Medicaid Expansion’s Impact in Texas

Texas is one of twelve states that has chosen not to expand Medicaid, despite having the largest number of uninsured residents in the country. Ninety percent matching financing from the federal government means the state is missing out on not only any benefits to individuals but fiscal benefits to local economies. This policy brief summarizes research on fiscal impacts of Medicaid expansion and the number of Texans who would be eligible for expansion, as well as how much new federal annual spending would be expected if those Texans enrolled in Medicaid. The research was sponsored by the Episcopal Health Foundation, a philanthropic organization focused on improving community health in Texas. The full report, “County-Level Projections of Medicaid Expansion’s Impact in Texas,” can be found on their website and includes county-level data, interactive embeddable maps that show potential funding and health insurance coverage for every county in Texas, and complete details about the project’s methods.Episcopal Health Foundatio

The Effect of Public Insurance Coverage for Childless Adults on Labor Supply

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

What Happens to Texans’ Insurance Coverage When Medicaid and Marketplace Pandemic-Era Policies End?

Policy ReportThe COVID-19 related public health emergency (PHE) led to federal legislation that changed the landscape of Medicaid and Marketplace insurance coverage. Beginning in 2020, policy responses led to increasing Medicaid enrollment due to federal rules preventing Medicaid disenrollment, and increased Marketplace participation through generous subsidies extended to the majority of the working age population without access to employer provided coverage. In this brief, we describe and summarize the implications of the federally declared PHE and federal legislation for health insurance coverage during the 2020-2022 period in Texas at the state and county level, estimate the implications for insurance coverage once the PHE ends, and provide estimated aggregate fiscal impacts. Texas had the nation’s highest uninsurance rate at 18.4% in 2019, but since January 2020, total Texas Medicaid caseload has increased by 41% or 1.6 million people (as of June 2022), and about 750,000 individuals have newly enrolled in Marketplace coverage, likely substantially decreasing the number uninsured. The Medicaid policies have provided a net financial windfall to the state of $3.5 billion since January 2020. With the eventual end of the PHE, our conservative estimates expect that 550,000 to 700,000 individuals will lose Medicaid coverage, increasing the uninsurance rate by at least 2 percentage points or about 10%. Attention to policies and administrative actions that support ongoing insurance enrollment can help ensure that the large gains to insurance coverage achieved during the PHE can be sustained. Policies and administrative actions that would help ensure the historic gains in coverage are maintained include reducing red-tape costs of processing renewals and redeterminations by streamlining eligibility systems (including the use of information already available to the state), using the capacity of managed care and health insurance navigator organizations for outreach and processing, and taking advantage of increased federal matches for Medicaid expansion.Episcopal Health Foundatio

County-Level Projections of Medicaid Expansion’s Impact in Texas

Policy BriefTexas is one of twelve states nationwide that has not expanded Medicaid, despite the largest number of uninsured residents in the country. One commonly cited reason is the budgetary implications of a large increase in entitlement spending. In this brief, we summarize the research on fiscal impacts of Medicaid expansion and provide estimates of the number of currently uninsured Texans who would be eligible for Medicaid expansion, by county, as well as how much new federal annual Medicaid spending would be expected if those Texans enrolled in Medicaid. We estimate that 954,000 newly eligible adults would enroll in an expansion, bringing approximately $5.41 billion in federal dollars annually to the state. With a required state matching share of 1 for every 9 federal dollars, and numerous potential offsets for the state portion, the fiscal implications appear to be favorable from the state and local government perspective. In the context of uncertainty around future direct funding for hospitals and the pandemic that continues to damage local economies and health systems, Medicaid expansion may be able to provide some fiscal relief.Episcopal Health Foundatio

Marketplace Health Insurance & the Public Health Emergency: Implications for Texas

Texas has the highest uninsurance rate in the country. The COVID-19 related public health emergency led to the American Rescue Plan Act, federal legislation that increased premium subsidies for private Marketplace health insurance plans and expanded eligibility criteria. Since early 2021, total Texas Marketplace enrollment has increased by 70% or 750,000 people. In recent work, the authors used public data to estimate the gains in Marketplace coverage attributable to the policy, the remaining share of uninsured individuals who may remain eligible for subsidized Marketplace coverage, and projected losses in coverage when these temporary policies expire at the end of 2025. This article is a companion to the December 2023, issue of The Takeaway on Medicaid and the Public Health Emergency.Episcopal Health Foundatio

The Effect of Public Insurance Coverage for Childless Adults on Labor Supply

This study provides plausibly causal estimates of the effect of public insurance coverage on the employment of non-elderly, nondisabled adults without dependent children (“childless adults”). We take advantage of the sudden imposition of an enrollment cap in Wisconsin, comparing the labor supply of enrollees to eligible applicants placed on a waitlist using a regression discontinuity design and difference-in-differences methods. We find enrollment into public insurance leads to sizable and statistically meaningful reductions in employment, with an estimated effect size of just over 5 percentage points, a 12 percent decline. Confidence intervals rule out positive and large negative effects. (JEL G22, H75, I13, I18, I38, J22) </jats:p

Estimates of Crowd-Out from a Public Health Insurance Expansion Using Administrative Data

We use a combination of administrative and survey data to estimate the fraction of individuals newly enrolled in public health coverage (Wisconsin’s combined Medicaid and CHIP program) that had access to private, employer-sponsored health insurance at the time of their enrollment and the fraction that dropped this coverage. We estimate that after expansion of eligibility for public coverage, approximately 20% of new enrollees had access to private health insurance at the time of enrollment and that only 8% dropped this coverage (with the remaining 12% having both private and public coverage). We also identify an “upper bound” estimate, which suggests that the percentage of new enrollees with private insurance coverage at the time of enrollment is, at most, 27%. These estimates of crowd-out are relatively low compared with estimates from the literature based on Medicaid and CHIP expansions, although based both on different data and on a different method.

Medicaid Expansion’s Impact in Texas

Texas is one of twelve states that has chosen not to expand Medicaid, despite having the largest number of uninsured residents in the country. Ninety percent matching financing from the federal government means the state is missing out on not only any benefits to individuals but fiscal benefits to local economies. This policy brief summarizes research on fiscal impacts of Medicaid expansion and the number of Texans who would be eligible for expansion, as well as how much new federal annual spending would be expected if those Texans enrolled in Medicaid. The research was sponsored by the Episcopal Health Foundation, a philanthropic organization focused on improving community health in Texas. The full report, “County-Level Projections of Medicaid Expansion’s Impact in Texas,” can be found on their website and includes county-level data, interactive embeddable maps that show potential funding and health insurance coverage for every county in Texas, and complete details about the project’s methods.Episcopal Health Foundatio

Medicaid & the Public Health Emergency: Implications for Texas

The COVID-19 related public health emergency (PHE) led to federal legislation that changed the current landscape of Medicaid coverage. Beginning in March 2020, states agreed to suspend Medicaid disenrollment in exchange for increased federal funds to help stabilize their budgets. Texas had the nation’s highest uninsurance rate at 18.4% in 2019, but as of June 2022, total Texas Medicaid caseload has increased by 41% or 1.6 million people, substantially decreasing the number of uninsured. The authors used public data to estimate the gains in Medicaid coverage attributable to the PHE and losses in caseload when the policy expires, as well as the net fiscal impacts.Episcopal Health Foundatio

The Role of Paid Family Leave in Labor Supply Responses to a Spouse\u27s Disability or Health Shock

Disability onset and major health shocks can affect the labor supply of those experiencing the event and their family members, who face a tradeoff between time spent earning income and providing care. This decision could be affected by the availability of paid family leave. We examine the role of paid leave mandates in caregiving and labor supply decisions after a spouse\u27s disability or health shock. Using data from the Survey of Income and Program Participation, we show that paid leave mandates reduce the likelihood that potential caregivers report decreasing their paid work hours to provide caregiving after a spouse\u27s health shock. However, if caregivers are unlikely to have access to job protection, paid leave mandates also increase the likelihood of leaving the labor market to provide caregiving and working fewer weeks. There is limited evidence of an effect of paid leave on other employment outcomes. Our findings demonstrate that paid leave has some influence on household labor supply decisions after spousal health shocks, but its role should be considered together with the availability of job protection