Download or read book Essays on Health Insurance Coverage and Food Assistance Programs written by Daniela Zapata Sapiencia and published by . This book was released on 2012 with total page 140 pages. Available in PDF, EPUB and Kindle. Book excerpt: "Empirical work shows that health insurance coverage improves children's health and that healthier children have better educational and labor market outcomes. This suggests that the benefits of higher insurance rates among children go beyond improvements in health. However, there are no investigations in the United States that track the long-term socioeconomic benefits of health insurance coverage during childhood. Using data from the Children of the National Longitudinal Survey of Youth to estimate family fixed effects models, I find evidence that health insurance coverage at ages 0-4 has a positive effect on test scores in mathematics, reading recognition, reading comprehension, and vocabulary at ages 5-14. The second essay in this dissertation, co-authored with Charles Courtemanche, investigates the effect of the Massachusetts health care reform on self-reported health. The main objective of this reform was to achieve universal health insurance coverage through a combination of insurance market reforms, mandates, and subsidies. This reform was later used as a model for the Patient Protection and Affordable Care Act (ACA). Using individual-level data from the Behavioral Risk Factor Surveillance System and a difference in differences estimation strategy, this essay provides evidence that this reform led to better overall self-assessed health. Several determinants of overall health, including physical health, mental health, functional limitations, joint disorders, body mass index, and moderate physical activity also improved. Public food assistance programs share the fundamental goal of helping needy and vulnerable people in the U.S. obtain access to nutritious foods that they might not otherwise be able to afford. These programs also have other objectives, such as improving recipients' health, furthering children's development and school performance. To investigate these broader impacts, the third chapter of this dissertation, co-authored with David Ribar, examines the relationship between participation in food assistance programs, family routines and time use. Results from fixed effects models estimated using longitudinal data from the Three-City Study indicate that SNAP participation is negatively associated with homework routines. WIC participation on the other hand, is positively associated with family routines in general and with dinner routines, homework routines, and family-time routines in particular."--Abstract from author supplied metadata.

Download or read book Essays on Health Insurance and the Family written by Marcus Owen Dillender and published by . This book was released on 2013 with total page 216 pages. Available in PDF, EPUB and Kindle. Book excerpt: The three chapters of this dissertation explore the ties among health insurance, changing cultural institution, and labor economics. The first chapter focuses on the relationship between health insurance and wages by taking advantage of states that extended health insurance dependent coverage to young adults before the Patient Protection and Affordable Care Act. Using American Community Survey and Census data, I find evidence that extending health insurance to young adults raises their wages, both while they are eligible for insurance through their parents' employers and afterwards. The increases in wages can be explained by increases in human capital and increased flexibility in the labor market that comes from people no longer having to rely on their own employers for health insurance. The second chapter focuses on understanding the impact of allowing coverage of spouses through employer-sponsored health insurance. The fact that people choose to enter into marriage makes comparing the differences between married and unmarried couples uninformative. To get around this, I examine how shocks to access to insurance through a spouse's employer brought on by extensions in legal recognition have influenced health insurance and labor force decisions for same-sex couples. I find extending legal recognition to same-sex couples results in female same-sex couples being more likely to have one member not in the labor force. The third chapter examines what extending legal recognition to same-sex couples has done to marriage rates in the United States using a strategy that compares how marriage rates change after legal recognition in states that alter legal recognition versus states that do not. Despite claims that allowing same-sex couples to marry will reduce the marriage rate for opposite-sex couples, I find no evidence that allowing same-sex couples to marry reduces the opposite-sex marriage rate. The opposite-sex marriage rate does decrease, however, when domestic partnerships are available to opposite-sex couples.

Download or read book Essays on Public Health Insurance Expansions written by Laura Rose Wherry and published by . This book was released on 2012 with total page 138 pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation is comprised of two essays examining expansions in eligibility for public health insurance in the U.S. In the first essay, I focus on expanded eligibility for family planning services under Medicaid and the impact on fertility and the utilization of women's preventive care. In the second essay, which is joint work with Bruce D. Meyer, we examine the immediate and longer-term mortality effects of Medicaid eligibility expansions for children. Both of these papers use variation in public health insurance eligibility created by changes in federal or state eligibility rules to identify a causal relationship between public coverage and health-related outcomes.

Download or read book Essays on the Interaction Between Children s Health Insurance and Parental Circumstances written by Jamie Rubenstein Taber and published by . This book was released on 2012 with total page 131 pages. Available in PDF, EPUB and Kindle. Book excerpt: In the first chapter of this dissertation, I study the effect of child support health insurance mandates on children's health insurance coverage. Children are more likely to lose health insurance when their parents divorce or separate, which is problematic because lack of health insurance is associated with reduced preventive care, diagnosis of diseases at later stages, and higher mortality. In order to increase coverage for children and reduce costs associated with public health insurance, many states have passed child support laws which mandate that a parent provide health insurance for the children if it is available at a reasonable cost. This paper is the first to evaluate the impact of these statutes on the number of children who lose health insurance due to parental divorce or separation. I codify the relevant laws by state and year from 1990 through 2007 in terms of the presence of mandates and the number and type of enforcement mechanisms. These variables are then linked to panels of the Survey of Income and Program Participation (SIPP), which provide the remainder of the necessary variables. Three main regressions are estimated. The first measures the overall effect of child support health insurance mandates on children's insurance coverage. The second equation measures the first intermediate step, whether child support health insurance mandates result in an order in the child support agreement to provide health insurance. The third equation measures the second intermediate step, whether an order for the parents to provide health insurance results in insurance coverage for children. I find that child support laws requiring parents to provide health insurance do not significantly impact the presence or type of health insurance coverage for children of divorced or separated parents. Additionally, these laws do not increase the probability that the child support agreement contains an order to provide health insurance, and an order to provide health insurance does not increase the probability of either any coverage or private coverage. In the second paper, we study the relationship between divorce and health insurance. Changing marital status is an important source of health insurance change. However, neither the health nor family economics literatures have examined this phenomenon. Using the SIPP, we document how health insurance status changes over time for men, women, and children as divorce and separation occur, as well as the likely causes of these changes. We find modest changes in overall coverage, but these changes mask large changes in type of coverage as people divorce or separate. In the third paper, we look at the effects of government aid expansions on labor market outcomes. While many studies investigate the magnitude by which public insurance expansions 'crowdout' private coverage, we ask a question new question: are such families able to recoup the benefits of no longer relying on employer provided coverage for children when they move to public coverage? Our findings from the SIPP do not show noticeable improvements, though our findings from the Current Population Survey (CPS) show a positive and significant effect on income and hourly wages.

Download or read book Three Essays on Health Insurance Arrangements Among Married Couples written by David M. Zimmer and published by . This book was released on 2004 with total page 474 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Essays in Health Insurance written by Hubert Piotr Janicki and published by . This book was released on 2011 with total page 88 pages. Available in PDF, EPUB and Kindle. Book excerpt: This work is driven by two facts. First, the majority of households in the U.S. obtain health insurance through their employer. Second, around 20% of working age households choose not to purchase health insurance. The link between employment and health insurance has potentially large implications for household selection into employment and participation in public health insurance programs. In these two essays, I address the role of public and private provisions of health insurance on household employment and insurance decisions, the distribution of welfare, and the aggregate economy. In the first essay, I quantify the effects of key parts of the 2010 health care reform legislation. I construct a lifecycle incomplete markets model with an endogenous choice of health insurance coverage and calibrate it to U.S. data. I find that the reform decreases the fraction of uninsured households by 94% and increases ex-ante household welfare by 2.3% in consumption equivalence. The main driving force behind the reduction in the uninsured population is the health insurance mandate, although I find no significant welfare loss associated with the elimination of the mandatory health insurance provision. In the second essay, I provide a quantitative analysis of the role of medical expenditure risk in the employment and insurance decisions of households approaching retirement. I construct a dynamic general equilibrium model of the household that allows for self-selection into employment and health insurance coverage. I find that the welfare cost of medical expenditure risk is large at 5% of lifetime consumption equivalence for the non-institutionalized population. In addition, the provision of health insurance through the employer accounts for 20% of hours worked for households ages 60-64. Finally, I provide an quantitative analysis of changes in Medicare minimum eligibility age in a series of policy experiments.

Download or read book Essays in Health Economics written by Hui Ding and published by . This book was released on 2022 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation explores various topics in health economics, specifically the use of different types of health care (i.e., mental health, durable medical equipment, and chronic disease management in primary care settings) and how public insurance policies affect the price and utilization of health care products and services. In Chapter 1, I explore the geographic variation in mental health care use among the Medicare population. Using administrative data from Medicare, I isolates the patient- and place-specific drivers of the geographic variation in mental health care use among elderly adults. Specifically, I use an event-study framework with individual fixed effects to study changes in mental health care utilization for patients who move across areas with differing rates of average utilization. My results show that 60 percent of the geographic variation is attributed to place-specific factors. I then explore components of the "place effect", finding that mental health care provider capacity explains only one tenth of it. Beyond that, local attitudes toward mental health play an important role, as shown by asymmetric responses for people who move from low-to-high and high-to-low care utilization areas, especially among those who were never diagnosed with any mental illness before moving. Lastly, I find a strong negative correlation between area-level mental health care utilization and suicide rates, and evidence that moving to high utilization areas is associated with a lower risk of self-harm-related Emergency Department visits. These findings suggest that promoting mental health care could benefit the elderly population, and that there is substantial scope for achieving this goal with interventions targeting place-specific factors. In Chapter 2, along with co-authors Mark Duggan and Amanda Starc, I study Medicare's competitive bidding program (CBP) for durable medical equipment (DME). We use Medicare claims data to examine the effect on prices and utilization, focusing on continuous positive airway pressure (CPAP) devices for sleep apnea. We find that spending falls by 47.2% percent after a highly imperfect bidding mechanism is introduced. This is almost entirely driven by a 44.8% price reduction, though quantities also fall by 4.3\%. To disentangle supply and demand, we leverage differential cost sharing across Medicare recipients. We measure a demand elasticity of -0.272 and find that quantity reductions are concentrated among less clinically appropriate groups. In Chapter 3, along with co-authors Yiwei Chen, Min Yu, Jieming Zhong, Ruying Hu, Xiangyu Chen, Chunmei Wang, Kaixu Xie and Karen Eggleston, I investigate the effect of chronic disease management provided in primary health care (PHC) setting in rural China. Health systems globally face increasing morbidity and mortality from chronic diseases, yet many - especially in low- and middle-income countries - lack strong chronic disease management and PHC system. We provide evidence on China's efforts to promote PHC management using unique five-year panel data in a rural county, including health care utilization from medical claims and health outcomes from biomarkers. Utilizing plausibly exogenous variation in management intensity generated by administrative and geographic boundaries, we compare hypertension/diabetes patients in villages within two kilometers distance but managed by different townships. Results show that, compared to patients in townships with median management intensity, patients in high-intensity townships have 4.8% more PHC visits, 5.2% fewer specialist visits, 11.7% fewer inpatient admissions, and 3.6% lower medical spending. They also tend to have better medication adherence and better control of blood pressure. The resource savings from avoided inpatient admissions substantially outweigh the costs of the program.

Download or read book Three Essays on Health Care Spending written by Minkyoung Yoo and published by . This book was released on 2012 with total page 110 pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation is composed of three essays that consider the determinants and persistence of health care spending and how policies that control increasing health care costs affect the distribution of health care spending in the U.S. In the first essay, I study the association between education and health care spending for a set of health conditions amenable to self-management. Empirical findings from estimated health expenditure models reveal strong inverse relationships between education and health care spending among elderly adults with hypertension and/or asthma. Additionally, I find that greater educational attainment is associated with a reduced likelihood of being in the top 5% of health care spenders for elderly adults with hypertension and nonelderly adults with diabetes, and also with less severe conditions. The second essay assesses how the distribution of family out-of-pocket health care spending has been affected by changes in recent cost-sharing to understand the effectiveness of the risk protection function of private health insurance against high medical care expenses. The results suggest that families who rely more on health care because of one or more their member's existing health conditions are most affected by changes in cost sharing during the period 2001-2005 and the increased exposure to out-of-pocket spending occurrs primarily for families at higher percentiles of the out-of-pocket spending distribution, thus reducing the "return" to risk protection from holding private health insurance. The final essay examines the dynamics of out-of-pocket health care spending by looking at the persistence of such spending among Medicare beneficiaries. The findings suggest that having a certain chronic condition or a health shock clearly increases the probability of out-of-pocket health care spending persistence. Additionally, having an existing health insurance that supplements Medicare coverage or the acquisition of a new supplementary health insurance has a significant impact on the probability of persistence.

Download or read book Essays on Contracts in Health Insurance written by Ilya Rahkovsky and published by . This book was released on 2010 with total page 176 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Essays on Health Care Consumption and Household Finance written by Tal A. Gross and published by . This book was released on 2009 with total page 111 pages. Available in PDF, EPUB and Kindle. Book excerpt: (cont.) This paper studies the transition in insurance status as teenagers move from their family's coverage to uninsured status or other insurance plans. I find no evidence that teenagers stock up on medical care before coverage ends, but rather a general decrease in health care consumption in the last month of coverage.

Download or read book Essays on Health Insurance Plan Design written by Chenyuan Liu and published by . This book was released on 2020 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Health care markets have great economic importance and represent a large share of GDP in the U.S. Health insurance plans play a key role in the efficiency of these markets. My dissertation studies the design of health insurance contracts and how they affect market efficiency. Chapter 1 of my dissertation the prevalence of financially dominated options in health plan menus. We analyze Kaiser Family Foundation data on health plans that firms offer to their employees. For firms offering both a high-deductible and lower-deductible health plan, 62 percent of the time the high-deductible option has lower maximum spending risk for the employee. We estimate that the high-deductible plan dominates at roughly half of firms. We identify adverse-selection pricing as a likely mechanism for these surprising patterns and discuss implications for our understanding of the value of plan choice in employer-sponsored health insurance. Chapter 2 of my dissertation identifies both theoretically and empirically a new channel of sorting in insurance markets under asymmetric information: sorting by plan design. A model allowing for rich contract designs predicts high-risk individuals will sort into risk-minimizing straight-deductible plans, while lower-risk individuals prefer plans that trade higher maximum expenditure risk for coverage against small losses. Analyzing data from the ACA Exchange, I find that within coverage tiers, plans vary significantly along multi-dimensional cost-sharing attributes. Further, straight-deductible plans attract higher-risk enrollees than other designs as the model predicts. I discuss how these insights can inform discussions around the standardization of insurance plans. Chapter 3 of my dissertation studies the effects of capitated payment models on physicians' treatment decisions in the treatment of lower back pain in the U.S. We use a large employer-sponsored health insurance claim database from 2003 to 2006, and leverage capitation variation within the plan and physician to mitigate selection concerns. We find that the treatment intensity of capitated patients is 5 to 10 percent lower than otherwise similar non-capitated patients, mainly from therapy, diagnostic testing, and drugs. We also find no evidence of increased readmission rates for capitated patients.

Download or read book Essays on Health Family and Work Choices written by Joelle Abramowitz and published by . This book was released on 2013 with total page 86 pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation investigates how changes in policies, technology, and lifestyles affect individual's decisions about their health, well-being, and life choices. The dissertation primarily focuses on two questions within this topic: i) the effects of greater affordability of assisted reproductive technology (ART) on women's marriage and fertility timing decisions and ii) the effects of time spent working on individual's obesity and health status and the mechanisms contributing to these effects. In two chapters, I examine whether greater affordability of ART has impacted women's fertility and marriage choices. ART consists of medical technologies that help women and couples with fertility problems conceive a child using such methods as in-vitro fertilization (IVF). Since the percentage of women facing infertility increases greatly with age, by making it affordable for women to delay family formation and then use ART to start families later if they face infertility, greater affordability of ART could induce women to delay marriage and childbearing. To formally identify channels through which greater affordability of ART might impact women's decisions about timing of family, I develop theoretical models of greater affordability of ART and women's allocation of time on work and family investment over the life course. To test the implications of the models, I utilize empirical strategies exploiting variation in the mandated insurance coverage of ART across U.S. states and over time. In the first chapter, I use linear probability models and the 1977-2010 Current Population Survey to examine the likelihood that women of different ages with and without mandated insurance coverage of ART have ever been married in order to compute marriage rates between age groups, the differences in the likelihoods of having ever been married between one age group and the next. Results show that greater access to ART is associated with marital delay for white (but not for black) women. In the second chapter, to estimate a more precise analysis and examine channels for the effects on marriage, I perform survival and competing risks analyses using the 1986-2009 Panel Study of Income Dynamics to examine the effects of the mandates on the hazards of transitioning to first marriage and first birth for single and childless women, respectively. The findings of this research suggest that the mandates are associated with delayed marriage and childbearing at younger ages and speeded transition to marriage and motherhood after age 30, but only for college graduate women, consistent with the theoretical framework's prediction that women with steeper wage trajectories should be more influenced by the mandates to delay family formation. For the full sample of women, the mandates appear to be associated with speeded transition to marriage after age 25 and motherhood within marriage after age 30, but not with delay at younger ages. This research builds on the literature examining changes in women's marriage and fertility timing and on the literature investigating the effects of ART insurance mandates. This research is valuable for understanding the impacts of technology and policy as well as the factors impacting women's marriage and fertility timing. In the third chapter, I investigate mechanisms for the positive relationship between time spent working and Body Mass Index (BMI). BMI might increase and health status might decline with more hours spent working since as leisure time declines, the opportunity cost of time rises, and it becomes more costly to undertake health-producing activities and receive medical care. Additionally, more time spent working would increase the incidence of detrimental effects of the workplace such as job-related stress, which would have a negative effect on health. This chapter uses the 2006, 2007, and 2008 American Time Use Surveys (ATUS) linked with Eating and Health module data to identify channels through which time spent working could affect BMI. While other datasets provide information on individuals' market work time, the ATUS also provides insight into individuals' non-market work activities. Linked with the Eating and Health module, it permits inference to be drawn about individuals' time use in a variety of activities as well as measures relating to eating and health, including BMI. Making use of this data, in this chapter I first replicate the results of other papers by estimating the effect of working time on BMI and find that increased working time is associated with a positive and significant effect on own BMI for both men and women. Then, to investigate the channels through which working time may impact BMI, I next estimate a series of equations to determine whether a variety of potential mediators significantly change the estimated effect of time spent working on own BMI. A number of the tested channels appear to mediate the effect of hours worked on BMI with strong significant effects found for exercise, active time, and screen time, and marginally significant effects found for secondary eating and food preparation. No significant effects were found for primary eating, secondary drinking, grocery shopping, purchasing prepared food, sleeping, housework, commuting, or own medical care. These results suggest the main channels through which working hours could be related to BMI are related to physical activity. These findings suggest plausible mechanisms for the association between time spent working and obesity. This work contributes to the literature by using time use data to examine the effect of time spent working on BMI as well as by modeling the channels through which time use affects weight and health outcomes. While previous work has explored the effect of working time on BMI, this paper considers the effect of working time on various measures of time use to get a fuller picture of how work time affects lifestyle choices that affect weight and health. This is valuable because recent research has found that there is a growing disparity in working hours between Americans and those in other industrialized countries, and the full consequences of increasing working hours are not explored in the literature and can have significant implications for labor and tax policy. Further, to prescribe effective policy interventions, it is necessary to know the channels through which any effects are arising. This work contributes to the literature by investigating the potential eating, health investment, and physical activity channels driving the positive relationship between working time and BMI to obtain a fuller picture of how work time affects lifestyle choices that affect weight and health. This is valuable because as Americans transition to more sedentary jobs, the full consequences of increased work hours in those jobs are not explored in the literature and can have significant implications for labor and tax policy. Accordingly, the paper provides insights useful for designing effective policy interventions aiming to reduce obesity prevalence. This research has examined questions related to individuals' health and life choices with relevant policy implications. Recent decades have seen significant changes in the roles of and opportunities for women and associated changes in lifestyle and the family, and this dissertation explores the effects of these changes. The findings of this research suggest that women have responded to lower prices of infertility treatment with higher educated women delaying marriage and child bearing, and it could be the case that these invest more time when younger in education and work. In addition, the research suggests that increased time spent working may be associated with an increase in BMI driven by allocating less time to physical activity. These results suggest that changes in technology and lifestyle over recent decades have had real effects on individuals' life choices and health.

Download or read book Essays on Health Care Markets written by Ami Ko and published by . This book was released on 2017 with total page 282 pages. Available in PDF, EPUB and Kindle. Book excerpt: The two chapters of my dissertation develop and estimate economic models to analyze the demand for and the provision of health care services. Specifically, I analyze the optimal design of health care markets to promote higher quality and lower cost, which can have profound implications for the well-being of people. The first chapter, "An Equilibrium Analysis of the Long-Term Care Insurance Market," uses a model of family interactions to explain why the long-term care insurance market has not been growing. By developing and estimating a structural model of family interactions, I study how family care affects the workings of the long-term care insurance market. I argue that private information about the availability of family care induces adverse selection where individuals with limited access to family care heavily select into insurance coverage. I demonstrate that pricing on family demographics substantially mitigates adverse selection by reducing the amounts of private information. I propose child demographic-based pricing as an alternative risk adjustment that could decrease the average premium, invigorate the market, and generate welfare gains. The second chapter, "Partial Rating Area Offering in the ACA Marketplaces," joint with Hanming Fang, studies insurance companies' plan offering decisions in the marketplaces established by the Patient Protection and Affordable Care Act of 2010 (ACA). Under the ACA, insurance companies can vary premiums by "rating areas" which usually consist of multiple counties. In a given rating area, the ACA mandates uniform pricing for all counties, but, it does not mandate universal offering. We first demonstrate that it is not uncommon to observe insurance companies selling plans to only a subset of counties within a rating area. Using both theoretical and empirical approaches, we find evidence that partial rating area coverage is explained by insurers' incentive to risk screen consumers. While the ACA allows price discrimination based on rating areas and not on counties, we argue that insurers are effectively price discriminating consumers based on counties by endogenously determining their service area within a rating area.

Download or read book Health Insurance is a Family Matter written by Institute of Medicine and published by National Academies Press. This book was released on 2002-09-18 with total page 296 pages. Available in PDF, EPUB and Kindle. Book excerpt: Health Insurance is a Family Matter is the third of a series of six reports on the problems of uninsurance in the United Sates and addresses the impact on the family of not having health insurance. The book demonstrates that having one or more uninsured members in a family can have adverse consequences for everyone in the household and that the financial, physical, and emotional well-being of all members of a family may be adversely affected if any family member lacks coverage. It concludes with the finding that uninsured children have worse access to and use fewer health care services than children with insurance, including important preventive services that can have beneficial long-term effects.

Download or read book Three Essays on Health Insurance and Health Care Consumption written by Fei Liu and published by . This book was released on 2007 with total page 249 pages. Available in PDF, EPUB and Kindle. Book excerpt: The third essay investigates the switching behavior of non-elderly enrollees in U.S. managed care plans. Treatment effect analysis is used to examine the disaggregated expenditures of plan switchers and plan stayers prior to their decision to switch or stay. Propensity score matching methods are used to estimate the average treatment effects on the treated. The results, which are based on a national representative data set from the Medical Expenditure Panel Survey, indicate that switchers (from HMO to non-HMO) spend more on hospitalization. The other type of switchers (from non-HMO to HMO) spends less on prescribed medicine and office-based physician visits. The findings suggest that the non-HMO private managed care plans provide better coverage on hospitalization, office-based physician visits and prescribed medicine than the HMO plans.

Download or read book Three Essays on the Economics of Health Insurance written by Joseph Orsini and published by . This book was released on 2015 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: This dissertation explores the functioning of the non-group health insurance market under various regulatory regimes. The first chapter estimates the relationship between health status and product choice in this market prior to the Affordable Care Act (ACA). I use insurers' decisions of whether to approve or reject applications for health insurance to identify this relationship. These decisions are based upon a comprehensive health history that the consumer must disclose to the insurer upon applying. I assume that the insurer uses this health history, as well as the financial characteristics of the product that was applied for, to estimate the expected cost of insuring the consumer, approving whenever this cost exceeds the product's premium. This assumption allows me to estimate how insurers' forecasts of applicants' costs differ depending on the type of product chosen in a discrete choice framework. I estimate that demanders of high deductible coverage are much costlier to insure than others. Additional analysis reveals that these consumers are likely to be impoverished, suggesting that cash constraints and/or price sensitivity may explain their preference for minimal coverage. The second chapter is co-authored with Pietro Tebaldi, and estimates the impact of age-based pricing restrictions in the post-reform market. The ACA fixes the ratio between health insurance premiums charged to consumers of different ages, which generates a relationship between the fraction of relatively old consumers in a geographic market and the prices faced by young consumers in that market. We show that this relationship is present in the prices faced by consumers on the ACA exchanges, but was not present in the pre-ACA market. We take this as evidence that the relationship between price and population age observed in the ACA data is indeed attributable to this regulation. We then use this variation, combined with a model of insurer price-setting, to back out the age-specific prices that would prevail if the regulation of interest were eliminated. We estimate that this regulation substantially raises premiums for younger buyers while reducing them for older buyers, and therefore alters the allocation of coverage to consumers of different ages. Because the value of the subsidies that the federal government provides is directly tied to premiums, this regulation has also had a substantial impact on the federal budget, decreasing subsidy outlays by approximately $2.3 billion. The final chapter is co-authored with Michael Dickstein, Mark Duggan, and Pieto Tebaldi, and explores another aspect of the ACA's pricing restrictions. Individual states have discretion in how they define coverage regions, within which insurers must charge the same premium to buyers of the same age, family structure, and smoking status. We exploit variation in these definitions to investigate whether the size of the coverage region affects outcomes in the ACA marketplaces. We find large consequences for small and rural markets. When states combine small counties with neighboring urban areas into a single region, the included rural markets see .6 to .8 more active insurers, on average, and savings in annual premiums of between $200 and $300.

Download or read book Essays on Health Economics and Immigration written by Paulette Cha and published by . This book was released on 2005 with total page 111 pages. Available in PDF, EPUB and Kindle. Book excerpt: Immigrants are more likely to be low income than their US-born peers, but they face more barriers to enrolling in government safety net programs. Children of immigrants, the majority of whom are US citizens, are less likely to enroll in some programs designed to protect their health and welfare. This dissertation explores issues of immigrant families’ engagement with public health insurance and nutritional assistance programs in three chapters. The first chapter describes levels and time trends of immigrant families’ participation in key safety net programs. The study covers the years 1996 to 2013 using data from the Survey of Income and Program Participation (SIPP) and the New Immigrant Survey (NIS). For children, the study presents data and regression-adjusted estimates of the associations between being from an immigrant family, and having likely undocumented family members, and participation in each of five safety net programs: the Food Stamps Program; National School Lunch Program; School Breakfast Program; Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); and public health insurance. The second chapter evaluates the effects of six state policies that implemented early Affordable Care Act (ACA) adult Medicaid expansions. The analysis focuses on citizen adults of immigrant and native families. It uses the American Community Survey (ACS) from 2008 to 2013 and a difference-in-differences method with synthetic control states to estimate the effects of the expansions on insurance coverage outcomes for citizen adults of immigrant and native family backgrounds. The policies produced a range of responses, from a 2 percentage point public insurance coverage increase in California to an 8 percentage point increase in Connecticut. There was some evidence of private insurance crowd-out in Connecticut, the District of Columbia, and Minnesota, but there were also net reductions in uninsurance for most states. Responses to the new policies were slightly lower among young adults than for the full adult population. In general, insurance coverage changes did not measurably differ among individuals from immigrant families as compared with those from native families. The third chapter analyzes public health insurance expansions for children. Medicaid expansions have the potential to greatly increase coverage for children in immigrant families, who have low levels of private insurance and high uninsurance rates. However, take-up may be lower in immigrant families than native families due to poor information and “chilling” anti-immigrant sentiment. I estimate take-up from 1996 to 2013 using instrumental variables regression and data from the Survey of Income and Program Participation (SIPP). This study finds that new eligibility for public insurance produces a 9-to-13 percentage point increase in public coverage among children of immigrants, which is indistinguishable from the 11-to-12 percentage point increase among children of natives. These findings reject a strong chilling effect, although the question will be important to revisit in the changing policy environment.