Association for Public Policy Analysis & Management

An extensive literature in economics has studied the effects of gaining public health insurance eligibility on health outcomes. In contrast, not much is known of the effects of losing public health insurance eligibility on health. This paper is the first to comprehensively study the effects of one of the largest

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.