Health insurance coverage during the COVID-19 pandemic: The role of Medicaid expansion

Using data from the US Census Bureau's Household Pulse Survey, we analyzed the likelihood of loss of health insurance and enrollment into new health coverage during the early months of the COVID-19 pandemic. Loss of employment was associated with a significant increase in the likelihood of loss of health insurance and, specifically, an increase in the likelihood of employer-sponsored health insurance. However, individuals in Medicaid expansion states experienced a lower likelihood of loss of health insurance compared with individuals in nonexpansion states. At the same time, there was a statistically significant increase in Medicaid enrollment in expansion states, by 3.2 percentage points. Reemployment or acquiring employment was associated with a gain in health insurance coverage. During an economic downturn, eligibility, and coverage gaps leave many without affordable coverage options, and the pandemic will likely bring renewed attention to gaps in Medicaid coverage in nonexpansion states.     

The Affordable Care Act,the Medicaid Coverage Gap,and Hispanic Consumers: A Phenomenology of Obamacare

The historic health care reform of the Patient Protection and Affordable Care Act, commonly referred to as Obamacare, enabled more than 20 million Americans to gain health insurance and access to health care. However, the original mandate requiring states to expand Medicaid was ruled as optional in 2012 by the Supreme Court. Focusing on Hispanic consumers residing in a state that opted out of the Medicaid expansion, this study reports on the consumer experience of Obamacare. Findings show that study participants are in an unfavorable situational context, better understood when the cultural context is considered, and cultural resistance recognized. The findings also show that participants are confused, discouraged, and fearful of the continued unaffordability of health insurance and the lawful need to enroll or be penalized. For these participants, affordable health insurance has not been realized and this research gives an insight on those individuals falling through the cracks.     

Consumer Preferences for Health Care Reform Options

This study uses the 1992 Health and Retirement Study to examine consumer preferences for four health care reform options: tax-financed national health insurance, personally subsidized Medicare extensions, publicly subsidized nursing home insurance, and tax credits for health insurance purchases. Males, non-Caucasians, the self-employed, those in excellent health, and those who reside in the Northeast favor national health insurance, while those with high levels of liquid and non-liquid assets tend to disfavor it. Males and those with higher expectations of living in nursing homes tend to favor personally subsidized Medicare extensions to cover nursing homes and home health care. Those with higher expectations of living in nursing homes also favor publicly subsidized nursing home insurance. Relatively little support for subsidized nursing home insurance is found among males and those with high levels of liquid and non-liquid assets. The self-employed tend to support tax credits for health insurance premiums.     

Medicaid, State Finances, and the Bottom Line for Businesses

Current Medicaid expenditures account for about nine percent of the federal budget and almost a quarter of state budgets and are growing rapidly. State Medicaid budgets are especially vulnerable to recession since states cannot incur large and sustained fiscal deficits. Without change, Medicaid burdens will cause state finances to be diverted from infrastructure and education, with negative effects on the costs and productivity of business. Also affecting business are the state governments experimenting with policies that shift Medicaid burdens to private employers. Simultaneously, the states are initiating efforts to ease Medicaid’s relentless cost increases and address its long-run problems. JEL Classification I180,H720     

Protecting Consumers From Uninsured Motorists: An Alternative Financing Mechanism

For over 65 years, state legislators have debated how consumers who have been injured by financially irresponsible motorists will be compensated. While uninsured motorists insurance has become the modal choice among several states, responsible motorists in most states must completely pay for this coverage themselves. Motorists who drive without liability insurance contribute virtually nothing to meeting the costs of accidents they cause. This paper proposes that premiums for basic limits of uninsured motorists coverage be collected by a small universal motor fuel surcharge. These state-collected premiums then would be distributed to insurers on the basis of the number of vehicles that they insure within the jurisdiction. It is proffered that this mechanism is both more equitable and significantly lower in cost for the average motorist than the various present mechanisms of financing uninsured motorists coverage.     

Elderly Consumers' Knowledge Related to Medigap Protection Needs

Elderly consumers’ knowledge of Medicare coverage and the major factors they considered in purchasing supplementary health insurance were examined. Perceptions of the financial consequences of being hospitalized also were investigated. The findings based on a sample of Florida residents indicated that many older people may be ill-prepared to correctly assess their medigap protection needs and to choose wisely among alternative insurance policies if they decide to purchase supplementary coverage. Inadequate knowledge may result in unfulfilled expectations about protection when medical expenses are incurred, vulnerability to questionable insurance sales appeals and methods, and purchase of uneconomic duplicate coverage.     

Kynecting the Dots: How Kentucky’s Willingness to Loosen the Reins Sparked a Health Insurance Enrollment Race in the Bluegrass State

The development of health insurance exchanges within the Patient Protection and Affordable Care Act (ACA) legislation is one of the hottest health policy issues of this decade. With the surprise enrollment success of Kentucky’s exchange called “Kynect,” the influence of how marketing and branding have contributed to the embrace of the policy has garnered interest from scholars and practitioners alike. Driven by the utilization of in-depth interviews, this study found that Kynect’s success was aided by three emergent themes: frequent communication between the outsourced marketing firm, Doe-Anderson, and relevant stakeholders; the willingness to delegate all marketing and branding control to Doe-Anderson; and a multiparty commitment to developing and executing a campaign that would simultaneously adhere to public values and accentuate a feeling of localness to constituents across the state. The paper contributes to existing literature by providing an inside look at how a government can find marketing success against historical odds.     

Health insurance and job creation by the self-employed

Health insurance is regulated at the state level by the use of state-mandated health benefits. These are regulations issued by the state that mandate minimum levels of certain benefits as part of policies offered, e.g., drug abuse and alcohol treatment services, treatment for mental illnesses, etc. In this paper, we evaluate the impact of state health insurance mandates on job creation by small firms using data from the Survey of Income and Program Participation (SIPP) dataset for the period 1993–1995. Results from an ordered probit regression indicate that, the larger the number of mandates in a state, the lower the probability that a self-employed person will be a significant employment generator. These results hold when we consider both the sum of mandates as well as a cost-weighted measure of the most expensive mandates.     

大病保险对中老年居民医疗利用及健康的影响——基于CHARLS数据的实证检验

运用CHARLS 2011、2013、2015年三期数据,采用双重差分模型和准自然实验框架,分析城乡居民大病保险制度对中老年居民医疗服务利用和健康的影响及其作用机制,并从城乡和收入两个角度对制度实施效应的异质性进行探究。研究表明:大病保险制度实施能够显著促进中老年居民住院医疗服务及健康,增加中老年居民住院概率1.03%,提高住院次数0.022次,提高住院总费用10.4个百分点,总体健康水平提高0.023个单位;制度实施主要促进了农村和中等收入群体的住院医疗服务利用和健康水平的改善,对低收入人群住院医疗服务影响有限,且对城镇居民和高收入群体的影响并不显著;作用机制分析显示大病保险制度实施通过提高居民医疗服务利用进而起到改善其健康水平的作用。研究表明大病保险制度对中老年居民的住院服务利用和健康起到积极作用,但对于低收入群体的效应仍有待进一步改善。     

Health insurance provision and labor contracts for small firms

Healthcare reform in the USA requires all Americans to buy health insurance and businesses above a certain size to offer healthcare coverage to their employees by 2014. Understanding why some entrepreneurs do not provide employer-based health insurance is important and might help to solve future health insurance problems. Using two unique features which have not yet been discussed in the literature, namely, efficiency–wage theory and a compensation package of monetary wage and health insurance coverage, we provide here a theoretical foundation to why small firms are less likely to offer health insurance and are more likely to have employees with only a weak preference for acquiring health insurance. To reach the goal of health insurance coverage for all, one feasible solution is to allow small firms or individuals to pool together and pay a lower insurance premium.     

税延政策下不同收入层人群养老保险模式选择——基于累进税制和比例税制的综合实证研究

个税递延型商业养老保险政策的实施将对不同收入层次和不同收入来源人群的养老保险模式选择产生重大影响,而我国现行以累进型为主的个人所得税制度在这一影响发生的过程中发挥着根本性作用.基于这一影响机制,本文重点研究EET模式商业养老保险的受益群体范围,以不同收入水平和不同收入来源的杭州市居民为研究对象,以包含社会养老保险和商业养老保险的动态养老金总替代率期望值为调节目标,构建包含个人所得税的累进税率和比例税率变量的保险精算模型,设计和测算了投保期内的下临界点S1和上临界点S2.在此基础上,从居民购买商业养老保险意愿度和社会公平的角度出发,探讨对两个临界点的进一步调整,分析EET模式商业养老保险受益群体范围以外人群的行为决策,并最终提出政策性建议.     

Cigarette Consumption in Different U.S. States, 1955–1998: An Empirical Analysis of the Potential Use of Excise Taxation to Reduce Smoking

The use of excise taxation as a tool for financing part of Medicaid and national health care costs as well as for discouraging smoking behavior was a major political issue in the 1980s and early 1990s. It failed to gain Congressional support despite a significant increase in both federal and most state tax rates over the past twenty years. Annual data and OLS techniques are used to analyze the demand for cigarettes in the 50 states and the District of Columbia over the period from 1955 to 1998. Results show the demand for cigarettes to be relatively price inelastic. However, the estimates indicate more elasticity for high tax states than for low tax states. The price inelastic coefficient of the aggregate demand suggests that the main impact of taxation is likely to result in increased revenues to states rather than in directly reducing tobacco usage. The ultimate impact on smoking usage depends on how these increased revenues are spent and whether they become directed at smoking reduction. Cigarette demand is also found to be income inelastic, which implies that the tobacco industry has been growing less rapidly or even declining relative to the rising trend of the per capita disposable personal income in many states.     

Health Insurance,Job Lock,and the Supply of Self‐Employment

Unlike most wage earners, self‐employed Americans have limited access to health insurance and face higher costs. Thus, social commentators and policymakers argue that many potential entrepreneurs are “locked” into their current jobs for fear of losing their health coverage even though they could be more productive in self‐employment. Using a large data set for the period 2000–2008, we find the availability of employer‐provided health insurance to be negatively correlated to the likelihood of self‐employment in the long run, but the effect to be mediated by individual and family health status. However, we find employer‐provided health insurance to have no significant effect on the probability of switching in the short run. Finally, we find differences in the magnitude of the effects between our samples of husbands and wives.     

The Governance of Transactions by Commercial Intermediaries: An Analysis of the Re-engineering of Intermediation by Electronic Commerce

Efficiency arguments explain why commercial intermediaries exist and will continue to be involved in the exchanges despite the spread of digital networks. Commercial intermediaries provide producers and consumers with a set of information, logistic, securization and insurance (and liquidity) services. By bundling these services and by dedicating assets and learning capabilities to their production, commercial intermediaries allow transaction costs to be reduced. Digital networks per se cannot allow transacting parties to benefit from such efficient providers of intermediation services. Rather than establishing direct relationships among producers and consumers, the Internet will support a re-organization of existing intermediation chains, because traditional intermediaries will reinforce their ability to provide these service by using ITs. The analysis of the role of commercial intermediaries thus leads to a better understanding of the future of e-commerce. In turn, e-commerce provides New-Institutional Economics with a stimulating case study.     

灵活就业人员医疗保险参与及受益归属——基于逆向选择和正向分配效应的双重检验

当前,灵活就业人员医疗保险发展不充分与不平衡的问题格外突出,这不仅会制约医保制度公平性与可持续能力的提高,同时会阻碍经济社会的全面、协调和可持续发展。本文运用中国劳动力动态调查数据(CLDS),研究灵活就业人员参加医保的决定因素以及受益归属,从而为新时期医保制度顶层设计提供决策依据。结果表明:一方面,无论是在参保决策还是险种决策阶段,灵活就业人员的健康风险显著正向影响参保状态,说明逆向选择效应显著存在;另一方面,低收入的参保人利用了更多优质的医疗服务,获得了更多的医保基金补偿,并显著改善了健康状况,因此医保发挥了积极的正向分配作用。但是过高的保障水平,在改善医疗可及性的同时会激发道德风险,从而加剧逆向选择问题并阻碍正向分配效应,对更加公平可持续医保制度的建立造成负面影响。     

The Impact of the Rhode Island Catastrophic Health Insurance Plan

Under Rhode Island's statewide Catastrophic Health Insurance Plan (CHIP) in effect since January, 1975, and similar to the Long-Ribicoff National Health Insurance Proposal, Rhode Island pays catastrophic medical expenses over and above a “personal resource payment” (out-of-pocket expenses) that varies with income and amount and type of health insurance coverage. Those with qualified plans (plans providing more services) pay less out-of-pocket. Benefits accrue mainly to some middle income households. CHIP has increased demand for and prices for health insurance with qualifying coverage, and utilization of medical care. Similar impacts on a larger scale may be expected from any national health insurance program.     

国际会计准则下的寿险责任准备金核算浅析

随着社会发展步伐的加快,经济的迅速发展,政治、科技交流的不断加快,会计成为最受关注的职业,各国的会计准则也在不断地适应市场而变化,国际会计准则也不断修正,寿险责任金的核算成为了新的关注焦点,那么在国际会计准则下的寿险责任准备金的核算是什么样的呢?     

Health insurance and the supply of entrepreneurs: new evidence from the affordable care act

Is the difficulty of purchasing health insurance as an individual or small business a major barrier to entrepreneurship in the USA? I answer this question by taking advantage of the natural experiment provided by the Affordable Care Act’s dependent coverage mandate, which allowed many 19–25 year olds to acquire health insurance independently of their employment. Using a difference-in-difference strategy, I find that the dependent coverage mandate did not increase self-employment among young adults overall, but increased self-employment among disabled young adults by 19–23%.     

Improving Incentives in Health Care Spending

Although U.S. economic growth is likely to continue to be robust, the growth of private and public spending on health care presents long-run public policy challenges. To meet these challenges health care resources must be used more efficiently. Currently, there are few incentives to put health care dollars to the highest value use. This is true in both public and private spending. An important element of the problem lies in the tax-preferred treatment given to employer-provided insurance but not to out-of-pocket spending. The resulting bias towards first-dollar insurance coverage means that consumers are insulated from the real costs of the health care that they consume and have little reason to evaluate whether the benefits are greater than those costs. Moreover, they seldom have sufficient price and quality information to make informed decisions. Health Savings Accounts (HSAs) are a promising way to remove the tax-penalty for enrolling in catastrophic insurance and paying for routine care out of pocket. Given the information that they need, consumers would then have more choices and more control, strengthening their role in reducing waste, improving efficiency, and promoting competition. Coupled with other policies, HSAs can be a critical component in moving toward an efficient and equitable health care system. JEL Classification I11