Association for Public Policy Analysis & Management

Panel: Public Health Insurance Programs, Health Care Access, and Medical Expenditures

(Health Policy)

Medicare and Medicaid are the two largest public health insurance programs in the United States. Our panel covers a range of topics related to the costs of these programs as well as access to them. Two of the papers study impacts of the Medicaid expansion component of the Patient Protection and Affordable Care Act (ACA), while the other two examine ongoing issues related to the design of Medicaid and Medicare. The first paper, “The Effect of ACA State Medicaid Expansions on Medical Out-of-Pocket Expenditures”, considers the effect of the ACA’s state Medicaid expansions on medical out-of-pocket expenditures using data from the Current Population Survey Annual Social and Economic Supplement. The main sample consists of childless non-elderly adults – the group most directly targeted by the ACA’s Medicaid expansion – while subsample analyses evaluate how the effects vary by income. The other paper on the ACA, entitled “Effects of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non-Expansion States”, estimates the effects of the ACA on health insurance coverage rates and sources using data from the American Community Survey. The authors exploit geographic variation in state Medicaid expansion decisions and local pre-treatment uninsured rates to separately identify the impacts of the ACA in states that expanded Medicaid and those that did not. The paper also examines how the impacts vary with income, race/ethnicity, age, and marital status. The panel’s third paper, “Medicaid Program Choice, Participant Inertia, and Health Care Utilization”, examines how default options influence insurance plan selections among low income individuals choosing among Medicaid managed care plans. Using administrative data from the Kentucky Medicaid program, this paper documents the extent to which individuals auto-assigned into the least generous of the three plans remained enrolled in that plan even after the second open enrollment period. Individuals pay premium penalties if they delay Medicare enrollment beyond the initial enrollment period, presumably to guard against adverse selection from individuals waiting until a negative health shock to decide on a plan. The final paper of the panel, “Late Enrollment Penalties, Medicare Enrollment and Medicare Costs of Older Americans”, provides an empirical analysis on how Medicare costs and Medicare enrollment behavior would be affected if Medicare late enrollment penalties were modified. Using data from the Medicare Current Beneficiary Survey, which has information on individual Medicare expenditures, health insurance premiums and Medicare enrollment information, this paper estimate a life cycle model of labor supply and Medicare enrollment decisions, which accounts for Medicare late enrollment penalties, uncertain medical expenses and health insurance coverage.