Browsing by Subject "Health insurance"

Now showing 1 - 14 of 14

Essays in economics dynamics and uncertainty
(2012-05) Dumav, Martin; Corbae, Dean; Stinchcombe, Maxwell; Mathevet, Laurent; Wiseman, Thomas; Zitkovic, Gordan
This work presents a systematic investigation of two topics. One is in stochastic dynamic general equilibrium. It incorporates private information into dynamic general equilibrium framework. An existence of competitive equilibrium is established. Quantitative analysis is provided for health insurance problem. The other topic is in decision problems under ambiguity. Lack of precise information regarding a decision problem is represented by a set of probabilities. Descriptive richness of the set of probabilities is defi ned. It is used to generalize Skorohod's theorem to sets of probabilities. The latter is used to show the constancy of the coefficient in alpha-maximin multiple prior preferences. Examples illustrate: the implications of this representation; and the restrictions arising from the failure of descriptive richness.
Essays in health economics
(2022-05) Stripling, Sam; Geruso, Michael; Cabral, Marika; Oettinger, Gerald
The three chapters of this dissertation explore the effects of two of the largest policy levers in the United States, Medicare and Medicaid, on health and hospitals. My first chapter examines the effects of Medicare on short-run mortality. Despite being at the forefront of policy debates, credibly estimating whether health insurance reduces mortality remains empirically elusive. The key challenge is creating research designs that have the statistical power to reliably detect the effects of health insurance on mortality. This chapter presents new, population-level estimates of the impact of Medicare on short-run mortality. I use restricted-access Census data to link complete, administrative death records to individual survey responses for nearly 30% of the US population. To understand the effects of Medicare on mortality, I use a regression discontinuity design, comparing the mortality of individuals just above and below the age-65 eligibility threshold. I also consider whether the impact of Medicare on mortality differs by demographics, previous health insurance status, and income-level. I find no statistically significant effects of Medicare on mortality for the full population, previously uninsured, or low-income individuals. The second chapter of my dissertation looks at the effects of the Affordable Care Act Medicaid Expansion on mortality. Given that Medicaid and Medicare are two of the largest policy levers for improving health in the United States, it is important to compare the mortality effects of Medicare to those of Medicaid. This chapter examines whether Medicaid eligibility reduces mortality for near-elderly individuals. I begin by using CDC data and a differences-in-differences design to analyze whether the ACA Medicaid Expansion reduced the mortality rate for individuals aged 55-64. I note several potentially important limitations in using CDC data for studying the effects of Medicaid on mortality. I discuss the merits of circumventing these limitations by using the restricted Census infrastructure to link survey data to administrative death records. I conclude with a cross-study comparison of the effects of Medicare and Medicaid on mortality, and discuss the policy relevance of my findings. The third chapter of my dissertation studies how hospitals respond to the Affordable Care Act Medicaid Expansions. While the first two chapters of the dissertation focus on the benefits of public health insurance for insurance recipients, public health insurance can also significantly benefit health care providers. Hospitals frequently provide health care to uninsured patients without receiving compensation. ACA Medicaid expansions reduced hospitals’ uncompensated care burdens by providing the uninsured with a means of payment in the form of insurance. Anecdotal evidence from hospital administrators suggests hospitals in expansion states respond to their improved financial positions by increasing capacity, purchasing equipment, and hiring more workers. I investigate such claims using hospital financial report data from CMS. Using a differences-in-differences regression framework, I find no evidence that hospitals in expansion states increased bed capacity, capital expenditures, or FTEs relative to hospitals in non-expansion states.
Essays on adverse selection
(2020-06-19) So, Jae Min; Town, Robert J.; Ackerberg, Daniel; Geruso, Michael; Miravete, Eugenio; Handel, Ben
This dissertation addresses the issues of adverse selection in the health insurance market. The literature on adverse selection focuses on consumer responses and their effects on pricing. In contrast to most previous literature, these essays consider not only the demand side but also the supply side of the health insurance markets in investigating the effect of adverse selection and relevant policies. The first chapter provides evidence of the effects of adverse selection on insurers' behavior. I exploit the gradual implementation of risk adjustment from 2004 to 2007 in Medicare Advantage (MA). Under this policy, the government reimburses private insurers proportional to the health risk of their enrollees. I present evidence that benefit generosity and diversity of MA plans are responsive to the incentive of risk selection. The second chapter develops and estimates an oligopoly model of MA to investigate the effects of adverse selection on welfare, allowing for endogenous benefit designs of insurance plans. I exploit information on plan-level average risk scores and market shares as well as plan characteristics from Centers for Medicare and Medicaid Services (CMS) to identify the demand for MA plans. My findings show adverse selection, which is based on the generosity of the benefits of MA plans. Specifically, high-risk consumers valued benefit generosity more than low-risk consumers did. The findings of the demand and cost estimates also verified adverse sorting in MA, implying that benefit generosity is vulnerable to under-provisioning. Finally, the third chapter investigates the effects of risk adjustment on welfare. The results of counterfactual analyses show that the effects of risk adjustment on consumer welfare can be underestimated under a fixed contract where the benefit designs of insurance plans are exogenous. Furthermore, I show that even with an increase in benefit generosity under a flexible contract, risk adjustment can decrease consumer surplus because of an increase in premiums and a decrease in the diversity of MA plans. However, these unintended effects of risk adjustment can be mitigated in competitive markets that include a large number of insurers. Finally, I show that risk adjustment decreases overpayments arising from risk selection and thus the total spending on Medicare.
Essays on health insurance and the family
(2013-05) Dillender, Marcus Owen; Youngblood, Sandra Black
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.
Essays on public and labor economics
(2024-05) Son, Jinyeong; Cabral, Marika; Tuttle, Cody; Magdalena, Bennett; Murphy, Richard
This dissertation comprises three chapters in the fields of public and labor economics. Specifically, they address questions in two areas: (i) the determinants of children’s human capital accumulation, particularly from the perspective of health status, and (ii) the consequences of public policy interventions in health insurance markets. Chapter 1 examines the effects of pregnancy timing among teenagers aged 15–18 on their short- and long-run educational and labor market outcomes. Specifically, I estimate the marginal impact of a one-year difference in pregnancy timing for each age interval—15–16, 16–17, and 17–18—leveraging linked administrative data from Texas. To identify the effect of pregnancy timing, I examine both within-individual changes in outcomes surrounding pregnancy and across-individual comparisons in outcomes after pregnancy, among matched individuals who are balanced on a wide range of characteristics but differ in the timing of pregnancy. The results indicate that experiencing pregnancy one year earlier increases absences and the likelihood of leaving school, particularly during the postpartum year. Further, the results indicate that becoming pregnant one year earlier has adverse long-term consequences: it reduces high school graduation by age 20, decreases college enrollment and completion in the early 20s, and leads to lower employment and earnings in the mid-20s, with these detrimental effects being most pronounced for the youngest group. Finally, I present suggestive evidence that providing parental support to teenage mothers during the postpartum year could mitigate the short-term disruptions they face, such as increased absences and higher dropout rates. Chapter 2, previously published in the Journal of Public Economics, explores whether and to what extent state-mandated health insurance benefits improve health outcomes in the context of diabetes mandates. Specifically, in Chapter 2, I use data from the restricted-use Multiple Cause of Death Mortality database and the Behavioral Risk Factor Surveillance System to investigate the effects of diabetes mandates on diabetes-related mortality rates, along with the underlying mechanisms behind the estimated effects. Using a difference-in-differences framework that leverages variation in the enactment of mandates both across states and over time, I find that approximately 3.1 fewer diabetes-related deaths per 100,000 occur annually in mandate states than in non-mandate states. The mechanism analysis suggests higher utilization of the mandated medical benefits caused these mortality improvements. These findings can inform the ongoing policy debate on strengthening or weakening coverage mandates, including Essential Health Benefits under the Affordable Care Act. Chapter 3, co-authored with Marika Cabral and Colleen Carey, investigates the determinants of health insurance choice in Medicare—a setting with vast geographic variation in the share of individuals selecting the public option versus private alternative. We analyze insurance decisions among individuals who move to quantify the relative importance of individual-specific factors (such as preferences or income) and place-specific factors (such as local health insurance options) on insurance decisions. We find roughly 40% of the geographic variation in the share selecting private coverage is due to place-based factors, while the remainder is explained by individuals. Our findings highlight the importance of individual factors in these decisions and may inform discussions about the use of policy to address geographic disparities.
Essays on public policy and labor economics
(2017-07-13) Zhou, Yun, Ph. D.; Trejo, Stephen J., 1959-; Cabral, Marika; Geruso, Michael L; Olmstead, Todd A
The majority of insured Americans obtain health insurance coverage through employment as a non-portable fringe benefit. The link between health insurance coverage and employment could have potential important implica- tions on workers’ labor market decisions. My dissertation consists of three chapters that contribute to the understanding of the interaction between health insurance and workers’ job mobility. My first chapter studies the effect of the state dependent coverage man- dates on the job mobility of young adults. Prior to the Affordable Care Act, many states had already implemented insurance mandates that extended the age that young adults could gain access to parental health insurance, an alternative insurance source which is not contingent on employment. If young workers with employer-sponsored insurance (ESI) are locked into less preferred jobs for fear of losing health benefits, expanded dependent coverage is expected to reduce the job lock and increase mobility. Expanded eligibility could also decrease mobility among those who are pushed out of a better matched but uninsured job in search of access to ESI (job push). Using Survey of Income and Program Participation (SIPP) 2000-2010 data, the impact of the state mandates on job mobility is identified by a triple-difference framework that exploits the state level dependent coverage variations in eligibility criteria, mandate implementation states, and mandate implementation time. Results show that expanded dependent coverage led to a 5% decrease in the mobility of workers with no ESI (job push). I find no evidence of reduced job lock. The second chapter of my dissertation extends the analysis of my first chapter to the Affordable Care Act (ACA) Dependent Coverage Mandate. The ACA Dependent Coverage Mandate was passed on March 23rd, 2010, and became effective on September 23, 2010. The mandate requires that health insurance plans that provide dependent coverage must cover dependents until the age of 26. Using SIPP 2008-2013 data, and both difference-in-difference framework and regression discontinuity design, I find consistent evidence of reduced job push and no evidence of reduced job lock. The estimated reduced job push is larger than the state analysis. The third chapter studies the impact of the ACA Medicaid expansion on childless adults’ job mobility. The ACA Medicaid expansion raised the Medi- caid income eligibility threshold to 138% of the Federal Poverty Line (FPL) for everyone including childless adults who were not the traditional beneficiaries of the Medicaid. 32 states adopted the expansion while 19 states opted out. The reform could potentially increase childless adults’ job mobility if they are “locked” in their jobs for fear of losing employer-sponsored health insurance. Using the 2011-2016 basic monthly Current Population Survey (CPS), this paper tests this hypothesis by comparing the job mobility of childless adults in expansion states to those residing in non-expansion states, before and after the expansion. Results show the existence of “job lock” effect: the ACA Medicaid expansion increased the childless adults’ job mobility by 7% - 9%, and the increase comes entirely from job-to-job transitions. I find no evidence of the “employment lock”: the availability of Medicaid did not cause childless adults to be more likely to become unemployed or leave the labor force.
Essays on the economics of health insurance, labor markets, and migration
(2016-12) Dolan, Ricki Marie Sears; Trejo, Steven J., 1959-; Linden, Leigh; Kline, Brendan; Crosnoe, Robert
This dissertation contains three chapters, two which focus on health insurance and one focusing on migration. The first chapter examines how a policy expanding public health insurance for young children affected their parents' labor market and health insurance outcomes. I use variation in the initial income thresholds, children's age cutoffs and timing of implementation across states to estimate the effect of a person's youngest child gaining access to public health insurance on self-employment. I find that having a child become Medicaid eligible increases a father's self-employment and increases his business income. I find no significant effect on self-employment for mothers, but I find that the increasing eligibility is associated with a large negative effect on their probability of remaining in a wage job. The second chapter examines how expanding dependent health insurance for young adults affects the health insurance and labor market outcomes of those young adults and their parents. I exploit two sources of variations in the age at which young adults age out of their parents' health insurance: i) state reforms passed between 2000 and 2010 that extended the maximum age of health insurance dependents beyond 18 and ii) the Affordable Care Act that extended coverage for all young adults in the United States until their 26th birthdays. Using regression discontinuity, I find evidence that the policies increased young adult dependent coverage. Dependent coverage for eligible young adults increased by 8 percentage points over ineligible young adults, while health insurance in the young adults' own name decreased by 6.5 percentage points. I also see evidence that parents of eligible young adults responded by changing their own coverage. The final chapter investigates the relationship between children and migration using data from the American Communities Survey. To address the issue that both migration and fertility might be correlated with unobserved variables I use twin births as an instrumental variable for the number of children. I find that that an additional child decreases migration by 0.6 percentage points and decreases the probability that a woman lives in her birth state by 1.4 percentage points. This suggests that more children hinder migration.
Filling the gap in healthcare coverage : how cities and states can bolster health insurance affordability for independent workers and small employers
(2019-05) Hart, Patricia Dawn; Angel, Jacqueline Lowe
The nature of work is changing in the United States. The emergence of the gig economy and the rise of knowledge work have created new opportunities and challenges for workers. While flexibility has increased over the past decade, with more individuals working when and where they want, wages have remained stagnant and employee benefits — often associated with traditional attachments to work — have moved further out of reach for many working adults. Affording quality health insurance on the individual and small group markets is a major financial burden for independent workers and small employers (companies with 50 or fewer employees). Ideally, federal legislation would be adopted to ensure that the US healthcare policy regime meets the needs of working Americans. Indeed, the passage of the Patient Protection and Affordable Care Act (ACA) of 2010 moved the country closer to such a solution. But the bill was not a panacea. Many consumers earn too much to enroll Medicaid or receive subsidies through the ACA, but not enough to afford quality health insurance on their own. And experts believe recent regulatory action will add to this hardship by raising rates in the individual and small group markets. Cities and states, nevertheless, are well positioned to make quality healthcare coverage more affordable for their residents. These governments also have a lot to gain by acting, as expanding quality health insurance to more independent workers and small employers is linked to enhanced job creation, workforce productivity, and innovation intensity. Adopting progressive healthcare policies at the sub-federal level could relieve financial stress and improve health outcomes among affected populations
From Startups To Take-Up: Influencing A Generation
(2018-05) San Soucie, Carolyn
Employer-sponsored health insurance is the primary form of health insurance coverage in the United States. 49% of the American population is insured through an employer-sponsored plan. Its role is central in maintaining affordable and adequate access to health care for millions of Americans. Young, healthy adults comprise a population notorious for remaining uninsured, yet they are vital for the success of any health insurance pool. Influencing young adults to take-up offers of employer-sponsored health insurance through improved policy initiatives will lead to necessary reforms of the entire system. This thesis analyzes the ways in which the sharing economy and associated marketplace trends influence the rates of young, healthy adults signing up for employer-sponsored health insurance. Furthermore, it recommends public policies to promote a more equitable system of health insurance coverage throughout the country given the growing crisis in the employment-based system. By understanding the socio-demographic factors of the population of individuals who elect to take-up offers of insurance through their workplace and the psychosocial factors of the decision-making process as a whole, it is possible to increase rates of insurance participation among young, healthy adults even as current economic influences drastically alter the workplace.
Health benefits and support for Austin musicians
(2009-12) Kalan, Harsh; Burd, Gene; Brenner, R B.
There is plenty of support for local musicians in Austin. It ranges from providing health benefits to receiving home loans to equipment insurance. The live music capital of the world has provisions for recording artists as well as street performers whose primary source of income is music. These facilities go a long way in maintaining Austin‟s identity as one of the major music cities in the world. They also bring together members of this community for benefits that help strengthen the local music industry, which has been an important part of the city‟s economy for several years.
New aspects of product risk measurement and management in the U.S. life and health insurance industries
(2012-05) Shi, Bo; Baranoff, Etti G.; Sager, Thomas W.; Brockett, Patrick L.; Shively, Thomas S.; Kendrick, David A.
Product risk is important to firms’ enterprise risk management. This dissertation focuses on product risk in the U.S. life insurance and health insurance industries. In particular, we add new dimensions to the measurement of product risk for these industries, and we explore how these industries manage product risk in a context of other enterprise risks. In this dissertation, we identify new product risks, propose new measures, and study the management of these risks. In the life insurance industry, we identify a new type of product risk, the guarantee risk, caused by variable annuities with guaranteed living benefits (VAGLB). We propose a value-at-risk type measure inspired by the risk-based capital C3 Phase II to quantify the guarantee risk. In the health insurance industry, where the degree of uncertainty varies for different types of health insurance policies, we develop four exposure-based risk measures to capture health insurers’ product risks. Then we study how life and health insurers manage product risks (and asset risks) by using capital in the context of other risks and appropriate controls. We add to the literature in the life insurance industry by examining the relationship between capital and risks when the guarantee risk is accounted for. In the health insurance industry, to our knowledge, no similar research on the relationship between capital and risks has been conducted. In view of the current topicality of health insurance, our research therefore adds a timely contribution to the understanding of health insurer risk management in an era of health care reform. Capital structure theories, transaction cost economics, and insurers’ risk-taking behaviors provide the theoretical foundation for our research. As to methodology, we implement standard capital structure models for the life and health insurance industries using data from the National Association of Insurance Commissioners (NAIC) annual filings of life/health insurers and health insurers. Simultaneous equations modeling is used to model life and health insurers’ enterprise risk management. And the estimation is conducted by the generalized estimation equations (GEE). We find that both U.S. life/health insurers and health insurers prudently build up capital as they experience more product risk and asset risk controlling for the other enterprise risks. We also find that life/health insurers may be using derivatives as a partial substitute for capital when managing new product risk caused by VAGLB, the guarantee risk.
Quality reporting, bonus payments and welfare in Medicare Advantage
(2021-05-11) Charbi, Alexandra Nikolaos; Town, Robert J.; Ackerberg, Daniel; Miravete, Eugenio J; Cabral, Marika; Aizawa, Naoki
When consumers are imperfectly informed about the quality of a product, market forces do not incentivize firms to provide the socially optimal level of quality. Imperfect information is a recognized and frequent market failure in the context of public health and has led to initiatives aimed at increasing consumers' access to information and at incentivizing firms to provide higher quality services. This study analyzes the welfare effects of quality disclosure and quality subsidies on the Medicare Advantage (MA) market. MA is a subsidized program that provides health insurance to the elderly and disabled population in the U.S. as an alternative to Traditional Medicare. The study begins by introducing the institutional background of the market that provides a unique setup to analyze. On the demand side, consumers receive information on the quality of health insurance plans through a Star Rating System (SRS). On the supply side, higher-rated insurers receive a quality-linked subsidy through a Quality Bonus Program (QBP). The second chapter provides evidence that consumers do not respond to the information they receive. The question then arises, ``Why is this happening?'' Is is because consumers are not aware of the SRS? Is it because consumers do not value the information they receive through the SRS? Or, is it because consumers do not care about the dimension of quality the SRS is informing them on? At the same time, star ratings increase over time. Simple density distribution graphs suggest that this increase is motivated by the financial incentives that QBP provides insurers with. Those two observations raise the question of what the relative impacts of the two policies together are on welfare. The third chapter describes a survey I designed and conducted to answer the first set of questions regarding the demand side of the market-Do consumer know about the SRS? Do consumers value the information they receive? Do consumers about the dimension of quality the star ratings are informing them on?-Surveying Medicare-eligible individuals, I find that 80% of the population is unaware of the SRS. In the survey, I also conduct a conjoint analysis to elicit preferences for star ratings. I find that respondents who reported they were aware of the SRS place a monthly value of $25 on an extra star rating; slightly more than the ones who reported they were unaware. The fourth chapter presents a structural equilibrium model of supply and demand that separately identifies and quantifies the relative impacts of each policy on welfare. The model also incorporates the survey results by flexibly allowing for different consumer types: those who are unaware and those who do not care about the SRS. I combine the survey stated preference with revealed preference choice data and estimate a Bayesian learning discrete choice model. On the supply side, insurers endogenously choose price and quality. My analysis shows that although both the SRS and the QBP lead to higher quality, welfare improvement is very small compared to the incurred costs. In particular, 75% of the expenditures spent on the QBP is not rationalized by any welfare improvement. The final chapter concludes and states potential paths for future research.
RediClinic : an evaluation of a convenient care clinic in a shifting medical landscape
(2010-12) Edwards, Lauren Jean; Mackert, Michael; Love, Brad
This paper offers in-depth look at the convenient care/retail clinic industry in the context of today’s changing medical landscape with specific focus on Texas-based RediClinic. In addition to a detailed analysis of RediClinic, this paper proposes detailed advertising, marketing and social media recommendations that will aid RediClinic in bolstering its brand image and expanding its client base. Every suggested tactic is framed within the rapidly changing healthcare environment present in America, and specific focus is given to the recent passing of the Patient Protection and Affordable Care Act. This paper attempts to aid RediClinic in understanding and leveraging its most important strengths: its strong position within the Texas market, and its service to those who are currently uninsured.
Total and segmented direct cost-of-care for stage IV non-small cell lung cancer in a privately insured population
(2011-05) Bell, Allison Miriam; Koeller, Jim; Frei, Christopher; Ryan, Laurajo; Penrod, John
Introduction: New treatments for stage IV (adv) NSCLC have emerged this past decade. Recent pharmacoeconomic research has focused on cost of treatment, comparative costs of therapies, and cost/cost effectiveness of adding a biologic to traditional therapy. Drug cost is thought to be a primary driver of cost change in NSCLC, yet to our knowledge, characterization of the direct cost of NSCLC has not been published since the new treatments have emerged in the guidelines. Our primary objective was to characterize the direct and segmented cost of adv NSCLC from 2000-9. We also want to determine cost impact of new therapies, and cost trend from 2000-9. Methods: This PharMetrics claims database study includes diagnosed NSCLC patients [greater than or equal to] 20 yo. Small cell lung cancer was excluded. Claims were divided into disease segments and time periods representative of changes in therapy ("pre" (2000-2), "transition" (2003-5), and "current" (2006-9) periods). Descriptive statistics (median, interquartile range (IQR)), chi-square test (nominal data), and Wilcoxan rank sum tests were performed on the data. To adjust for baseline confounders, multivariate least squares regression models were created. Results: Costs are reported as medians in terms of per patient per month (pppm). Overall monthly cost (n=969) was $10,281 pppm. Diagnosis cost $6,601 pppm, active treatment cost $9,287 pppm, and end-of life cost $12,215 pppm. There was no difference in cost between the “transition” (n=439) and “current” (n=503) periods overall or for any segment of disease. Comorbidities had no effect on cost. For patients receiving at least 5 months of active treatment medication (n=316) total median cost was $144,147 per patient ($9,371 pppm). Discussion: There was no difference in cost between the transition and current periods, in regards to either overall cost or segmented cost. The most expensive segment was end-of-life, with a median cost exceeding $12,000 pppm. Surprisingly, comorbidities had no effect on cost. Newer agents (biologics, TKIs, and pemetrexed) represent only a modest portion of cost, with a majority of cost for stage IV NSCLC comprised of non-drug costs.