The Effect of Health Insurance Expansions on Insurance Status, Access to Care, and Labor Market Participation Open Access

Guy, Jr., Gery P. (2010)

Permanent URL: https://etd.library.emory.edu/concern/etds/vm40xr630?locale=en
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Abstract

Low-income childless adults are among the most likely group in the United States to be without health insurance coverage, accounting for over half of the non-elderly uninsured. One reason for these high rates of uninsurance is their historical exclusion from public health insurance programs. However, in recent years, policy changes provided states with more opportunities to expand health insurance coverage to this population. This dissertation is comprised of three articles investigating the effect of these health insurance expansion efforts on health insurance status, access to care, and labor market participation.

The first chapter analyzed the impact of public health insurance expansions and the use of enrol ee cost-sharing on insurance status and receipt of preventive screenings and physician services. The results show that childless adult expansions, regardless of cost-sharing levels, reduced uninsurance rates and decreased the likelihood that costs prohibited a physician visit. However, cost-sharing played an important role in the utilization of preventive services. Expansions with traditional cost-sharing levels led to increases in preventive service utilization, while those with increased cost-sharing requirements did not increase preventive service use.

The second chapter examined the effects of public and private health insurance premiums on insurance status. The results show that reduced public premiums are associated with an increased probability of public health insurance and a decreased probability of private health insurance and uninsurance. Additionaly, reduced private premiums increased the probability of private insurance and decreased the probability of uninsurance. Using the regression results, the effects of the premium levels included in the Patient Protection and Affordable Care Act (PPACA) were simulated. Among states with current programs, PPACA would provide health insurance coverage to an additional 507,605 uninsured childless adults.

The third chapter examined the effect of expanding public health insurance on labor force participation. Specifically, the effect of the expansions on leaving work, full-time employment, and part-time employment were examined. The analysis finds no effect of public health insurance eligibility on the likelihood of leaving work and full-time employment. However, the results show that the public health insurance eligibility resulted in a 4.1 percentage point increased likelihood of part-time employment.

Table of Contents

Table of Contents
CHAPTER 1...1

Abstract...1
Introduction...2
Background...3
Methods...5

Data...5
Target Population...7
Multivariate Analysis...8

Results...11
Limitations...14
Discussion...15

CHAPTER 2...30

Abstract...30
Introduction...31
Background...32
Data and Methods...35

Conceptual Framework...35
Data...36
Insurance Status...36
Eligibility and Premium Determination...37
Multivariate Analysis and Identification...38

Results...40
Sensitivity Analysis...42
Simulations...43
Limitations...44
Discussion and Policy Implications...45

CHAPTER 3...59

Abstract...59
Introduction...60
Background...61
Methods...65

Data...65
Multivariate Analysis...66

Results...69
Limitations and Sensitivity Analysis...70
Discussion...71

List of Tables
CHAPTER 1
Table 1: Summary of childless adult health insurance expansions...24

Table 2: Descriptive statistics of childless adult sample, 1997-2007, Behavioral Risk Factor Surveil ance System (BRFSS)...25
Table 3: The effect of expansion program eligibility on insurance status...26
Table 4: The effect of expansion program eligibility on access to physician services...27

Table 5: The effect of expansion program eligibility on access to cancer screening services...28
Table 6: The effect of expansion program eligibility on access to cholesterol screening...29

CHAPTER 2
Table 1: Summary of childless adult health insurance expansions and yearly premiums, 2000-2008...53
Table 2: Descriptive statistics of childless adult sample pooled across states and years, 2000-2008...54
Table 3: Regression coefficients: The effect of premium levels on insurance status of childless adults eligible for public health insurance expansion programs...55
Table 4: Regression coefficients: The effect of premium levels on insurance status of childless adults eligible for premium assistance programs...56
Table 5: Simulated changes in health insurance status of eligible low income childless adults under PPACA premium levels...57
Table 6: Simulation results applied to al childless adults under 400% FPL in expansion states...58

CHAPTER 3

Table 1: Summary of childless adult health insurance expansions...80

Table 2: Descriptive statistics of childless adult sample, 1998-2008...81

Table 3: The marginal effect of expansion program eligibility on labor market participation...82

Table 4: The marginal effect of expansion program eligibility on labor market participation among those with employer sponsored coverage in the previous year...83

Table 5: The marginal effect of expansion program eligibility on labor market participation among those without employer sponsored coverage in the previous year...84

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