Medicaid expansions for the working age disabled: Revisiting the crowd-out of private health insurance

Abstract

Disabled individuals under 65 years old account for 15% of

Shock, but no shift: Hospitals' responses to changes in patient insurance mix

“…To improve upon earlier work, I employ an alternative method of identifying cost shifting that avoids using a change in the reimbursement rate and also measures cost-shifting from a Medicaid perspective. I take advantage of a unique Medicaid expansion described in Wagner (2015). The Omnibus Reconciliation Act of 1986 (OBRA86) gave states the authority to increase Medicaid income more than 74.73 percent.…”

“…3 The goal of this paper is to test the cost-shifting hypothesis by exploiting recent Medicaid expansions for individuals with disabilities that reduced the average revenue per patient received by hospitals. Wagner (2015) demonstrated that these Medicaid expansions led to 100 percent crowd-out of private health coverage among the disabled population. Crowd-out occurs when newly eligible individuals with private health insurance drop their current health plans in favor of public coverage through Medicaid.…”

“…The first step in this project is to verify the existence of the onefor-one shift in insurance types within the dataset. Wagner (2015) used data from the Survey of Income and Program Participation (SIPP) and the March Current Population Survey (CPS) to demonstrate that Medicaid expansions for the disabled generate 100 percent crowd-out. In this paper, I use data from the Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP) from the Agency for Healthcare Research and Quality and replicate the basic results of Wagner (2015) with hospitalizations.…”

“…Wagner (2015)'s primary analysis relied on data from the Survey of Income and Program Participation (SIPP) which is a monthly level household survey, but found similar results using the March CPS. Given that the NIS is an annual survey, this paper uses the March CPS to construct simulated eligibility in order to better align with the timeline of the NIS.…”

The effect of Affordable Care Act Medicaid expansion on hospital revenue

“…Pines et al (2016) and Moghtaderi, Black, Zocchi, & Pines, (2020) found a relative drop in privately insured ED visits in expansion states after ACA Medicaid expansion. Wagner (2015) reported that Medicaid expansions led to nearly 100% crowd out of private insurance for disabled persons who became Medicaid eligible. Johnston, McMorrow, Thomas, and Kenney (2020) report evidence of crowd out among new low‐income mothers who become Medicaid‐eligible under the ACA.…”