Medicaid,family spending,and the financial implications of crowd-out |
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| Institution: | 1. Center for Health and Community, University of California, San Francisco, San Francisco, California;2. Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California;3. School of Medicine, University of California, San Francisco, San Francisco, California;4. Health Begins, Studio City, California;5. Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California;1. Bureau of Labor Statistics, United States;2. Department of Economics, Colby College, Waterville, ME, USA;1. Georgia State University, Georgia State University, Department of Economics, P.O. Box 3992, Atlanta, GA, United States;2. University of Kentucky, Department of Economics, 223B Gatton Business and Economics Building, Lexington, KY, United States;3. University of Kentucky, College of Pharmacy, 789 South Limestone St., Lexington, KY, United States;1. School of Commerce, Meiji University, 1-1 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8301, Japan;2. Faculty of Commerce, Waseda University, 1-6-1 Nishiwaseda, Shinjuku-ku, Tokyo, 169-8050, Japan;1. OHSU Center for Health System Effectiveness (CHSE), Department of Emergency Medicine, School of Medicine, 3030 SW Moody Ave, Portland, 97201, OR, USA;2. OHSU-PSU School of Public Health, Portland 97239, OR, USA;3. OHSU Institute on Development and Disability, Department of Pediatrics, School of Medicine, Portland, 97239, OR, USA |
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| Abstract: | A primary purpose of health insurance is to protect families from medical expenditure risk. Despite this goal and despite the fact that research has found that Medicaid can crowd out private coverage, little is known about the effect of Medicaid on families’ spending patterns. This paper implements a simulated instrumental variables strategy with data from the Consumer Expenditure Survey to estimate the effect of an additional family member becoming eligible for Medicaid on family-level health insurance coverage and spending. The results indicate that an additional family member becoming eligible for Medicaid increases the number of people in the family with Medicaid coverage by about 0.135–0.142 and decreases the likelihood that a family has any medical spending in a quarter by 2.7 percentage points. As previous research often finds with different data sets, I find evidence that Medicaid expansions crowd out some private coverage. Unlike most other data sets, the Consumer Expenditure Survey allows for considering the financial implications of crowd-out. The results indicate that families that transition from private coverage to Medicaid are able to spend significantly less on health insurance expenses, meaning Medicaid expansions can be welfare improving for families even when crowd-out occurs. |
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| Keywords: | Medicaid eligibility Crowd-out family spending |
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