The Effect of Health Insurance on Mortality: What Can We Learn from the Affordable Care Act Coverage Expansions? (original) (raw)
Related papers
2019
We also thank the Editor and two anonymous reviewers. Code related to this project can be found at https:// github.com/hollina/simulated-power-analysis. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research. NBER working papers are circulated for discussion and comment purposes. They have not been peer-reviewed or been subject to the review by the NBER Board of Directors that accompanies official NBER publications.
The Oregon health insurance experiment: evidence from the first year
2011
In 2008, a group of uninsured low-income adults in Oregon was selected by lottery to be given the chance to apply for Medicaid. This lottery provides a unique opportunity to gauge the effects of expanding access to public health insurance on the health care use, financial strain, and health of low-income adults using a randomized controlled design. In the year after random assignment, the treatment group selected by the lottery was about 25 percentage points more likely to have insurance than the control group that was not selected. We find that in this first year, the treatment group had substantively and statistically significantly higher health care utilization (including primary and preventive care as well as hospitalizations), lower out-of-pocket medical expenditures and medical debt (including fewer bills sent to collection), and better self-reported physical and mental health than the control group.
An Empirical Evaluation On The Effectiveness Of Medicaid Expansion Across 49 States
2020
In 2014 the Patient Protection and Affordable Care Act (ACA) introduced the expansion of Medicaid where states can opt to expand the eligibility for those in need of free health insurance. In this paper we attempt to assess the effectiveness of Medicaid expansion on health outcomes of state populations using Differencein-Difference (DD) regressions to seek for causal impacts of expanding Medicaid on health outcomes in 49 states. We find that in the time frame of 2013 to 2016, Medicaid expansion seems to have had no significant impact on the health outcomes of states that have chosen to expand.
Milbank Quarterly, 2002
Many policy proposals address the lack of insurance coverage, with the most commonly discussed being tax credits to individuals, expansions of existing public programs, subsidies for employers to offer coverage to their workers, and mandates for employers and individuals. Although some policy options may be favored (or disfavored) on theoretical or ideological grounds, many debates about policy center on empirical questions: How much will this option cost? How many people will obtain insurance coverage?Estimates of costs and consequences influence policy in three ways. First, the Office of Management and Budget, the Congressional Budget Office, the Centers for Medicare and Medicaid Services, the Treasury Department, and other government agencies incorporate estimates of the costs of proposals in their budget calculations. Particularly in times of fiscal restraint, the cost of a proposal is central to its legislative prospects. Second, recognizing the importance of final budget numbers, policy advocates include estimates in their advocacy.The fate of a proposal to expand health insurance is influenced by predictions of the proposal's effects on the number of newly insured and the cost of new coverage. Estimates vary widely, for reasons that are often hard to discern and evaluate. This article describes and compares the frameworks and parameters used for insurance modeling. It examines conventions and controversies surrounding a series of modeling parameters: how individuals respond to a change in the price of coverage, the extent of participation in a new plan by those already privately insured, firms' behavior, and the value of public versus private coverage. The article also suggests ways of making models more transparent and proposes "reference case" guidelines for modelers so that consumers can compare modeling results.
Journal of Public Health Management and Practice, 2017
Context: Despite implementation of the Affordable Care Act (ACA), as of 2015, about 25.8 million working-age Americans remained uninsured and vulnerable to premature death because of poor health care access. The ACA-mandated phasing out of disproportionate share hospital payments that supported charity care may aggravate care access for the residual uninsured. Objectives: To estimate excess deaths among the uninsured and the potential ACA impact on the basis of a recent cohort's mortality experience. We hypothesized a higher uninsured mortality risk than the available pre-2000 estimate because of worsening of care disparities owing to technology-driven advances in life-saving care. Design: We conducted a retrospective cohort study of the 1999 to 2002 National Health and Nutrition Examination Survey respondents observed through 2011. We estimated (a) weighted Cox proportional mortality hazard of uninsured working-age adults adjusted for demographics, comorbidity, and lifestyle behaviors, (b) weighted mortality rates among the uninsured and insured within age and comorbidity strata, and (c) excess deaths because of uninsurance using the Institute of Medicine methodology. Setting: Noninstitutionalized US population. Participants: Adults aged 20 to 64 years. Main Outcome Measure: Mortality. Results: Of 7274 study-eligible respondents, 20.6% were uninsured and 478 died during follow-up, for an adjusted uninsured mortality hazard ratio of 1.57 (95% confidence interval, 1.12-2.21) versus privately insured, translating to 48 529 excess deaths among the population aged 25 to 64 years in 2011 (7.8% of total deaths in this age group). The estimated proportion of excess deaths was 52% higher than the pre-2000 cohort study. The mortality disparity increased with age and comorbidity. Conclusions: Findings support our hypotheses, and indicate that post-ACA, a residual 4.7% excess mortality among working-age adults will continue, about 30 428 excess deaths annually. Restoration of disproportionate share hospital supports and continued advocacy for universal health care coverage are needed to reduce avoidable deaths.
The Effect of Medicaid Expansion on Heart Attack Mortality
2018
The aim of this study is to estimate the effect of Medicaid expansion on the number of deaths from heart attacks using a difference in differences model. We modified the standard difference in differences framework to by including both state and year fixed effects to account for the fact that states expanded Medicaid at different times. Furthermore, we added state specific linear time trends as well as state unemployment rates as controls to test the robustness of the model. We obtained our data from the Center for Disease Control's Underlying Causes of Death Database. We found that Medicaid expansion had a statistically insignificant effect on heart attack mortality which would imply that Medicaid expansion did not affect heart attack mortality. iv
The Affordable Care Act’s Coverage Impacts in the Trump Era
INQUIRY: The Journal of Health Care Organization, Provision, and Financing
The 2016 US presidential election created uncertainty about the future of the Affordable Care Act (ACA) and led to postponed implementation of certain provisions, reduced funding for outreach, and the removal of the individual mandate tax penalty. In this article, we estimate how the causal impact of the ACA on insurance coverage changed during 2017 through 2019, the first 3 years of the Trump administration, compared to 2016. Data come from the 2011–2019 waves of the American Community Survey (ACS), with the sample restricted to non-elderly adults. Our model leverages variation in treatment intensity from state Medicaid expansion decisions and pre-ACA uninsured rates. We find that the coverage gains from the components of the law that took effect nationally—such as the individual mandate and regulations and subsidies in the private non-group market—fell from 5 percentage points in 2016 to 3.6 percentage points in 2019. In contrast, the coverage gains from the Medicaid expansion inc...
The RAND Health Insurance Experiment, Three Decades Later
Journal of Economic Perspectives, 2013
n the voluminous academic literature and public policy discourse on how health n the voluminous academic literature and public policy discourse on how health insurance affects medical spending, the famous RAND Health Insurance Experi-insurance affects medical spending, the famous RAND Health Insurance Experiment stands apart. Between 1974 and 1981, the RAND experiment provided health ment stands apart. Between 1974 and 1981, the RAND experiment provided health insurance to more than 5,800 individuals from about 2,000 households in six different insurance to more than 5,800 individuals from about 2,000 households in six different locations across the United States, a sample designed to be representative of families locations across the United States, a sample designed to be representative of families with adults under the age of 62. The experiment randomly assigned the families to with adults under the age of 62. The experiment randomly assigned the families to health insurance plans with different levels of cost sharing, ranging from full coverage health insurance plans with different levels of cost sharing, ranging from full coverage ("free care") to plans that provided almost no coverage for the fi rst approximately ("free care") to plans that provided almost no coverage for the fi rst approximately 4,000(in2011dollars)thatwereincurredduringtheyear.TheRANDinvestigators4,000 (in 2011 dollars) that were incurred during the year. The RAND investigators 4,000(in2011dollars)thatwereincurredduringtheyear.TheRANDinvestigators4,000 (in 2011 dollars) that were incurred during the year. The RAND investigators were pioneers in what was then relatively novel territory for the social sciences, both in were pioneers in what was then relatively novel territory for the social sciences, both in the conduct and analysis of randomized experiments and in the economic analysis of the conduct and analysis of randomized experiments and in the economic analysis of moral hazard in the context of health insurance. moral hazard in the context of health insurance.
2011
In this paper we develop a stochastic dynamic general equilibrium overlapping generations (OLG) model with endogenous health capital to study the macroeconomic effects of the Affordable Care Act of March 2010 also known as the Obama health care reform. We find that the insurance mandate enforced with fines and premium subsidies successfully reduces adverse selection in private health insurance markets and subsequently leads to almost universal coverage of the working age population. On other hand, spending on health care services increases by almost 6 percent due to moral hazard of the newly insured. Notably, this increase in health spending is partly financed by the larger pool of insured individuals and by government spending. In order to finance the subsidies the government needs to either introduce a 2.7 percent payroll tax on individuals with incomes over $200, 000, increase the consumption tax rate by about 1.1 percent, or cut government spending about 1 percent of GDP. A stable outcome across all simulated policies is that the reform triggers increases in health capital, decreases in labor supply, and decreases in the capital stock due to crowding out effects and tax distortions. As a consequence steady state output decreases by up to 2 percent. Overall, we find that the reform is socially beneficial as welfare gains are observed for most generations along the transition path to the new long run equilibrium.