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| Home > Conferences & Events Home > Coverage: For Richer, For Poorer, In Sickness and In Health> Conference Highlights |
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Ann Arbor Research Conferences
Coverage: For Richer, For Poorer, In Sickness and In Health
June 28 – 29, 2007
Ann Arbor, Michigan
SCHIP, health savings accounts, the impact of wealth on health insurance status, and the cost of care for the chronically ill were among the topics of the eight papers presented at the 2007 conference. |
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| Conference Highlights | Participant List | Papers Presented |
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Author |
Conference Paper |
Summary |
Bernard, Didem
Banthin, Jessica
Encinosa, William |
Wealth, Assets, and the Affordability of Health Insurance (PDF) |
We examine family wealth and asset holdings across the uninsured and insured in the 2002 MEPS. We find that the standard model, which only uses current income to approximate family wealth, severely overestimates private insurance enrollment for the low income with low wealth, and underestimates enrollment for the low income with high wealth. The life cycle asset model corrects this and consistently predicts enrollment better than the standard model. For example, for people without an employer-sponsored insurance offer, the standard model underestimates enrollment for the low income-high wealth group by 26.7 percentage points, while the life cycle model only underestimtes by 4.4 percentage points. Overall, we find that 26% to 59% of the uninsured appear to be able to afford insurance once assets are taken into account. In particular, the lowest decile of income ($7,000) will not have a 75% probability of take-up until they have accumulated $135,000 in assets in 2002 dollars. |
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Cardon, James
Showalter, Mark
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Health Savings Accounts, High-Deductible Policies, and the Uninsured: Simulating the Effects of HAS Tax Policy Using a Utility-Maximization Framework
(PDF) |
The Bush Administration has proposed aiding the uninsured population by offering tax credits and deductions to consumers outside the employment-based group market who use Health Savings Accounts (HSAs.) Analysis is hindered by lack of data and theoretical uncertainty about consumers' valuation of HSAs and related products. Our research will build on previous work to explore the impact of these proposals on the uninsured. A novel aspect of our approach is a calibration of underlying preference parameters that allow us to simulate how consumers will value products like high-deductible insurance and HSAs. We focus on three groups of particular policy interest: 1) the currently uninsured who do not have access to group coverage, 2) the currently uninsured who have access to group coverage, but choose to be uninsured, 3) the currently insured in group coverage. |
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DeCicca, Philip
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Health Insurance Availability and Entrepreneurship: Evidence from New Jersey (PDF) |
I investigate the impact of New Jersey's Individual Health Coverage Plan on the self-employment of its residents. The IHCP, which was implemented in August 1993, included an extensive set of reforms intended to encourage access to individual health insurance while promoting competition in the non-group market. I find evidence that the IHCP increased self-employment among New Jersey residents, relative to residents of Pennsylvania which did not substantially reform its non-group market over the period in question. This finding is robust to a number of sensitivity checks, including choie of comparison group and length of post-policy period. Consistent with key features of the IHCP, I investigate its impact by marital and health statuses and find more pronounced relationships among individuals for whom the IHCP likely represented a valuable source of alternative coverage. In particular, I find larger average behavioral responses for unmarried individuals, smokers and obese individuals. |
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Dow, William
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Beyond Reinsurance: Risk-Adjusted Subsidies for the Chronically Ill
(PDF) |
Government-sponsored health reinsurance has been increasingly promoted as a strategy for addressing problems in the non-group health insurance market. While reinsurance is promising, economic analysis has identified superior schemes for better accomplishing the same goals at lower cost. Specifically, reinsurance can be considered a crude special case of risk-adjusted insurance subsidies. This paper considers economic benefits and budgetary costs of reinsurance schemes as compared to more sophisticated risk-adjustment, calibrated to the current U.S. context. In particular, risk adjustment is likely to perform better at reducing insurer cream-skimming incentives. Although in the past risk adjustment had been considered too complex to implement in practice, recent experience shows that risk adjustment is now feasible, and we argue that incorporation of risk adjustment would strengthen many current U.S. health insurance reform proposals. |
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| Fang, Hanming
Gavazza, Alessandro
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Dynamic Inefficiencies in Employment Based Health Insurance System: Theory and Evidence
(PDF) |
We investigate how the U.S. employment-based health insurance system affects health care decisions. We stress that health is a form of human capital that affects productivity on the job and we suggest that the current U.S. system might lead to an inefficient low level of individual health due to employees' turnover. Turnover in frictional labor markets creates an externality that limits employer and employee's ability to privately capture the full benefits of health investments. Moreover, we show that under-investment in health is possibly related to the turnover rate of the workers' industry and increases medical expenditure in retirement. When employers offer health insurance, the contracts have higher deductibles and employers' contribution to the insurance premium is lower in high turnover industries. Moreover, workers in high turnover industries have lower medical expenditure and undertake less preventive care. |
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| Leininger, Lindsey |
The Impact of the Medicaid Expansions of the Late 1990's on the Insurance Coverage of Poor Adolescents (PDF) |
This paper examines the effects of the Medicaid expansions of the late 1990s on the insurance coverage of poor adolescents. Results suggest that the introduction of Medicaid eligibility had a large impact on the insurance coverage of poor adolescents. The probability of being publicly insured at the time of survey rose substantially as a result of the expansions; both the probability of being privately insured and the probability of being uninsured decreased as a result of the expansions. The baseline specification implies that approximately 40% of the increase in public coverage came from those who were previously privately insured. |
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Marton, Jim
Talbert, Jeffrey
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The Impact of SCHIP Premiums and Health Status on the Insurance Coverage of Children (PDF) |
This paper uses data from Kentucky’s SCHIP program to address two issues relating to the impact of public premiums on health insurance coverage for children. First, public insurance claims data is used to examine whether or not the impact of public health insurance premiums vary by child health type. Second, results from a survey of families whose children lost SCHIP coverage due to premium non-payment is used to examine the extent to which these children are able to find another source of health coverage. The results suggest that, in general, children with chronic health conditions, such as diabetes, asthma, or a mental health condition, are less likely to leave public coverage than children without one of these health conditions. Our survey results suggest that roughly half of responding families found some type of alternative health coverage after losing SCHIP coverage, with less healthy children being more likely to be covered than healthy children. |
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Nichols, Donald
Plotzke, Michael
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The Reality of SCHIP and Uninsureds: Do SCHIP Mandatory Wait Periods Increase the Uninsured Rolls? (PDF) |
Due to the low risk of not insuring a healthy child for a short, finite period of time, it is plausible that SCHIP mandatory wait periods, where a child must forgo private insurance for several months before enrolling in SCHIP, do not provide enough incentive for parents to keep their children enrolled in private insurance. Using data from the 1996 Survey of Income and Program Participation (SIPP), we find that children eligible for SCHIP in states with shorter mandatory wait periods are more likely to be uninsured during the six months following the implementation of SCHIP than children in states with no mandatory wait periods. These children also have lower preventative care utilization, but there is no difference in their acute care utilization or health after one year. |
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