Health Economics Commons^™

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 …

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.

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 …

How Long Before Recertifying Medicaid And Chip Children?, Zhuan Pei

Employment Research Newsletter

No abstract provided.

The Effect Of Public Insurance Coverage For Childless Adults On Labor Supply, Laura Dague, Thomas C. Deleire, Lindsey Leininger

Upjohn Institute Working Papers

This study provides plausibly causal estimates of the effect of public insurance coverage on the employment of nonelderly, nondisabled adults without dependent children (“childless adults”). We use regression discontinuity and propensity score matching difference-in-differences methods to take advantage of the sudden imposition of an enrollment cap, comparing the labor supply of enrollees to eligible applicants on a waitlist. We find that enrollment into public insurance leads to sizable and statistically meaningful reductions in employment up to at least nine quarters later, with an estimated size of 2–10 percentage points, depending on the model used.

Macroeconomic Effects And Microeconomic Determinants Of Fertility, Maria R. Apostolova-Mihaylova

Theses and Dissertations--Economics

This dissertation focuses on the relationship between the education-based fertility gap and economic growth and on policy as a determinant of fertility.

In the first essay I evaluate the impact of differential fertility (the difference between fertility rates of women with high educational attainment and women with low educational attainment) on economic growth by accounting for critical marginal effects and the general level of educational attainment in a given country. I also examine the possibility that this effect varies based on level of inequality and income levels. I find that for a less developed country with high income inequality, higher …

What Is The Optimal Subsidy For Exercise? Informing Health Insurance Companies' Fitness Reimbursement Programs, Molly E. Frean

Economics Honors Projects

Health care costs account for 17% of US GDP and many programs and policies seek to reduce these costs. This paper focuses on exercise as preventive care due to its immense physiological benefits. I model the profit-maximizing choice of health insurance companies to subsidize exercise and the utility-maximizing choice of individuals to engage in exercise using a traditional principal-agent framework. I then use principles from behavioral economics and psychology to critique these models and provide further insight into understanding our underconsumption of such preventive services. I end with an evaluation of current programs and suggestions for improvement using empirical findings.

Retiree Health Benefits As Deferred Compensation: Evidence From The Health And Retirement Study, James Marton, Stephen A. Woodbury

Upjohn Institute Working Papers

Are early retiree health benefits (RHBs) a form of deferred compensation that binds workers to an employer? Most employers who offer RHBs offer them only to workers who have 10 or more years of tenure with the firm and have reached age 55. Accordingly, workers in firms offering RHBs have an incentive to stay with a firm in the years before they attain eligibility for RHBs, and a greater incentive than otherwise to retire thereafter. We test for the existence of such a pattern of incentives by examining the age-specific relationship between workers’ eligibility for RHBs and retirement. The findings …

Health Insurance Exchanges: A Panacea Or A Band-Aid?, Luisa Sanchez De Tagle

Electronic Theses and Dissertations

In 2010, the 111th Congress passed the first national health care reform in the United States, the Patient Protection and Affordable Care Act (ACA). This landmark legislation is intended to "fix" a health care system renowned for decreasing access and escalating costs. This paper examines one of the principal reforms in the ACA, the state health insurance exchanges. The author finds theoretical and empirical evidence to support the exchanges' potential (in conjunction with other relevant ACA reforms) to increase access, decrease insurers' excess profits and shift health care costs away from those least able to afford them. The exchanges fall …

Three Essays On The Health Insurance Coverage Of Young Adults, David M. Yaskewich

Theses and Dissertations--Economics

This dissertation examines the health insurance status of young adults during the transition to adulthood. In a series of three essays, I analyze what happens as young adults reach important milestones and the effects of public policies. The first essay is a descriptive study on how insurance status changes after reaching age 19 and graduating from college. The likelihood of becoming uninsured rises sharply once turning age 19 and then peaks at age 23. While the proportion uninsured also increases following college graduation, this increase disappears after one year. The second essay analyzes the effect of a dependent age law …

The Health And Wealth Of A Nation: Employer-Based Health Insurance And The Affordable Care Act, Nan L. Maxwell

Upjohn Press

This research examines the behaviors of firms with respect to their provision of health care prior to the Affordable Care Act (ACA) deliberations and uses those behaviors to assess changes in employer-sponsored health insurance that might occur once the ACA is fully implemented.

The Effect Of Employer Health Insurance Offering On The Growth And Survival Of Small Business, Adela Luque, C. J. Krizan, Alice Zawacki

Upjohn Institute Technical Reports

No abstract provided.

The Efficiency Of A Group-Specific Mandated Benefit Revisited: The Effect Of Infertility Mandates, Joanna N. Lahey

Upjohn Institute Working Papers

This paper examines the labor market effects of state health insurance mandates that increase the cost of employing a demographically identifiable group. State mandates requiring that health insurance plans cover infertility treatment raise the relative cost of insuring older women of child-bearing age. Empirically, wages in this group are unaffected, but their total labor input decreases. Workers do not value infertility mandates at cost, and so will not take wage cuts in exchange, leading employers to decrease their demand for this affected and identifiable group. Differences in the empirical effects of mandates found in the literature are explained by a …

Employer-Provided Health Insurance And Labor Supply Of Married Women, Merve Cebi

Upjohn Institute Working Papers

This work presents new evidence on the effect of husbands’ health insurance on wives’ labor supply. Previous cross-sectional studies have estimated a significant negative effect of spousal coverage on wives’ labor supply. However, these estimates potentially suffer from bias due to the simultaneity of wives’ labor supply and the health insurance status of their husbands. This paper attempts to obtain consistent estimates by using several panel data methods. In particular, the likely correlation between unobserved personal characteristics of husbands and wives—such as preferences for work—and potential joint job choice decisions can be controlled by using panel data on intact marriages. …

Health Insurance Availability And Entrepreneurship, Philip Decicca

Upjohn Institute Working Papers

Despite a strong interest in entrepreneurship, economists have devoted little attention to the role of health insurance availability. I investigate the impact of a unique policy experiment—New Jersey’s Individual Health Coverage Plan—on self-employment. Implemented in August 1993, the IHCP included an extensive set of reforms that loosened the historical connection between traditional employment and health insurance by facilitating access to coverage that was not employer-linked. I find evidence that the IHCP increased self-employment among New Jersey residents, relative to various sets of comparison states. Consistent with key policy features, including pure community rating of premiums, I find larger behavioral responses …

Health Insurance Tax Credits And Health Insurance Coverage Of Low-Earning Single Mothers, Merve Cebi, Stephen A. Woodbury

Upjohn Institute Working Papers

No abstract provided.

The Influence Of Retiree Health Benefits On Retirement Patterns, James Marton, Stephen A. Woodbury

Upjohn Institute Working Papers

We estimate the effect of employer offers of retiree health benefits (RHBs) on the timing of retirement using a sample of Health and Retirement Study (HRS) men observed over a period of up to 12 years. We hypothesize that the effect of RHBs differs for workers of different ages-a hypothesis we can test now that the main HRS cohort has aged sufficiently. We apply three well-known panel data estimators and find that, for men in their 50s, RHBs have little or no effect on retirement decisions; however, a substantial effect emerges for men in their early 60s. We use simulations …

Fragmentation In Mental Health Benefits And Services: A Preliminary Examination Into Consumption And Outcomes, Barak D. Richman, Daniel Grossman, Frank Sloan

Faculty Scholarship

In this chapter, we examine consumption patterns and health outcomes within a health insurance system in which mental health benefits are administered under a carved-out insurance plan. Using a comprehensive dataset of health claims, including insurance claims for both mental and physical health services, we examine both heterogeneity of consumption and variation in outcomes. Consumption variation addresses the regularly overlooked question of how equal insurance and access does not translate into equitable consumption. Outcomes variation yields insights into the potential harms of disparate consumption and of uncoordinated care. We find that even when insurance and access are held constant, consumption …

Health Insurance Tax Credits And Health Insurance Coverage Of Low-Income Single Mothers, Merve Cebi, Stephen A. Woodbury

Employment Research Newsletter

No abstract provided.

Literature Review, Joshua J. Gagne

Value-Based Purchasing Newsletter

Each issue of Value-Based Purchasing will provide a summary of recent articles from the published VBP literature. In this issue, we spotlight several recent publications regarding pay-for-performance programs and financial incentives for quality care.

News Briefs

Value-Based Purchasing Newsletter

No abstract available.

Clinical Performance Measurements And Incentives Enable Value Based Purchasing, Jerry Reeves

Value-Based Purchasing Newsletter

No abstract available.

Welcome To Value-Based Purchasing, Neil I. Goldfarb, Dale Shaller

Value-Based Purchasing Newsletter

No abstract available.

Refundable Tax Credits For Health Insurance: The Sensitivity Of Simulated Impacts To Assumed Behavior, David W. Emmons, Eva Madly, Stephen A. Woodbury

Upjohn Institute Working Papers

We replicate and extend a simulation model developed by Jonathan Gruber with the goals of illuminating Gruber's modeling of health insurance coverage under a tax credit and examining the sensitivity of the results to changes in the model's key parameters. The replications suggest that a refundable tax credit of $1,000 for a single individual or $2,000 for a family for private health insurance would reduce the number of uninsured individuals by between 17.5 and 28 percent and require new government expenditures of between $16.6 and $44 billion, of which about $7.4-$9.7 billion would be for coverage of previously uninsured individuals. …

Refundable Tax Credits For Health Insurance, David W. Emmons, Eva Madly, Stephen A. Woodbury

Employment Research Newsletter

No abstract provided.

The Road To Universal Health Coverage In Massachusetts: A Story In Three Parts, John E. Mcdonough

New England Journal of Public Policy

In 1988, the Massachusetts Legislature passed a new law, a “play or pay” employer mandate, requiring all employers with six or more workers to provide health insurance coverage for their employees. A few years later, with Medicaid identified as a “Budget Buster,” the Weld administration sought deregulation as the way to cut costs and expand access by establishing MassHealth, which dropped the employer mandate and expanded Medicaid, and eventually distinguished Massachusetts as the state with the greatest percent of covered citizens. But MassHealth enrollment has declined as premium costs have risen, and the Uncompensated Care Pool is once again faced …

The Political Economy Of Health Care Reforms, Huizhong Zhou Editor

Upjohn Press

A leading group of health care economists propose solutions to problems related to Medicare, managed care, health insurance, coverage for the uninsured, and the role of tax policy in health care.