The Effects of Language and Geography-Defined Groups on Health Insurance Choice

The objective of this study is to measure how language and geography-defined groups influence participation in public health insurance programs. The theoretical model in this paper shows how better information on insurance states, gleaned through language group contacts in one’s local area, can help individuals decide whether or not to take up a public benefit or remain uninsured. This study focuses on Medicaid-eligible adults and Medicaid/CHIP-eligible children who speak a non-English language at home, and uses pooled cross-sections of the 2008-2009 American Community Survey (ACS). Adapting an empirical method developed by Bertrand, Luttmer, and Mullainathan (2000), I define the main variable of interest as the interaction between contact availability, the density of an individual’s language group in an individual’s local area, and group quality, the information and preferences related to Medicaid that an individual’s language group may possess, as measured by the language group’s Medicaid take-up rate. The empirical framework also uses language group and Public Use Microdata Area (PUMA) fixed effects to control for observable and unobservable differences across language groups and local areas. The main results and sensitivity analyses strongly suggest that language and geography groups have a statistically significant impact on an individual’s probability of taking-up Medicaid/CHIP: For a policy change that increases Medicaid use by 1 percentage point, the network for these language groups will increase the probability of taking-up Medicaid by 10 percentage points for adults and 7 percentage points for children. As eligibility expands under the Affordable Care Act and more people in a given language group enroll in Medicaid/CHIP, the multiplier effect could lead to higher overall program participation than might otherwise might be anticipated in a scenario without non-market interactions. These results can also help policymakers target outreach funds towards uninsured non-English speakers who are eligible for public benefits

State Progress Toward Health Reform Implementation

Provides updated state-level estimates of the effects of the 2010 healthcare reform act on coverage and costs, including correlations between a state's progress in establishing insurance exchanges and expected benefits in coverage and federal subsidies

Value Based Cost Sharing Meets the Theory of Moral Hazard: Medical Effectiveness in Insurance Benefits Design

The conventional theory of optimal coinsurance rates in health insurance in the presence of moral hazard indicates that, in situations of equal risk characteristics, coinsurance should vary if the price-responsiveness or price-elasticity of demand for different medical services varies, and should be larger for the more price responsive services. An alternative theory called "value-based cost sharing" indicates that coinsurance should be lower for services with higher (marginal) benefits relative to costs. This paper reconciles the two views. It shows that, if patient demands are based on correct information on benefits and costs, the conclusion of the conventional view is identical to the conclusion from the value-based approach. If patient demands differ from correct demands, it is shown that optimal coinsurance depends both on the extent and direction of information imperfection and on price-responsiveness or price elasticity. The paper also shows, as an alternative to adjusting coinsurance to deal with information imperfection, that providing better information which affects patient demands can be superior if uninformed patient demands exceed informed patient demands, but value based cost sharing can be superior to providing information (even if the cost of information is minimal) when patient demands fall short of informed demands. An extended numerical example illustrates these points.

A Decade of Coverage Losses: Implications for the Affordable Care Act

Examines 2000-10 trends in employer-sponsored health insurance and Medicaid/CHIP coverage by income group; contributing factors, including a growing low-income population; and projected coverage among low-income adults under the 2010 healthcare reform

Is There a Market for Voluntary Health Insurance in Developing Countries?

In many developing countries the proportion of health care spending paid out of pocket is about half of all spending or more. This study examines the distribution of such spending by income and care type, and the variation in spending about its expected value, in order to see whether voluntary private health insurance that reduces variation in spending might be able to be supplied. Using data from the World Health Survey for 14 developing countries, we find that out of pocket spending varies by income but that most spending usually occurs in income quintiles below the topmost quintile. We use estimates of the variance of total spending, hospital spending, physician spending, and outpatient drug spending about their means to generate estimates of the risk premia risk averse consumers might pay for insurance coverage. For hospital spending and total spending, these risk premia as a percent of expenses are generally larger than reasonable estimates of private health insurer loading as a percent of expenses, suggesting that voluntary insurance might be feasible. However, the strong relationship between spending and income suggests that insurance markets may need to be segmented by income.

How Has the ACA Changed Finances for Different Types of Hospitals? Updated Insights from 2015 Cost Report Data

The American Health Care Act, which was considered by Congress, would have repealed the state option to expand Medicaid under the ACA. However, with the ACA remaining intact, states that did not expand Medicaid now have the chance to reconsider.Key FindingsUsing data through fiscal year 2015:In states that expanded Medicaid through the ACA, hospitals had $5.0 million in increased Medicaid revenue and$3.2 million decreased uncompensated care costs, on average per hospital. Hospitals in states that expanded Medicaid through the ACA improved average operating margins by 2.5 percentage points.Small hospitals, for-profit and non-federal-government-operated hospitals, and those in non-metropolitan areas saw the strongest gains in profit margins.ConclusionFor states still considering Medicaid expansion, experts say that expansion likely would improve hospitals' payer mix and overall financial outlook, particularly for hospitals in non-metro areas

The Long-Term Effects of Childhood Exposure to the Earned Income Tax Credit on Health Outcomes

The Earned Income Tax Credit (EITC) is a central component of the U.S. safety net, benefiting about 27 million families. Using variation in the federal and state EITC, this paper evaluates the long-term impact of EITC exposure during childhood on the health of young adults. We find that an additional $100 in the average annual EITC exposure between ages 0 and 18 increases the likelihood of reporting very good or excellent health by 2.7 percentage points and decreases the likelihood of being obese by 1.0 percentage point between ages 22 and 27. Direct program transfers, increases in pre-tax family earnings, and increases in health insurance coverage are channels through which the EITC improves health

Effects of Public Premiums on Children's Health Insurance Coverage: Evidence from 1999 to 2003

This study uses 2000 to 2004 Current Population Survey data to examine the effects of public premiums on the insurance coverage of children whose family incomes are between 100% and 300% of the federal poverty level. The analysis employs multinomial logistic models that control for factors other than premium costs. While the magnitude of the estimated effects varies across models, the results consistently indicate that raising public premiums reduces enrollment in public programs, with some children who forgo public coverage having private coverage instead and others being uninsured. The results indicate that public premiums have larger effects when applied to lower-income families