RESUMO
Many opioid control policies target the prescribing behavior of health care providers. In this paper, we study the first comprehensive state-level policy requiring providers to access patients' opioid history before making prescribing decisions. We compare prescribers in Kentucky, which implemented this policy in 2012, to those in a control state, Indiana. Our main difference-in-differences analysis uses the universe of prescriptions filled in the two states to assess how the information provided affected prescribing behavior. We find that a significant share of low-volume providers stopped prescribing opioids altogether after the policy was implemented, though this change accounted for a small share of the reduction in total volume. The most important margin of response was to prescribe opioids to fewer patients. Although providers disproportionately discontinued treating patients whose opioid histories showed the use of multiple providers, there were also economically meaningful reductions for patients without multiple providers and single-use acute patients.
Assuntos
Médicos , Programas de Monitoramento de Prescrição de Medicamentos , Analgésicos Opioides/uso terapêutico , Prescrições de Medicamentos , Pessoal de Saúde , Humanos , Padrões de Prática MédicaRESUMO
CONTEXT: Medicaid expansion has costs and benefits for states. The net impact on a state's budget is a central concern for policy makers debating implementing this provision of the Affordable Care Act. How large is the state-level fiscal impact of expanding Medicaid, and how should it be estimated? METHODS: We use Michigan as a case study for evaluating the state-level fiscal impact of Medicaid expansion, with particular attention to the importance of macroeconomic feedback effects relative to the more straightforward fiscal effects typically estimated by state budget agencies. We combine projections from the state of Michigan's House Fiscal Agency with estimates from a proprietary macroeconomic model to project the state fiscal impact of Michigan's Medicaid expansion through 2021. FINDINGS: We find that Medicaid expansion in Michigan yields clear fiscal benefits for the state, in the form of savings on other non-Medicaid health programs and increases in revenue from provider taxes and broad-based sales and income taxes through at least 2021. These benefits exceed the state's costs in every year. CONCLUSIONS: While these results are specific to Michigan's budget and economy, our methods could in principle be applied in any state where policy makers seek rigorous evidence on the fiscal impact of Medicaid expansion.
Assuntos
Análise Custo-Benefício , Medicaid/economia , Medicaid/legislação & jurisprudência , Medicaid/organização & administração , Modelos Econômicos , Patient Protection and Affordable Care Act/legislação & jurisprudência , Michigan , Estados UnidosRESUMO
In 2004, France introduced a national program of organized breast cancer screening. The national program built on preexisting local programs in some, but not all, départements. Using data from multiple waves of a nationally representative biennial survey of the French population, we estimate the effect of organized screening on the percentage of women obtaining a mammogram. The analysis uses difference-in-differences methods to exploit the fact that the program was targeted at women in a specific age group: 50 to 74 years old. We find that organized screening significantly raised mammography rates among women in the target age range. Just above the lower age threshold, the percentage of women reporting that they had a mammogram in the past 2 years increased by over 10 percentage points after the national program went into effect. Mammography rates increased even more among women in their 60s. Estimated effects are particularly large for women with less education and lower incomes, suggesting that France's organized screening program has reduced socioeconomic disparities in access to mammography.
Assuntos
Detecção Precoce de Câncer/estatística & dados numéricos , Mamografia/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Idoso , Neoplasias da Mama/diagnóstico , Feminino , França , Humanos , Pessoa de Meia-Idade , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: To document how health insurance coverage changed for White, Black, and Hispanic adults after the Affordable Care Act (ACA) went into effect. METHODS: We used data from the American Community Survey from 2008 to 2014 to examine changes in the percentage of nonelderly adults who were uninsured, covered by Medicaid, or covered by private health insurance. In addition to presenting overall trends by race/ethnicity, we stratified the analysis by income group and state Medicaid expansion status. RESULTS: In 2013, 40.5% of Hispanics and 25.8% of Blacks were uninsured, compared with 14.8% of Whites. We found a larger gap in private insurance, which was partially offset by higher rates of public coverage among Blacks and Hispanics. After the main ACA provisions went into effect in 2014, coverage disparities declined slightly as the percentage of adults who were uninsured decreased by 7.1 percentage points for Hispanics, 5.1 percentage points for Blacks, and 3 percentage points for Whites. Coverage gains were greater in states that expanded Medicaid programs. CONCLUSIONS: The ACA has reduced racial/ethnic disparities in coverage, although substantial disparities remain. Further increases in coverage will require Medicaid expansion by more states and improved program take-up in states that have already done so.
Assuntos
Renda/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/etnologia , Adulto , Etnicidade/estatística & dados numéricos , Feminino , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Humanos , Masculino , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Patient Protection and Affordable Care Act , Grupos Raciais , Estados Unidos , Adulto JovemRESUMO
Even as the number of children with health insurance has increased, coverage transitions--movement into and out of coverage and between public and private insurance--have become more common. Using data from 1996 to 2005, we examine whether insurance instability has implications for access to primary care. Because unobserved factors related to parental behavior and child health may affect both the stability of coverage and utilization, we estimate the relationship between insurance and the probability that a child has at least one physician visit per year using a model that includes child fixed effects to account for unobserved heterogeneity. Although we find that unobserved heterogeneity is an important factor influencing cross-sectional correlations, conditioning on child fixed effects we find a statistically and economically significant relationship between insurance coverage stability and access to care. Children who have part-year public or private insurance are more likely to have at least one doctor's visit than children who are uninsured for a full year, but less likely than children with full-year coverage. We find comparable effects for public and private insurance. Although cross-sectional analyses suggest that transitions directly between public and private insurance are associated with lower rates of utilization, the evidence of such an effect is much weaker when we condition on child fixed effects.
Assuntos
Serviços de Saúde da Criança/economia , Acessibilidade aos Serviços de Saúde/economia , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/economia , Seguro Saúde/economia , Pobreza , Criança , Serviços de Saúde da Criança/estatística & dados numéricos , Estudos Transversais , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Cobertura do Seguro/economia , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/classificação , Seguro Saúde/estatística & dados numéricos , Medicaid/economia , Medicaid/tendências , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Análise de Regressão , Fatores de Tempo , Estados UnidosRESUMO
In 2020, Colorado became the first state to cap out-of-pocket spending for insulin prescriptions, requiring fully insured health plans to cap out-of-pocket spending at $100 for a thirty-day supply. We provide the first evidence on the association of Colorado's Insulin Affordability Program with patient out-of-pocket spending, the amounts paid by plans per insulin prescription, and prescription filling. Using statewide claims data from the period 2018-21, we focused on the first two years that the copay cap law was in effect. We found that Colorado's Insulin Affordability Program was associated with significant reductions in out-of-pocket spending for insulin prescriptions, with the mean out-of-pocket payment per thirty-day supply falling nearly in half (from $62.59 to $35.64). Average plan payments increased slightly more ($31.39) than the decrease in out-of-pocket spending, as the total amount paid per prescription increased by about 1 percent. The average insulin user realized annual savings of $184, while the mean number of fills and the mean days' supply per year increased by 4.2 percent and 11.4 percent, respectively.
Assuntos
Gastos em Saúde , Insulina , Humanos , Colorado , Insulina/economia , Insulina/uso terapêutico , Gastos em Saúde/estatística & dados numéricos , Hipoglicemiantes/economia , Hipoglicemiantes/uso terapêutico , Feminino , Masculino , Pessoa de Meia-Idade , Custo Compartilhado de Seguro , Custos de Medicamentos , AdultoRESUMO
Importance: Many insulin users ration doses due to high out-of-pocket costs. Starting January 2020 with Colorado, 25 states and the District of Columbia enacted laws that cap insulin copayments. Objective: To estimate the association of Colorado's $100 copayment cap with out-of-pocket spending, medication adherence, and health care services utilization for diabetes-related complications. Design, Setting, and Participants: In this cohort study using Colorado's All-Payer Claims Database, nonelderly insulin users with type 1 diabetes were analyzed from January 2019 to December 2020. Outcome changes were compared in the prepolicy and postpolicy period among individuals continuously enrolled in state-regulated and non-state-regulated plans using difference-in-differences regressions. Subgroup analyses were conducted based on individuals' prepolicy spending (low: never ≥$100 out-of-pocket vs high: ≥$100 out-of-pocket cost at least once). Data were analyzed from June 2023 to May 2024. Exposure: Enrollment in state-regulated health insurance plans subject to the copayment cap legislation. Main Outcomes and Measures: Adherence to basal and bolus insulin treatment was evaluated using the proportion of days covered measure, out-of-pocket spending reflected prescription cost for a 30-day supply, and health care utilization for diabetes-related complications was identified using primary diagnosis codes from medical claims data. Results: The panel included 1629 individuals with type 1 diabetes (39â¯096 person-months), of which 924 were male (56.7%), 540 (33.1%) had 1 or more comorbidities, and the mean (SD) age was 40.6 (15.9) years. Overall, the copayment cap was associated with out-of-pocket spending declines of $17.3 (95% CI, -$27.3 to -$7.3) for basal and $11.5 (95% CI, -$24.7 to $1.7) for bolus insulins and increases in adherence of 3.2 (95% CI, 0.0 to 6.5) percentage points for basal and 3.3 (95% CI, 0.3 to 6.4) percentage points for bolus insulins. Changes in adherence were associated with increases within the prepolicy high-spending group (basal, 9.9; 95% CI, 2.4 to 17.4 percentage points; bolus, 13.0; 95% CI, 5.1 to 20.9 percentage points). The policy was also associated with a mean reduction of -0.09 (95% CI, -0.16 to -0.02) medical claims for diabetes-related complications per person per month among high spenders, a 30% decrease. Conclusions and Relevance: In this cohort study of Colorado's insulin copayment cap among individuals with type 1 diabetes, the policy was associated with an overall decline in out-of-pocket spending, an increase in medication adherence, and a decline in claims for diabetes-related complications only among insulin users who spent more than $100 in the prepolicy period at least once.
Assuntos
Diabetes Mellitus Tipo 1 , Gastos em Saúde , Hipoglicemiantes , Insulina , Humanos , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 1/economia , Masculino , Feminino , Adulto , Insulina/economia , Insulina/uso terapêutico , Colorado/epidemiologia , Gastos em Saúde/estatística & dados numéricos , Hipoglicemiantes/economia , Hipoglicemiantes/uso terapêutico , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Estudos de Coortes , Dedutíveis e Cosseguros/estatística & dados numéricos , Dedutíveis e Cosseguros/economia , Seguro Saúde/economia , Seguro Saúde/estatística & dados numéricos , Custo Compartilhado de Seguro/estatística & dados numéricos , Custo Compartilhado de Seguro/economia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricosRESUMO
We use 4 years of data from the retiree health benefits program of the University of Michigan to estimate the effect of price on the health plan choices of Medicare beneficiaries. During the period of our analysis, changes in the University's premium contribution rules led to substantial price changes. A key feature of this 'natural experiment' is that individuals who had retired before a certain date were exempted from having to pay any premium contributions. This 'grandfathering' creates quasi-experimental variation that is ideal for estimating the effect of price. Using regression discontinuity methods, we compare the plan choices of individuals who retired just after the grandfathering cutoff date and were therefore exposed to significant price changes to the choices of a 'control group' of individuals who retired just before that date and therefore did not experience the price changes. The results indicate a statistically significant effect of price, with a $10 increase in monthly premium contributions leading to a 2 to 3 percentage point decrease in a plan's market share.
Assuntos
Custo Compartilhado de Seguro/economia , Custos e Análise de Custo/economia , Seguro Saúde/economia , Medicare/estatística & dados numéricos , Fatores Etários , Idoso , Feminino , Humanos , Masculino , Medicare/economia , Aposentadoria/economia , Fatores Sexuais , Fatores Socioeconômicos , Estados UnidosRESUMO
BACKGROUND: In response to the opioid epidemic, many states implemented mandates requiring providers to check prescription drug monitoring programs (PDMPs) before prescribing opioids. We examine how overlapping benzodiazepine and opioid prescriptions changed after Kentucky implemented a PDMP mandate in July 2012. METHODS: We conducted an interrupted time series analysis using monthly data from Kentucky's PDMP from 2010 to 2016. Separate analyses were conducted for overlapping prescriptions from a single provider or multiple providers, and by sex and age group. We also conducted an individual-level longitudinal analysis that compared changes in utilization patterns after the mandate went into effect to changes in earlier periods during which the mandate was not in effect. RESULTS: Kentucky's PDMP mandate was associated with an immediate 7.5 % decline in the rate of overlapping benzodiazepine and opioid prescriptions and a significant change in the trend from increasing to decreasing. Approximately half of the immediate effect in level terms was explained by decreases in overlapping prescriptions written by a single provider. Our longitudinal analysis suggests that over one year the mandate reduced initiation of overlapping prescriptions by 29.3 % and reduced continuation of overlapping prescriptions by 9.4 %. The effects of the policy were largest for women and men aged 36-50. CONCLUSIONS: Though not the main rationale for the policy, Kentucky's PDMP mandate reduced overlapping prescriptions of benzodiazepines and opioids. Further efforts to reduce overlapping prescriptions should consider the effects on populations such as women over 50, who have high rates of overlapping prescriptions.
Assuntos
Programas de Monitoramento de Prescrição de Medicamentos , Masculino , Humanos , Feminino , Analgésicos Opioides/uso terapêutico , Kentucky/epidemiologia , Benzodiazepinas/uso terapêutico , Prescrições , Padrões de Prática Médica , Prescrições de MedicamentosRESUMO
Historically, lesbian, gay, bisexual, and transgender (LGBT) adults have faced barriers to obtaining health insurance coverage, which have contributed to disparities in access to care and health outcomes. The Affordable Care Act (ACA) and the 2015 Supreme Court ruling on marriage equality had the potential to improve access to health insurance for LGBT people. Using data from the nationally representative Health Reform Monitoring Survey, we provide new evidence on trends in coverage and access to care for LGBT and non-LGBT adults between 2013 and 2019. In 2013 LGBT adults were significantly less likely than non-LGBT adults to have insurance coverage and more likely to report difficulty obtaining necessary medical care. Disparities in insurance coverage began to decline in 2014, when the main coverage provisions of the ACA went into effect. By 2017-19, coverage rates for LGBT adults were comparable to those of non-LGBT adults, although significant disparities in access remained.
Assuntos
Minorias Sexuais e de Gênero , Pessoas Transgênero , Feminino , Estados Unidos , Humanos , Adulto , Patient Protection and Affordable Care Act , Reforma dos Serviços de Saúde , Seguro Saúde , Cobertura do Seguro , Acessibilidade aos Serviços de SaúdeRESUMO
Forty states mandate that providers query their patients' prescription histories in the state's prescription drug monitoring program (PDMP) before prescribing controlled substances. However, little is known about providers' use of PDMPs, either with or without a mandate. We measured the share of opioid prescriptions with PDMP queries in Kentucky from 2010 to 2018, before and after the implementation of the first comprehensive PDMP mandate in the US. Providers queried the PDMP for 12 percent of opioid prescriptions before the mandate; after the mandate, they queried for 56 percent of prescriptions. The share of prescriptions queried was lowest for patients without recent opioid use (3 percent before the mandate, 25 percent after) and highest for pain management specialists (31 percent before, 72 percent after). Over time, high-compliance providers reduced prescribing to the riskiest patients, whereas low-compliance providers continued to prescribe to them. Although the share of prescriptions queried greatly increased after the mandate, compliance remained incomplete, including for patients with high-risk patterns of opioid use.
Assuntos
Programas de Monitoramento de Prescrição de Medicamentos , Medicamentos sob Prescrição , Analgésicos Opioides , Humanos , Kentucky , Padrões de Prática Médica , PrescriçõesRESUMO
OBJECTIVE: To determine the relationship between Medicare's site-based outpatient billing policy and hospital-physician integration. DATA SOURCES: National Medicare claims data from 2010 to 2016. STUDY DESIGN: For each physician-year, we calculated the disparity between Medicare reimbursement under hospital ownership and under physician ownership. Using logistic regression analysis, we estimated the relationship between these payment differences and hospital-physician integration, adjusting for region, market concentration, and time fixed effects. We measured integration status using claims data and legal tax names. DATA COLLECTION: The study included integrated and non-integrated physicians who billed Medicare between January 1, 2010, and December 31, 2016 (n = 2 137 245 physician-year observations). PRINCIPAL FINDINGS: Medicare reimbursement for physician services would have been $114 000 higher per physician per year if a physician were integrated compared to being non-integrated. Primary care physicians faced a 78% increase, medical specialists 74%, and surgeons 224%. These payment differences exhibited a modest positive relationship to hospital-physician vertical integration. An increase in this outpatient payment differential equivalent to moving from the 25th to 75th percentile was associated with a 0.20 percentage point increase in the probability of integrating with a hospital (95% CI: 0.0.10-0.30). This effect was slightly larger among primary care physicians (0.27, 95% CI: 0.18 to 0.35) and medical specialists (0.26, 95% CI: 0.05 to 0.48), while not significantly different from zero among surgeons (-0.02; 95% CI: -0.27 to 0.22). CONCLUSIONS: The payment differences between outpatient settings were large and grew over time. Even routine annual outpatient payment updates from Medicare may prompt some hospital-physician vertical integration, particularly among primary care physicians and medical specialists.
Assuntos
Convênios Hospital-Médico/economia , Medicare/economia , Manejo da Dor/economia , Padrões de Prática Médica/economia , Mecanismo de Reembolso/economia , Assistência Ambulatorial/economia , Eficiência Organizacional/estatística & dados numéricos , Humanos , Setor Privado/economia , Estados UnidosRESUMO
We examine the effect of an income-based mandate on the demand for private hospital insurance and its dynamics in Australia. The mandate, known as the Medicare Levy Surcharge (MLS), is a levy on taxable income that applies to high-income individuals who choose not to buy private hospital insurance. Our identification strategy exploits changes in MLS liability arising from both year-to-year income fluctuations, and a reform where income thresholds were increased significantly. Using data from the Household, Income and Labour Dynamics in Australia longitudinal survey, we estimate dynamic panel data models that account for persistence in the decision to purchase insurance stemming from unobserved heterogeneity and state dependence. Our results indicate that being subject to the MLS penalty in a given year increases the probability of purchasing private hospital insurance by between 2 to 3 percent in that year. If subject to the penalty permanently, this probability grows further over the following years, reaching 13 percent after a decade. We also find evidence of a marked asymmetric effect of the MLS, where the effect of the penalty is about twice as large for individuals becoming liable compared with those going from being liable to not being liable. Our results further show that the mandate has a larger effect on individuals who are younger.
Assuntos
Seguro Saúde , Programas Nacionais de Saúde , Idoso , Características da Família , Hospitais Privados , Humanos , Renda , Cobertura do SeguroRESUMO
OBJECTIVES: We used data from the Behavioral Risk Factor Surveillance System to compare health insurance coverage, access to care, and women's cancer screenings for individuals in same-sex versus different-sex relationships. METHODS: We estimated logistic regression models by using data on 5265 individuals in same-sex relationships and 802,659 individuals in different-sex relationships. RESULTS: Compared with women in different-sex relationships, women in same-sex relationships were significantly less likely to have health insurance coverage, were less likely to have had a checkup within the past year, were more likely to report unmet medical needs, and were less likely to have had a recent mammogram or Pap test. Compared with men in different-sex relationships, men in same-sex relationships were significantly less likely to have health insurance coverage and were more likely to report unmet medical needs, although they were more likely to have had a checkup in the past year. CONCLUSIONS: In the largest and most recent nationally representative sample, we found important differences in health insurance coverage and access to care between individuals in same-sex relationships and those in different-sex relationships for both men and women.
Assuntos
Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Homossexualidade/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Adulto , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Pesquisas sobre Atenção à Saúde , Política de Saúde , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Heterossexualidade/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Mamografia/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Grupos Minoritários/estatística & dados numéricos , Estados Unidos , Esfregaço Vaginal/estatística & dados numéricosRESUMO
Large disparities in health insurance coverage and access to health services have long persisted in the US health care system. We considered how the insurance coverage expansions of the Affordable Care Act have affected disparities related to race and ethnicity. In the years since the law went into effect, insurance coverage has increased significantly for all racial/ethnic groups. Because coverage increased more for non-Hispanic blacks and Hispanics than for non-Hispanic whites, disparities in coverage have decreased. Despite these improvements, a large number of adults remain uninsured, and the uninsurance rate among blacks and Hispanics is substantially higher than the rate among whites.
Assuntos
Etnicidade , Patient Protection and Affordable Care Act , Adulto , Acessibilidade aos Serviços de Saúde , Disparidades em Assistência à Saúde , Humanos , Cobertura do Seguro , Seguro Saúde , Medicaid , Pessoas sem Cobertura de Seguro de Saúde , Estados UnidosRESUMO
CONTEXT: For many years, leading health care reform proposals have been based on market-oriented strategies. In the 1990s, a number of reform proposals were built around the concept of "managed competition," but more recently, "consumer-directed health care" models have received attention. Although price-conscious consumer demand plays a critical role in both the managed competition and consumer-directed health care models, the two strategies are based on different visions of the health care marketplace and the best way to use market forces to achieve greater systemwide efficiencies. METHODS: This article reviews the research literature that tests the main hypotheses concerning the two policy strategies. FINDINGS: Numerous studies provide consistent evidence that consumers' health plan choices are sensitive to out-of-pocket premiums. The elasticity of demand appears to vary with consumers' health risk, with younger, healthier individuals being more price sensitive. This heterogeneity increases the potential for adverse selection. Biased risk selection also is a concern when the menu of health plan options includes consumer-directed health plans. Several studies confirm that such plans tend to attract healthier enrollees. A smaller number of studies test the main hypothesis regarding consumer-directed health plans, which is that they result in lower medical spending than do more generous plans. These studies find little support for this claim. CONCLUSIONS: The experiences of employers that have adopted key elements of managed competition are generally consistent with the key hypotheses underlying that strategy. Research in this area, however, has focused on only a narrow range of questions. Because consumer-directed health care is such a recent phenomenon, research on this strategy is even more limited. Additional studies on both topics would be valuable.
Assuntos
Planos Médicos Alternativos/economia , Comportamento do Consumidor , Prática Clínica Baseada em Evidências/economia , Reforma dos Serviços de Saúde/economia , Competição em Planos de Saúde/economia , Comportamento de Escolha , Comportamento Competitivo , Humanos , Seguro Saúde/economia , Michigan , Motivação , Estados UnidosRESUMO
The central role that employers play in financing health care is a distinctive feature of the U.S. health care system, and the provision of health insurance through the workplace has important implications well beyond its role as a source of health care financing. In this paper, we consider the "goodness of fit" of employer-sponsored health insurance (ESI) in the current economic and health insurance environments and in light of prospects for a vigorous national debate over the shape of health care reform. The main issue that we explore is whether ESI can have a viable role in health system reform efforts or whether such coverage will need to be significantly modified or even abandoned as reform seeks to address important issues in the efficient provision and equitable distribution of health insurance coverage.
Assuntos
Planos de Assistência de Saúde para Empregados , Reforma dos Serviços de Saúde , Adulto , Humanos , Pessoa de Meia-Idade , Estados Unidos , Adulto JovemRESUMO
Objective: To analyze whether there was an increase in retirement or in part-time work among older workers after January 2014, when new health insurance coverage options became available because of the Affordable Care Act (ACA). Method: We analyze trends in retirement and part-time work for individuals aged 50-64 years in the basic monthly Current Population Survey from January 2008 through June 2016. We test for a break in trend in January 2014. We also test for differences in trends, both before and after 2014, in states that expanded their Medicaid programs in January 2014 under the ACA compared with those that did not. Results: We find that there was no change in the probability of retirement or part-time work among older workers in 2014 and later, either overall or in Medicaid expansion states relative to nonexpansion states. Discussion: Although many observers had predicted that an unintended consequence of health reform would be reduced labor supply, we find no evidence of this for older workers in the first 2.5 years after the law's major coverage provisions took effect.
Assuntos
Reforma dos Serviços de Saúde , Aposentadoria/estatística & dados numéricos , Emprego/estatística & dados numéricos , Feminino , Reforma dos Serviços de Saúde/legislação & jurisprudência , Reforma dos Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Medicaid/legislação & jurisprudência , Medicaid/estatística & dados numéricos , Pessoa de Meia-Idade , Patient Protection and Affordable Care Act , Aposentadoria/legislação & jurisprudência , Estados UnidosRESUMO
OBJECTIVE: To investigate the factors underlying the lower rate of employer-sponsored health insurance coverage for foreign-born workers. DATA SOURCES: 2001 Survey of Income and Program Participation. STUDY DESIGN: We estimate probit regressions to determine the effect of immigrant status on employer-sponsored health insurance coverage, including the probabilities of working for a firm that offers coverage, being eligible for coverage, and taking up coverage. DATA EXTRACTION METHODS: We identified native born citizens, naturalized citizens, and noncitizen residents between the ages of 18 and 65, in the year 2002. PRINCIPAL FINDINGS: First, we find that the large difference in coverage rates for immigrants and native-born Americans is driven by the very low rates of coverage for noncitizen immigrants. Differences between native-born and naturalized citizens are quite small and for some outcomes are statistically insignificant when we control for observable characteristics. Second, our results indicate that the gap between natives and noncitizens is explained mainly by differences in the probability of working for a firm that offers insurance. Conditional on working for such a firm, noncitizens are only slightly less likely to be eligible for coverage and, when eligible, are only slightly less likely to take up coverage. Third, roughly two-thirds of the native/noncitizen gap in coverage overall and in the probability of working for an insurance-providing employer is explained by characteristics of the individual and differences in the types of jobs they hold. CONCLUSIONS: The substantially higher rate of uninsurance among immigrants is driven by the lower rate of health insurance offers by the employers of immigrants.
Assuntos
Emigração e Imigração/estatística & dados numéricos , Planos de Assistência de Saúde para Empregados/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores SocioeconômicosRESUMO
We examined the complex relationship among work, health, and health insurance, which has been affected by changing demographics and employment conditions in the United States. Stagnation or deterioration in employment conditions and wages for much of the workforce has been accompanied by the erosion of health outcomes and employer-sponsored insurance coverage. In this article we present data and discuss the research that has established these links, and we assess the potential impact of policy responses to the evolving landscape of work and health. The expansion of insurance availability under the Affordable Care Act may have helped reduce the burden on employers to provide health insurance. However, the act's encouragement of wellness programs has uncertain potential to help contain the rising costs of employer-sponsored health benefits.