Inequality in health insurance coverage before and after the Affordable Care Act.

This study examines how the Affordable Care Act (ACA) affected income related inequality in health insurance coverage in the United States. Analyzing data from the American Community Survey (ACS) from 2010 through 2018, we apply difference-in-differences, and triple-differences estimation to the Recentered Influence Function OLS estimation. We find that the ACA reduced inequality in health insurance coverage in the United States. Most of this reduction was a result of the Medicaid expansion. Additional decomposition analysis shows there was little change in inequality of coverage through an employer plan, and a decrease in inequality for coverage through direct purchase of health insurance. These results indicate that the insurance exchanges also contributed to declining inequality in health insurance coverage.

Out of Pocket Costs and Health Insurance Take-Up Rates.

BACKGROUND: Over the first ten years of this century, the share of the US population covered by employer-sponsored health insurance plans experienced a significant decline. A decrease in the take-up rate accounts for about a quarter of this decline. Usually, the increasing share of the premium that is paid by workers is used to explain the decline in the take-up rate. However, in recent years the increase in copayments, deductible and coinsurance rate has far outpaced the increase in worker contribution. OBJECTIVE: In this study we analyze the impact of out-of-pocket (OOP) costs, which consist of both workers' contribution toward the premium and expected expenditures, on the take-up rate for firms that offer multiple plan types. METHODS: Using data from the Employer Health Benefits Survey we estimated a pooled ordinary least squares and a fixed effects model. Since we have information about different types of health insurance plans offered by the firm, we derive the cross-price elasticity of coverage. RESULTS: Our fixed effects estimations suggest that workers respond to an increase in the out-of-pocket contributions for Health Maintenance Organization (HMO) plans by switching to PPO plans without impacting the overall take-up rate, while workers respond to increases in the out-of-pocket contribution for Preferred Provider Organization (PPO) plans by switching to HMO plans or dropping out of the group coverage. CONCLUSION: In general, we found that the estimated elasticities are too small to explain the overall drop in take-up rates even in light of the large increases in required worker contributions and expected expenditures. Still, we highlight the growing importance of expected expenditures in explaining take-up rates.

Physical activity and time preference.

This paper investigates the link between time preference (whether a person is more present or future oriented) and time spent participating in physical activity. Using data on time spent engaged in physical activity from the National Longitudinal Surveys of Youth 1979 cohort, 2006 wave, where time preference is proxied by the expected share of money saved from a hypothetical $1000 cash prize. I find that time preference is a significant predictor of the amount of time spent participating in both vigorous and light-to-moderate physical activity for women and vigorous physical activity for men. The results are robust to various sample restrictions and alternative measures of time preference. The findings in this paper fill in a gap in the relationship between time preference and body composition by examining one of the pathways through which the former might affect the latter using a large, nationally representative dataset.

Plan choice, health insurance cost and premium sharing.

We develop a model of premium sharing for firms that offer multiple insurance plans. We assume that firms offer one low quality plan and one high quality plan. Under the assumption of wage rigidities we found that the employee's contribution to each plan is an increasing function of that plan's premium. The effect of the other plan's premium is ambiguous. We test our hypothesis using data from the Employer Health Benefit Survey. Restricting the analysis to firms that offer both HMO and PPO plans, we measure the amount of the premium passed on to employees in response to a change in both premiums. We find evidence of large and positive effects of the increase in the plan's premium on the amount of the premium passed on to employees. The effect of the alternative plan's premium is negative but statistically significant only for the PPO plans.