The Impact of Macroeconomic Conditions on the Health Insurance Coverage of Americans (original) (raw)
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Health insurance coverage and the macroeconomy
Journal of Health Economics, 2005
The primary objective of this paper is to improve our understanding of the historic relationship between state and national macroeconomic climate and the health insurance coverage of Americans.
California Journal of Politics and Policy, 2015
Background: The economic recession that began in 2008, or the "Great Recession," did not affect all counties in California equally. With differential effects of economic indicators such as job loss, it is possible that differential effects were also seen in health insurance rates by county and demographic group. Objective: To study whether the Great Recession had a differential impact on the uninsured rates among counties in California. Research Design: A four-level "recession index" measured the impact of various economic indicators, between the populations uninsured for all or part of the prior year in 2009 compared to 2007. Methods: Data sources include the 2007 and 2009 California Health Interview Surveys and California Employment Development Department unemployment data. Results: The medium recession impact group (that is, counties with high increases in unemployment and lower household incomes on average) had the highest growth in the uninsured rates, due to a large drop in job-based coverage only partially offset by public coverage. Changes in coverage by demographic groups were similar among recession index categories. Conclusions: We find that the uninsured in 2009 were older, more likely to be U.S.-born citizens, had lower household incomes, and were more likely to be unemployed and looking for work, regardless of the impact of the Great Recession at the county level. The growth in the uninsured rates in the medium-impact group highlights the importance of public health insurance programs as a safety net during economic downturns.
Recent Trends in Insured and Uninsured Unemployment: Is There an Explanation?
The Quarterly Journal of Economics, 1991
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California Journal of Politics and Policy, 2011
Lack of health insurance affects workers and families who depend on job-based coverage for health care. In 2007, the unemployment rate in California was 5.5%. By the end of 2009, it had more than doubled to 12.3%. This study uses data from the 2007 and 2009 California Health Interview Survey to assess changes in access to job-based health insurance among California workers and their dependents. We find that although increased unemployment dramatically reduced the number of employees, the proportion of employees with no access to job-based coverage through either their own or a spouse's work remained constant. Among adults with no family access to job-based insurance, the most significant determinants of being uninsured were income and citizenship. Due to more generous public health insurance options, children with the lowest household incomes were not significantly more likely to be uninsured than children with higher household incomes. The results highlight the importance of public health insurance for children and confirm the need for the Affordable Care Act's insurance expansion provisions.
Medicaid Access During Economic Distress: Lessons Learned From the Great Recession
Medical Care Research and Review, 2020
Medicaid enrollment increases during economic downturns which imply households using the public health insurance program during coverage gaps due to job loss. However, we provide new evidence demonstrating that the Medicaid program's countercyclical protections against economic downturns are largely concentrated in states with more generous Medicaid eligibility criteria for adults. We exploit the timing of the 2007-2009 Great Recession to compare trends in recession-linked Medicaid enrollment between states with more generous Medicaid eligibility guidelines and states with more restrictive guidelines. For similar effects of the recession, Medicaid enrollment grew larger states in with more generous Medicaid programs. Our work suggests for every 100 people becoming unemployed in states with a restrictive Medicaid program, about 96 would be uninsured, and about 11 would enroll in Medicaid. Conversely, about 49 would be uninsured in a state with more generous Medicaid guidelines and 57 would enroll in Medicaid.
Affilia, 2013
The study reported here determined that a national sample of single mothers had no health care coverage for an average of 9.35 months during a 32-month period during and after the Great Recession that began in December 2007 and ended in June 2009. Using comprehensively defined employment problems, it also found that adequately employed single mothers had the fewest months without health care coverage (M ¼ 4.36), which more than doubled for those who experienced unemployment or involuntary gaps in employment, and tripled for those who experienced underemployment. The multivariate results confirm that employment problems place single mothers at a high risk of lacking health insurance. Implications for health care policy are discussed.
Evaluating the Causal Effect of Insurance Access on Labor Market Outcomes Among Young Adults
2016
One of the first provisions enacted under the Patient Protection and A↵ordable Care Act (PPACA) was was the Young Adult Coverage Expansion, which took e↵ect on September 23, 2010. Under this provision, individuals up to age 26, can remain on their parent’s employer provided health insurance plan. Relatively little is known about the e↵ect of insurance coverage on the labor supply of young adults. In this paper, I exploit the exogenous expansion of health insurance coverage among a segment of young adults as an instrumental variable to control for the endogeneity of health insurance status. This allows me to estimate causal labor market e↵ects of insurance coverage. I leverage a di↵erence-in-di↵erence design in the first stage of a two-stage control function to estimate the e↵ect of the law on the probability of insurance coverage and use the predicted residual from this stage as my instrument in the second stage regression. The main structural equation estimates the causal e↵ect of ...