Short and Long Term Consequences of Health Insurance Provision
Sarah Miller
Business Economics
Health Policy
What happens when we use public policy to expand health insurance coverage to low-income kids, pregnant women, and adults?
- Short term: Improvements in financial well-being (Mazumder and Miller, AEJ: Economic Policy 2016), access to care and use of services (Miller and Wherry, New England Journal of Medicine 2017), use of appropriate care (Miller Journal of Public Economics 2012), provider response (Buchmueller, Miller, and Vujicic, AEJ: Economic Policy 2016).
- Long term: lower health care costs in adulthood, potentially offsetting the initial outlays (Wherry, Miller, Kaestner and Meyer, Review of Economics and Statistics forthcoming), improved educational and labor market outcomes (Miller and Wherry revise and resubmit, Journal of Human Resources).
- Intergenerational: Can health interventions be the key to breaking the cycle of poverty? (Miller and Wherry, in progress)
The ACA Medicaid Expansions and Credit Market Outcomes
Affordable Care Act was one of the largest expansions of public health insurance coverage since the 1960s. One motivation for expanding coverage is to provide financial protection.
- “That’s what health insurance reform is all about–the peace of mind that if misfortune strikes, you don’t have to lose everything.” - President Obama 2014 State of the Union.
The MEdicaid Expansion and Financial Outcomes
In Michigan, the ACA Medicaid plan is called the "Healthy Michigan Plan" and has enrolled over 600,000 individuals since it was launched in April of 2014.
To conduct this analysis, we partnered with the Michigan Department of Health and Human Services to match HMP enrollees to their credit reports.
- MDHHS provided information on use of health care services, enrollment, income, and demographic characteristics.
- These were matched using a "double blind" matching method with TransUnion credit reports.
Results: Unpaid Medical Bills
End of period effect: -$515 (35.5) p < 0.001
AMOUNT PAST DUE
End of the period effect: -$233.2 (43.25) p<0.001
PUBLIC RECORDS
(EVICTIONS, BANKRUPTCIES, JUDGMENTS)
End of the period effect: -0.0672 (0.008) p < 0.001
National Health Interview Survey
Not linked to Michigan data-- use low-income respondents in all states that expanded Medicaid and compare to those that did not expand.
Outcomes:
Health insurance coverage
Use of health care
Ease of access
Financial strain (self reported)
Improvements along almost all dimensions