski

Upjohn Institute Working Papers

We model the labor market impact of the key provisions of the national and Massachusetts "mandate-based" health reforms: individual mandates, employer mandates, and subsidies. We characterize the compensating differential for employer-sponsored health insurance (ESHI) and the welfare impact of reform in terms of "sufficient statistics." We compare welfare under mandate-based reform to welfare in a counterfactual world where individuals do not value ESHI. Relying on the Massachusetts reform, we find that jobs with ESHI pay $2,812 less annually, somewhat less than the cost of ESHI to employers. Accordingly, the deadweight loss of mandate-based health reform was approximately 8 percent of …

Aca Implementation In The South: The Political Economy Of Full Participation In Kentucky, Glen P. Mays

Health Management and Policy Presentations

This analysis, conducted as part of the ACA Implementation Research Network, examines economic and political forces shaping Kentucky's early experience with implementation of the Patient Protection and Affordable Care Act.

The Effect Of Medicare Eligibility On Spousal Insurance Coverage, Marcus Dillender, Karen Mulligan

Upjohn Institute Working Papers

A majority of married couples in the United States take advantage of the fact that employers often provide health insurance coverage to spouses. When the older spouses become eligible for Medicare, however, many of them can no longer provide their younger spouses with coverage. In this paper, we study how spousal eligibility for Medicare affects the health insurance and health care access of the younger spouse. We find spousal eligibility for Medicare results in the younger spouse having worse insurance coverage and reduced access to health care services.

The Dynamics Of Medicaid & Public Health Spending: Implications For Aca Implementation, Glen P. Mays

Health Management and Policy Presentations

We estimate the dynamics and interactions of governmental spending on Medicaid and other public health services in all 50 states over a 15 year period. Using a quasi-experimental design with instrumental variables estimation, we find evidence that increased Medicaid spending leads to reduced governmental spending on other public health services, consistent with a crowd-out effect. Over 10 years, such crowd-out has the potential to diminish the health status improvements generated through health insurance coverage expansions.

Reducing The Geographic Variance In Medical Expenditures: The Benefits Of A Primary-Care-Oriented Health System, Noah Bricker

Undergraduate Economic Review

The Affordable Care Act states that a primary goal of health care reform should be to lower costs and promote fiscal responsibility. With these two goals in mind, the bill proposes a more primary-care-oriented health system by enacting a 5-year temporary Medicare fee increase for primary care physicians as a means to increase the number of physicians and incentivize more primary care services. Using county and regional level Medicare data, this paper finds that an increase in the number of primary care physicians per capita would reduce per beneficiary Medicare spending and as a consequence, lower national health expenditures substantially.