"Effects of Losing Public Health Insurance on Healthcare Access, Utilization and Health Outcomes: Evidence from the TennCare Disenrollment
*Names in bold indicate Presenter
public health insurance disenrollments in the U.S. on access to care, utilization of medical care and preventive care, and self-assessed health. The disenrollment was part of a 2005 reform to Tennessee’s Medicaid program (TennCare) in which 170,000 residents – mainly non-elderly childless adults – lost public health insurance eligibility due to budget cuts. Using data from the 2000-2010 Behavior Risk Factor Surveillance System (BRFSS) and restricted-use versions of the 2000-2010 National Health Interview Survey with state identifiers, I compare differences in outcomes between childless adults and other adults in Tennessee with the associated differential for these two groups across other Southern states, before and after the reform. I confirm that the 2005 TennCare disenrollment significantly decreased overall health insurance coverage, and I provide the first evidence that the disenrollment significantly increased the likelihood of reporting forgone and delayed medical care due to cost and decreased the number of visits to a primary care physician. I also document increases in the number of days with bad health. Finally, I provide evidence of changes to patients’ place of care, suggesting moving away from primary care towards Emergency Department visits. I do not find consistent evidence of effects for preventive care, although I do find suggestive evidence of increases in healthy behaviors. Overall the effects of the reform are concentrated among less educated childless non-elderly adults. These findings have potentially important implications for recent state public insurance expansions that are part of federal health care reform.