Health Insurance Enrollment Decisions: Preferences for Coverage, Worker Sorting, and Insurance Take Up

The weak response by the uninsured to policy initiatives encouraging voluntary enrollment in health insurance has raised concerns regarding the extent to which the uninsured value health insurance. To address this issue, we use data from the 2001 Medical Expenditure Panel Survey to examine the association between health insurance preferences and coverage status. We also consider the role of such preferences in decisions to seek out and enroll in employment-based coverage. We find that adults with weak or uncertain preferences for health insurance are more likely than persons with strong preferences to be uninsured and less likely to acquire coverage. Our econometric work indicates that workers with weak or uncertain preferences are less likely to obtain job offers with insurance, reinforcing prior evidence that workers sort among jobs according to preferences for coverage. We also find that workers with weak or uncertain preferences are less likely to enroll in offered coverage and we estimate the subsidy necessary to compensate such workers for the utility loss were they to enroll. Our results suggest a dual approach to expanding coverage that includes both subsidies and educational efforts to inform targeted groups among the uninsured about the value of health insurance.

Overweight in Adolescents: Implications for Health Expenditures

We consider two compelling research questions raised by the increased prevalence of overweight among adolescents. First, what factors explain variation in adolescent bodyweight and the likelihood of being overweight? Next, do overweight adolescents incur greater health care expenditures compared to those of normal weight? We address the former question by examining the contribution of individual characteristics, economic factors, parental and family attributes, and neighborhood characteristics to variation in these bodyweight outcomes. For the second question, we estimate a two-part, generalized linear model of health spending. Using data from the Medical Expenditure Panel Survey, our econometric analyses indicate that adolescent bodyweight and the likelihood of being overweight are strongly associated with parental bodyweight, parental education, parental smoking behavior, and neighborhood attributes such as the availability of fresh food markets and convenience/snack food outlets, and neighborhood safety and material deprivation. Our expenditure model indicates that overweight females have annual expenditures that exceed those of normal weight by nearly $800 with part of the disparity explained by differences in mental health expenditures. We use both sets of empirical results to draw implications for policies to address adolescent overweight.

The Impact of State Dependent Coverage Expansions on Young Adult Insurance Status: Further Analysis

Outlines how state initiatives to expand dependent coverage affected young adults' rates of uninsurance and of employer-sponsored coverage. Considers differential time effects and implications for national reform provisions to expand coverage to age 26

Dependent Coverage Expansions: Estimating the Impact of Current State Policies

Presents preliminary findings on common provisions in state regulations of dependent health coverage and discusses the analytic approach to estimating the impact of state policy changes on young adults

Expenditures on Health Care for Children and Pregnant Women

The chronic health care crisis in the United States is primarily the result of rapidly rising health care costs which leave millions of children and pregnant women without health insurance, with restricted access to health care, and at risk for poor health. A better understanding of the current system is key to any reform effort. The authors analyze estimates of annual expenditures on medical care services for children covering the period from conception through age 18 years, including expenditures on pregnancy and delivery. They focus their attention on the distribution of health care expenditures by type of service and source of payment, on how expenditures differ for children of different ages and for adults, and on the rate of growth in expenditures on health care for children. The authors suggest that, because there has been a decline in the relative share of expenditures accounted for by children, efforts to expand third-party financing of their health care will be less likely to overwhelm the system than would efforts to expand coverage to other groups. Families who are especially in need of extended health care coverage are those of children with major illnesses who are exposed to catastrophic costs. Efforts at cost containment may be most effective if focused on pregnancy and newborn care, areas in which expenditures have grown extremely rapidly in recent years. Finally, the authors conclude that, if expansion of health insurance coverage for children in the near term were to be incremental, expanded coverage for children 3 to 12 years old would probably have the smallest budgetary impact of any expansion in access to care.

Employer-Sponsored Health Insurance and the Promise of Health Insurance Reform

The central role that employers play in financing health care is a distinctive feature of the U.S. health care system, and the provision of health insurance through the workplace has important implications well beyond its role as a source of health care financing. In this paper, we consider the “goodness of fit” of employer-sponsored health insurance (ESI) in the current economic and health insurance environments and in light of prospects for a vigorous national debate over the shape of health care reform. The main issue that we explore is whether ESI can have a viable role in health system reform efforts or whether such coverage will need to be significantly modified or even abandoned as reform seeks to address important issues in the efficient provision and equitable distribution of health insurance coverage

Health Insurance Enrollment Decisions: Preferences for Coverage, Worker Sorting, and Insurance Take-up

The weak response by the uninsured to initiatives encouraging voluntary enrollment in health insurance has raised concerns regarding the extent to which the uninsured value insurance. This concern is also relevant for proposals to mandate health insurance coverage since workers will suffer welfare losses if compelled to purchase coverage they perceive to be of little value. To address this issue, we use the 2001 Medical Expenditure Panel Survey to examine decisions by single workers to seek out and enroll in employer-sponsored insurance. We find that single workers with weak or uncertain preferences for health insurance are less likely to have jobs that offer coverage or to enroll in coverage when offered. Our results suggest a dual approach to expanding coverage that includes both subsidies and educational efforts regarding the value of health insurance