Health Insurance Availability and Entrepreneurship

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 for unmarried, older, and observably less-healthy individuals.Health Insurance, Entrepreneurship, Job Lock

Health Insurance Availability and Entrepreneurship

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 for unmarried, older, and observably less-healthy individuals

PUTTING OUT THE FIRES: WILL HIGHER TAXES REDUCE YOUTH SMOKING?

This paper re-examines the empirical support for predictions that proposed cigarette tax or price increases will substantially reduce youth smoking. Part of the support for these predictions comes from evidence that higher taxes reduce aggregate tobacco sales and adult smoking rates. But taxes may have much different impacts on youth starting behavior than on adult quitting behavior. We use a panel microdata set, the National Education Longitudinal Survey of 1988 (NELS:88), that spans a period when many states increased taxes on cigarettes.We are able to study the impact of taxes and prices on smoking behavior during exactly the period in adolescence when most smokers start their habits. Cross-sectional models of 12th grade smoking based on the NELS:88 data yield estimated price elasticities ranging from -0.29 to -0.98,similar to previous studies. But when we exploit the longitudinal nature of the data our results suggest that cigarette taxes or prices are not important determinants of smoking initiation. We find weak or nonexistent tax and price effects in models of the onset of smoking between 8th and 12th grade, models of the onset into heavy smoking between 8th and 12th grade, and discrete time hazard models that include state fixed effects. Our estimates create doubt about the strength of the response of youth smoking to higher taxes or prices, and suggest that alternative policy approaches to preventing youth smoking deserve serious attention. We also provide a new perspective on the relationship between smoking and schooling. We find that students with better tests scores are less likely to smoke, and that eventual dropouts are already more likely to smoke in 8th grade. Possible explanations for these patterns include individual heterogeneity in: the rate of time preference; tastes for deviancy; parental investment in smoking prevention as an aspect of child quality; and optimal lifetime plans for health and education human capital investment.Cigarette smoking; taxation

Managed Care and Medical Expenditures of Medicare Beneficiaries

This paper investigates the impact of Medicare HMO penetration on the medical care expenditures incurred by Medicare fee-for-service (FFS) enrollees. We find that increasing penetration leads to reduced spending on FFS beneficiaries. In particular, our estimates suggest that the increase in HMO penetration during our study period led to approximately a 7% decline in spending per FFS beneficiary. Similar models for various measures of health care utilization find penetration-induced reductions consistent with our spending estimates. Finally, we present evidence that suggests our estimated spending reductions are driven by beneficiaries who have at least one chronic condition

Managed Care and Medical Expenditures of Medicare Beneficiaries

This paper investigates the impact of Medicare HMO penetration on the medical care expenditures incurred by Medicare fee-for-service enrollees. We find that increasing penetration leads to reduced health care spending on fee-for-service beneficiaries. In particular, a one percentage point increase in Medicare HMO penetration reduces such spending by .9 percent. We estimate similar models for various measures of health care utilization and find penetration-induced reductions, consistent with our spending estimates. Finally, we present evidence that suggests our estimated spending reductions are driven by beneficiaries who have at least one chronic condition.

Who Pays Cigarette Taxes? The Impact of Consumer Price Search

We conduct an empirical study of the impact of consumer price-search on the shifting of cigarette excise taxes to consumer prices. We use novel data on the prices smokers report actually paying for cigarettes. We document substantial price dispersion. We find that cigarette taxes are shifted at lower rates to the prices paid by consumers who undertake more price search – carton buyers, and especially, smokers who buy cartons of cigarettes in a state other than their state of residence. We also find suggestive evidence that taxes are shifted at slightly higher rates to the prices paid by non-daily smokers, less addicted smokers, and smokers of light cigarettes.

Excise Tax Avoidance: The Case of State Cigarette Taxes

In this paper we contribute new empirical results about consumers’ decisions to avoid cigarette excise taxes, and a new applied welfare economic analysis of optimal excise taxation with tax avoidance. We examine direct measures of consumer excise tax avoidance in novel individual-level data from the 2003 and 2006 - 2007 Tobacco Use Supplements to the U.S. Current Population Survey. We estimate reduced-form models and a structural endogenous switching regression model. In the structural border-crossing equation, the decision to cross the border depends on the difference between the endogenous home- and border-state prices. The reduced-form and structural results show that the probability of cross-border cigarette purchases responds in predictable ways to the economic incentives created by the distance to the border and state tax differentials. To our knowledge, we are also the first study to extend the formula for optimal Pigouvian corrective taxation to incorporate excise tax avoidance. Taking into account tax avoidance implies the optimal tax is substantially below the simple Pigouvian tax that internalizes external costs. In illustrative calculations for 2003, we find that in 20 states the optimal tax that accounts for tax avoidance is at least 20 percent smaller than the simple Pigouvian tax.

Youth Smoking, Cigarette Prices, and Anti-Smoking Sentiment

In this paper, we develop a new direct measure of state anti-smoking sentiment and merge it with micro data on youth smoking in 1992 and 2000. The empirical results from the cross-sectional models show two consistent patterns: after controlling for differences in state anti-smoking sentiment, the price of cigarettes has a weak and statistically insignificant influence on smoking participation; and state anti-smoking sentiment appears to be a potentially important influence on youth smoking participation. The cross-sectional results are corroborated by results from discrete time hazard models of smoking initiation that include state fixed effects. However, there is evidence of price-responsiveness in the conditional cigarette demand by youth and young adult smokers.

Racial Difference in the Determinants of Smoking Onset

The large differences in youth smoking behavior across ethnic and racial groups are often overlooked in debates about prevention. This study examines how the determinants of the onset of smoking vary by race and ethnicity. Academic success is strongly associated with lower smoking rates among white youth, but this is not as true for Hispanics and African-Americans. Cultural assimilation may be an important determinant of smoking for Hispanics. Price increases do not appear to reduce smoking onset among white youth, but the results provide some support that higher prices will reduce smoking among Hispanic and African-American youth.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47953/1/11166_2004_Article_312405.pd