The Accident Externality from Driving

We estimate auto accident externalities (more specifically insurance externalities) using panel data on state-average insurance premiums and loss costs. Externalities appear to be substantial in traffic dense states: in California, for example, we find that a typical additional driver increases the total of other people's insurance costs by $2231 per year. In such states, an increase in traffic density dramatically increases aggregate insurance premiums and loss costs. In contrast, the accident externality per driver in low traffic states appears quite small. On balance, accident externalities are so large that a correcting Pigouvian tax could raise$45 billion annually in California alone, and over $140 billion nationally. The extent to which this externality results from increases in accident rates, accident severity or both remains unclear. It is also not clear whether the same externality pertains to underinsured accident costs like fatality risk.

Republican States Bolstered Their Health Insurance Rate Review Programs Using Incentives From the Affordable Care Act.

The Affordable Care Act (ACA) included financial and regulatory incentives and goals for states to bolster their health insurance rate review programs, increase their anticipated loss ratio requirements, expand Medicaid, and establish state-based exchanges. We grouped states by political party control and compared their reactions across these policy goals. To identify changes in states rate review programs and anticipated loss ratio requirements in the individual and small group markets since the ACAs enactment, we conducted legal research and contacted each states insurance regulator. We linked rate review program changes to the Centers for Medicare and Medicaid Services (CMS) criteria for an effective rate review program. We found, of states that did not meet CMSs criteria when the ACA was enacted, most made changes to meet those criteria, including Republican-controlled states, which generally oppose the ACA. This finding is likely the result of the relatively low administrative burden associated with reviewing health insurance rates and the fact that doing so prevents federal intervention in rate review. However, Republican-controlled states were less likely than non-Republican-controlled states to increase their anticipated loss ratio requirements to align with the federal retrospective medical loss ratio requirement, expand Medicaid, and establish state-based exchanges, because of their general opposition to the ACA. We conclude that federal incentives for states to strengthen their health insurance rate review programs were more effective than the incentives for states to adopt other insurance-related policy goals of the ACA

Do Small Group Health Insurance Regulations Influence Small Business Size?

The cost of health insurance has been the primary concern of small business owners for several decades. State small group health insurance reforms, implemented in the 1990s, aimed to control the variability of health insurance premiums and to improve access to health insurance. Small group reforms only affected firms within a specific size range, and the definition of the upper size threshold for small firms varied by state and over time. As a result, small group reforms may have affected the size of small firms around the legislative threshold and may also have affected the propensity of small firms to offer health insurance. Previous research has examined the second issue, finding little to no effect of health insurance reforms on the propensity of small firms to offer health insurance. In this paper, we examine the relationship between small group reform and firm size. We use data from a nationally representative repeated cross-section survey of employers and data on state small group health insurance reform. Contrary to the intent of the reform, we find evidence that small firms just below the regulatory threshold that were offering health insurance grew in order to bypass reforms.Health insurance, small business

Health Savings Accounts for Small Businesses and Entrepreneurs: Shopping, Take-Up and Implementation Challenges

A combination of high deductible health plans (HDHPs) and health savings accounts (HSAs) holds promise for expanding health insurance for small firms. We provide information on HSA take-up and shopping behavior from a 2008 survey of female small business owners, revealing that the HSA marketplace can be confusing for small firms. HSAs may have expanded access to health insurance for the smallest firms (under three employees), but not for small firms more generally. A sizable number of firms offering HSA-eligible insurance did not offer attached HSAs. Firms offering HSAs were satisfied with their experiences, but faced challenges in implementing them.Health Savings Accounts, Health Insurance Costs, Small Business

Health Savings Accounts for Small Businesses and Entrepreneurs: Shopping, Take-Up and Implementation Challenges

A combination of high deductible health plans (HDHPs) and health savings accounts (HSAs) holds promise for expanding health insurance for small firms. We provide information on HSA take-up and shopping behavior from a 2008 survey of female small business owners, revealing that the HSA marketplace can be confusing for small firms. HSAs may have expanded access to health insurance for the smallest firms (under three employees), but not for small firms more generally. A sizable number of firms offering HSA-eligible insurance did not offer attached HSAs. Firms offering HSAs were satisfied with their experiences, but faced challenges in implementing them.Health Savings Accounts, Health Insurance Costs, Small Business

National Bureau of Economic Research

Abstract: Does a one percent increase in aggregate driving increase accident costs by more than one percent? Vickrey [1968] and Edlin [1999] answer yes, arguing that as a new driver takes to the road, she increases the accident risk to others as well as assuming risk herself. On the other hand, more driving could result in increased congestion, lower speeds, and less severe or less frequent accidents. We study the question with panel data on state-average insurance premiums and loss costs. We …nd that in high tra¢c density states, an increase in tra¢c density dramatically increases aggregate insurance premiums and loss costs. In California, for example, we estimate that a typical additional driver increases the total of other people’s insurance costs by $1271-2432. In contrast, the accident externality per driver in low tra¢c states appears quite small. On balance, accident externalities are so large that a correcting Pigouvian tax could raise$45 billion in California alone, and over $140 billion nationally. It is not clear the extent to which this externality results from increases in accident rates, accident severity or both. It is also not clear whether the same externality pertains to underinsured accident costs like fatality risk

Opioid prescribing by multiple providers in Medicare: retrospective observational study of insurance claims

Objectives: To estimate the frequency and characteristics of opioid prescribing by multiple providers in Medicare and the association with hospital admissions related to opioid use. Design: Retrospective cohort study. Setting: Database of prescription drugs and medical claims in 20% random sample of Medicare beneficiaries in 2010. Participants: 1 808 355 Medicare beneficiaries who filled at least one prescription for an opioid from a pharmacy in 2010. Main outcome measures Proportion of beneficiaries who filled opioid prescriptions from multiple providers; proportion of these prescriptions that were concurrently supplied; adjusted rates of hospital admissions related to opioid use associated with multiple provider prescribing. Results: Among 1 208 100 beneficiaries with an opioid prescription, 418 530 (34.6%) filled prescriptions from two providers, 171 420 (14.2%) from three providers, and 143 344 (11.9%) from four or more providers. Among beneficiaries with four or more opioid providers, 110 671 (77.2%) received concurrent opioid prescriptions from multiple providers, and the dominant provider prescribed less than half of the mean total prescriptions per beneficiary (7.9/15.2 prescriptions). Multiple provider prescribing was highest among beneficiaries who were also prescribed stimulants, non-narcotic analgesics, and central nervous system, neuromuscular, and antineoplastic drugs. Hospital admissions related to opioid use increased with multiple provider prescribing: the annual unadjusted rate of admission was 1.63% (95% confidence interval 1.58 to 1.67%) for beneficiaries with one provider, 2.08% (2.03% to 2.14%) for two providers, 2.87% (2.77% to 2.97%) for three providers, and 4.83% (4.70% to 4.96%) for four or more providers. Results were similar after covariate adjustment. Conclusions: Concurrent opioid prescribing by multiple providers is common in Medicare patients and is associated with higher rates of hospital admission related to opioid use

US Trends in COVID-19–Associated Hospitalization and Mortality Rates Before and After Reopening Economies

Importance After abrupt closures of businesses and public gatherings in the US in late spring 2020 due to the COVID-19 pandemic, by mid-May 2020, most states reopened their economies. Owing in part to a lack of earlier data, there was little evidence on whether state reopening policies influenced important pandemic outcomes—COVID-19–related hospitalizations and mortality—to guide future decision-making in the remainder of this and future pandemics. Objective To investigate changes in COVID-19–related hospitalizations and mortality trends after reopening of US state economies. Design, Setting, and Participants Using an interrupted time series approach, this cross-sectional study examined trends in per-capita COVID-19–related hospitalizations and deaths before and after state reopenings between April 16 and July 31, 2020. Daily state-level data from the University of Minnesota COVID-19 Hospitalization Tracking Project on COVID-19–related hospitalizations and deaths across 47 states were used in the analysis. Exposures Dates that states reopened their economies. Main Outcomes and Measures State-day observations of COVID-19–related hospitalizations and COVID-19–related new deaths per 100 000 people. Results The study included 3686 state-day observations of hospitalizations and 3945 state-day observations of deaths. On the day of reopening, the mean number of hospitalizations per 100 000 people was 17.69 (95% CI, 12.54-22.84) and the mean number of daily new deaths per 100 000 people was 0.395 (95% CI, 0.255-0.536). Both outcomes displayed flat trends before reopening, but they started trending upward thereafter. Relative to the hospitalizations trend in the period before state reopenings, the postperiod trend was higher by 1.607 per 100 000 people (95% CI, 0.203-3.011; P = .03). This estimate implied that nationwide reopenings were associated with 5319 additional people hospitalized for COVID-19 each day. The trend in new deaths after reopening was also positive (0.0376 per 100 000 people; 95% CI, 0.0038-0.0715; P = .03), but the change in mortality trend was not significant (0.0443; 95% CI, −0.0048 to 0.0933; P = .08). Conclusions and Relevance In this cross-sectional study conducted over a 3.5-month period across 47 US states, data on the association of hospitalizations and mortality with state reopening policies may provide input to state projections of the pandemic as policy makers continue to balance public health protections with sustaining economic activity

Log Odds and the Interpretation of Logit Models

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142912/1/hesr12712.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142912/2/hesr12712_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142912/3/hesr12712-sup-0001-AppendixSA1.pd