CAREER: Public Health Insurance, Medical Expenditures, and Labor Market Outcomes

National Bureau Of Economic Research Inc, Cambridge MA

Investigators

Abstract

CAREER Project Abstract: The Impact of Expanded Health Insurance Coverage While the impact of expanded health insurance coverage has long been of interest to economists, the passage of the Massachusetts health reform in 2006 and the Affordable Care Act (ACA) in 2010 has brought health reform to the forefront of public discourse. Health spending comprises a growing portion of the U.S. economy, approaching 18% of GDP. At the same time, millions of Americans lack health insurance. These two realities motivate interest in three related projects. The goal of the first project is to characterize the evolution of nonelderly medical expenditures to inform insurance design; the goal of the second project is to examine the long term impact of Medicaid on health and labor market outcomes; and the goal of the third project is to measure the returns to intensive Medicare spending using variation across physicians. Intellectual Merit: Each project advances the frontier of knowledge by using a different data source that provides a rare level of detail. Part of the intellectual merit in the use of these data lies in data preparation -- developing processes to access the data, cleaning them, and deriving stylized facts from them. Further intellectual merit lies in the development and execution of simple theory and econometric methods that do not obscure the richness of the data. Project 1 uses data on almost all hospital visits in the state of New York from 1982 to 2009 linked to mortality records. These data include longitudinal patient identifiers, allowing detailed characterization of the evolution of medical expenditures for nonelderly individuals, especially those with high expenditures, mortality, and likelihood of insurance denial. Project 2 uses data on all federal tax returns filed from 1996 to 2009. These data permit analysis of the long term impact of Medicaid eligibility on employment, earnings, and education. Project 3 uses data on 100% of hospital inpatient Medicare claims between 1991 and 2010 linked to American Medical Association data on physicians. These data can be used to evaluate treatment and outcomes for all doctors who treat Medicare patients. Broader Impact: Building on a wide range of data, the research projects and education plan will aid in a greater understanding of the complexities of the health insurance market and its value in society. The objective of this research agenda is to advance the field of health economics by finding empirical answers to key policy questions. An equal priority will be making these answers accessible to other researchers, students, and the health policy community.