Health, families and private and public health insurance (JMP) Draft comming soon
Abstract: This paper evaluates the macroeconomic and welfare consequences of Medicaid expansions targeting low-income children and pregnant women between the late 1980s and 2010. By extending public coverage to dependents, these reforms reshaped household insurance decisions and altered the composition of private insurance markets. Motivated by new empirical evidence on shifts in insurance coverage, family-level dynamics, and medical spending patterns, I develop and estimate a general equilibrium model of household insurance choice, incorporating heterogeneous health risks, eligibility constraints, and endogenous premium adjustments. The analysis shows how institutional features of the U.S. insurance system mediate the effects of public coverage expansions and provides new insights for the design of public health insurance policy.
Medicaid Expansion and Parental Health Insurance
Abstract: This paper examines how the Medicaid expansion in the late 1980s and early 1990s focused on children and pregnant women impacted parents’ health insurance coverage. Using state-of-art difference-in-difference methodology, I find that while the expansion significantly increased the number of parents with children covered by Medicaid, it also substantially reduced parents’ private insurance coverage. For mothers, the decline in private insurance is, to a large extent, crowded out by public insurance. However, for fathers, it largely reflects a decrease in health insurance coverage, indicating a spillover effect. Overall, I find that Medicaid expansion explains almost 48% of the decline in private insurance in this period and accounts for nearly one-third of the increase in the uninsured. These findings highlight the importance of analyzing health insurance decisions at the household level, as expanding coverage for some family member can significantly alter the household’s willingness to pay for private insurance. Moreover, this study uncovers a novel mechanism contributing to the long-term decline in private health insurance since the late 1980s.