Inside the Sausage Factory: Improving Estimates of the Effects of Health Insurance Expansion Proposals (original) (raw)

Modeling health insurance expansions: Effects of alternate approaches

Journal of Policy Analysis and Management, 2004

Estimates of the costs and consequences of many types of public policy proposals play an important role in the development and adoption of particular policy programs. Estimates of the same, or similar, policies that employ different modeling approaches can yield widely divergent results. Such divergence often undermines effective policy-making. These problems are particularly prominent for health insurance expansion programs. Concern focuses on predictions of the numbers of individuals that will be insured and the costs of the proposals. Several different simulation modeling approaches are used to predict these effects, making the predictions difficult to compare. In this paper, we do the following: (1) We categorize and describe the different approaches used; (2) we explain the conceptual and theoretical relationships between the methods; (3) we demonstrate empirically an example of the (quite restrictive) conditions under which all approaches can yield quantitatively identical predictions;

Covering the Uninsured: Estimates of the Impact on Total Health Expenditures for 2002

2004

This study estimates the change in national health expenditures that would result if all uninsured persons in the non-elderly population were given health insurance coverage. Our analysis assumes that, after adjusting for individual characteristics, the uninsured, when given coverage, would spend the same for health care as the previously insured. We find that expanding public coverage would have cost 38.1to38.1 to 38.1to41.3 billion in 2002, while expanding private coverage would have cost 53.8to53.8 to 53.8to67.4 billion. These estimates are adjusted for uncompensated care and administrative costs. Public coverage is less costly than private coverage because of lower provider reimbursement rates. G. Edward Miller Division of Modeling and Simulation Center for Financing Access and Cost Trends Agency for Healthcare Research and Quality U.S. Department of Health and Human Services Agency for Healthcare Research and Quality (AHRQ) 540 Gaither Road Rockville, MD 20850 emiller@ahrq.gov Jessica S. Banthin D...

MODELING THE CAUSES AND CONSEQUENCES OF LACK OF HEALTH INSURANCE COVERAGE: GAPS IN THE LITERATURE

2000

The decline in the percentage of Americans covered by health insurance has generated concern among policy makers and scholars worried about negative consequences associated with lack of coverage. Moreover, because the health care financing system is intertwined with the labor market, policy makers are concerned about the consequences that any reforms to the health care financing system would have on labor markets and how labor market behavior would influence the success of health care financing reforms.

Another Look at the Effect of State Mandates for Health Insurance Benefits

2007

The research question we address is whether state laws that require health insurance policies to provide coverage for specified benefits have affected the size of the population without any private sector health insurance coverage. The laws are often alleged to increase the cost of insurance premiums and thus reduce incentives for smaller employers to offer and for individuals to purchase health insurance. Using data from the United States Census Current Population Survey (CPS) from 1996 to 2002, we measure the effects of 2 sets of high cost benefit mandates on the probability for workers to have health insurance through their employer. We use both individual and state level analyses. Generally we find weak and statistically insignificant effects associated with benefit mandates, though we see evidence that this relationship grows stronger over time. This journal article is available at ScholarlyCommons: http://repository.upenn.edu/wharton\_research\_scholars/43 Another Look at the Ef...

The Impact of Mandatory Coverage on State and Local Budgets

SSRN Electronic Journal, 2000

The policy option of extending mandatory Social Security coverage to newly hired uncovered state and local workers is often included in packages to eliminate the program's financing shortfall. The arguments for mandatory coverage go beyond financial considerations, though, as extending coverage would bring benefit protections that state and local workers currently lack and would improve equity by more broadly sharing the burden of Social Security's legacy costs. The main argument against mandatory coverage is that it would raise costs to public employers and workers. The actual cost increase depends on the extent to which employers reduce their existing pensions when adopting Social Security. This paper estimates the costs under four different integration strategies: 1) no adjustment to existing pensions; 2) match the level of the first-year benefit; 3) match the lifetime benefit; and 4) match the benefit to levels in neighboring states with Social Security coverage. This analysis is conducted for 22 state-administered plans in 13 states that were identified as lacking coverage. The results show that the cost of adding Social Security varies significantly, with the smallest increase for the "match lifetime benefit" option and the largest increase for the "no adjustment" option.

A cost-benefit analysis of the individual mandate in the health coverage system of the USA

International Journal of Public Policy, 2015

One of the challenging issues in the USA is health coverage system. The issue generally constitutes the major discussion topic of most presidential selection process. The paper analyses casual relationships of the issue and explains the cost benefit relationships between two policies, which are with the mandate and without mandate. One of the targets of the paper is to predict the effects of policy intervention on well being of the population regarding the health issue. By this way, the paper will generate a new approach on how to improve healthcare policy decisions. One of the most significant purposes of the study is to focus on policy alternatives regarding the health coverage system of the USA. The paper will study policy alternatives to decline the figures of people having no insurance. In order to decrease this amount, the paper will examine the cost-benefit of the system for the 20-year period.

Estimates of Crowd-Out from a Public Health Insurance Expansion Using Administrative Data

2011

We use a combination of administrative and survey data to estimate the fraction of individuals newly enrolled in public health coverage (Wisconsin's combined Medicaid and CHIP program) that had access to private, employer-sponsored health insurance at the time of their enrollment and the fraction that dropped this coverage. We estimate that after expansion of eligibility for public coverage, approximately 20% of new enrollees had access to private health insurance at the time of enrollment and that only 8% dropped this coverage (with the remaining 12% having both private and public coverage). We also identify an "upper bound" estimate, which suggests that the percentage of new enrollees with private insurance coverage at the time of enrollment is, at most, 27%. These estimates of crowd-out are relatively low compared with estimates from the literature based on Medicaid and CHIP expansions, although based both on different data and on a different method.

Quantitative analysis of health insurance reform: separating regulation from redistribution

RePEc: Research Papers in Economics, 2012

Two key components of the upcoming health reform are a reorganization of the individual health insurance market and an increase in income redistribution in the economy. Which component contributes more to the welfare outcome of the reform? We address this question by constructing a general equilibrium life cycle model that incorporates both medical expenses and labor income risks. We replicate the key features of the current health insurance system in the U.S. and calibrate the model using the Medical Expenditures Panel Survey dataset. We find that the reform decreases the number of uninsured by more than four times. It also generates substantial welfare gains, equivalent to almost one percent of the annual consumption. However, these welfare gains mostly come from the redistributive measures embedded in the reform. If the reform only reorganizes the individual market, introduces individual mandates but does not include any income-based transfers, the welfare gains are much smaller. This result is mostly driven by the fact that most uninsured people have low income. High burdens of health insurance premiums for this group are relieved disproportionately more by income-based measures than by the new rules in the individual market.