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Report
The Affordable Care Act and the market for higher education
Investment in human capital is a key determinant of wages and an important contributor to economic growth. However, incomplete markets for health insurance may distort educational incentives because of the link between employment and health insurance. The Medicaid expansion of the Affordable Care Act (ACA) dramatically broadened insurance offerings, and thus may have affected people’s incentives for education. To study how increasing efficiency in insurance markets affects educational investments, we use a triple-difference strategy comparing counties with different levels of uninsurance ...
Journal Article
Medicaid and the elderly
In 2009, Medicaid spent over $75 billion on 5.3 million elderly beneficiaries. This article describes the Medicaid rules for the elderly and discusses their economic implications.
Discussion Paper
Is Health Insurance Good for Your Financial Health?
What is the purpose of health care? What is the purpose of health insurance? When people fall ill, they seek health care in order to get better. But insurance has a slightly different function: Its main role is not to protect our health per se, but to protect our finances. For most people, lifetime health expenditures are quite low. However, some people have enormous health costs owing to major illnesses or health conditions. And this is where health insurance comes in?its goal (like that of any other form of insurance) is to protect these individuals against large, and sometimes ruinous, ...
Discussion Paper
Can Community Development Improve Health? Emerging Opportunities for Collaboration between the Health and Community Development Sectors
The two sectors of community development and health have long worked in the same neighborhoods, but they have not always worked together. This is starting to change, due in part to a growing recognition among health experts of the social, economic, and environmental factors that drive health outcomes. These social determinants of health have become the basis for new collaborations between community development and health professionals. This paper introduces professionals in both sectors to this emerging area of practice through a series of case studies of innovators in the southeastern United ...
Working Paper
Closing the Gap: The Impact of the Medicaid Primary Care Rate Increase on Access and Health
The difficulties that Medicaid beneficiaries face accessing medical care are often attributed to the program?s low reimbursement rates relative to other payers. There is little evidence, however, as to the actual effects of Medicaid payment rates for providers on access and health outcomes for beneficiaries. In this paper, we exploit time-series variation in Medicaid reimbursement rates primarily driven by the Medicaid fee bump?a provision of the Affordable Care Act mandating that states raise Medicaid payments to match Medicare rates for primary care visits for 2013 and 2014?to quantify the ...
Briefing
Medical Spending in Old Age
Older Americans' health care spending is relevant to many policy questions. Recent research shows that spending varies considerably with income, as do funding sources for that spending. Overall, the government pays more for lower-income individuals than higher-income individuals, but Medicaid is not just a program for the young and the poor. It provides substantial benefits to older adults with higher incomes as well.
Report
Can Treatment with Medications for Opioid Use Disorder Improve Employment Prospects? Evidence from Rhode Island Medicaid Enrollees
The nation’s long-standing crisis of opioid abuse intensified during the COVID-19 pandemic, with opioid-related deaths rising to nearly 81,000 in 2021, an increase of more than 60 percent from just two years earlier. Also during the pandemic, the labor force participation rate in the United States fell precipitously, and as of September 2022 it remained depressed by more than a full percentage point relative to its February 2020 level despite record numbers of job openings in 2021 and 2022. The unfortunate confluence of labor shortages and record-setting opioid mortality highlights the need ...
Report
The Affordable Care Act and the COVID-19 Pandemic: A Regression Discontinuity Analysis
Did Medicaid expansion under the Affordable Care Act affect the course of the COVID-19 pandemic? We answer this question using a regression discontinuity design for counties near the borders of states that expanded Medicaid with states that did not. Relevant covariates change continuously across the Medicaid expansion frontier. We find that (1) health insurance changes discontinuously at the frontier, (2) COVID-19 testing is discontinuously larger in Medicaid-expanding states, and (3) the fraction of beds occupied in ICUs is discontinuously smaller in Medicaid-expanding states. We also find ...
Working Paper
The effect of Medicaid eligibility expansions on births
In an effort to increase the use of prenatal care by pregnant women and the utilization of medical care by children, eligibility for Medicaid was expanded dramatically for pregnant women and children during the 1980s and early 1990s. By lowering the costs of prenatal care, delivery, and child health care for some individuals, Medicaid expansions may prompt some women to give birth who otherwise would not have children or lead some women to have more children than they otherwise would have. This study uses natality data from 1983 to 1996 to examine the relationship between a state's ...
Journal Article
Medicaid-the need for reform
Recent administration proposals to address the rising cost of Medicaid will do little to contain costs or truly reform the program. The primary issues are the large differences among state Medicaid programs in coverage and benefits and the programs high and rising costs. In this paper, we describe and develop several options for Medicaid reform that would expand coverage, provide fiscal relief to states, shift responsibility for some or all of the cost of dual eligibles to the federal government, and eliminate or restructure the disproportionate share programs. A number of other issues are ...