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Losing public health insurance: TennCare reform and personal financial distress

Author

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  • Argys, Laura M.
  • Friedson, Andrew I.
  • Pitts, M. Melinda
  • Tello-Trillo, D. Sebastian

Abstract

A primary goal of health insurance is smoothing the financial risk associated with health shocks. We estimate the effect of exposure to health-insurance reform on individual-level financial well-being. Utilizing a plausibly exogenous shock to health insurance status resulting from a sudden disenrollment from Tennessee's Medicaid program in 2005, we find that the reform resulted in a 2.78 point decline in credit risk score for an individual in the median county in Tennessee. This study is the first examining the impact of losing any form of public assistance on personal financial well-being and our results inform ongoing discussions around Medicaid reform.

Suggested Citation

  • Argys, Laura M. & Friedson, Andrew I. & Pitts, M. Melinda & Tello-Trillo, D. Sebastian, 2020. "Losing public health insurance: TennCare reform and personal financial distress," Journal of Public Economics, Elsevier, vol. 187(C).
    • Handle: RePEc:eee:pubeco:v:187:y:2020:i:c:s0047272720300669
    DOI: 10.1016/j.jpubeco.2020.104202
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    as
    1. Silvia Helena Barcellos & Mireille Jacobson, 2015. "The Effects of Medicare on Medical Expenditure Risk and Financial Strain," American Economic Journal: Economic Policy, American Economic Association, vol. 7(4), pages 41-70, November.
    2. Gary V. Engelhardt & Jonathan Gruber, 2011. "Medicare Part D and the Financial Protection of the Elderly," American Economic Journal: Economic Policy, American Economic Association, vol. 3(4), pages 77-102, November.
    3. Laura Argys & Andrew Friedson & M. Melinda Pitts, 2016. "Killer Debt: The Impact of Debt on Mortality," FRB Atlanta Working Paper 2016-14, Federal Reserve Bank of Atlanta.
    4. Bhashkar Mazumder & Sarah Miller, 2016. "The Effects of the Massachusetts Health Reform on Household Financial Distress," American Economic Journal: Economic Policy, American Economic Association, vol. 8(3), pages 284-313, August.
    5. Craig Garthwaite & Tal Gross & Matthew J. Notowidigdo, 2014. "Public Health Insurance, Labor Supply, and Employment Lock," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 129(2), pages 653-696.
    6. Dizioli, Allan & Pinheiro, Roberto, 2016. "Health insurance as a productive factor," Labour Economics, Elsevier, vol. 40(C), pages 1-24.
    7. Charles Courtemanche & James Marton & Benjamin Ukert & Aaron Yelowitz & Daniela Zapata, 2018. "Early Effects of the Affordable Care Act on Health Care Access, Risky Health Behaviors, and Self‐Assessed Health," Southern Economic Journal, John Wiley & Sons, vol. 84(3), pages 660-691, January.
    8. Judith Wooldridge & Leighton Ku & Teresa Coughlin & Lisa Dubay & Marilyn Ellwood & Shruti Rajan & Sheila Hoag, 1996. "Implementing State Health Care Reform: What Have We Learned from the First Year? The First Annual Report of the Evaluation of Health Reform in Five States," Mathematica Policy Research Reports a47179c19b0e4b3ea2a65cfc3, Mathematica Policy Research.
    9. Courtemanche, Charles & Friedson, Andrew & Koller, Andrew P. & Rees, Daniel I., 2019. "The affordable care act and ambulance response times," Journal of Health Economics, Elsevier, vol. 67(C).
    10. Yuliya Demyanyk & Otto Van Hemert, 2011. "Understanding the Subprime Mortgage Crisis," The Review of Financial Studies, Society for Financial Studies, vol. 24(6), pages 1848-1880.
    11. David K. Musto, 2004. "What Happens When Information Leaves a Market? Evidence from Postbankruptcy Consumers," The Journal of Business, University of Chicago Press, vol. 77(4), pages 725-748, October.
    12. Finkelstein, Amy & McKnight, Robin, 2008. "What did Medicare do? The initial impact of Medicare on mortality and out of pocket medical spending," Journal of Public Economics, Elsevier, vol. 92(7), pages 1644-1668, July.
    13. Carlos Dobkin & Amy Finkelstein & Raymond Kluender & Matthew J. Notowidigdo, 2018. "The Economic Consequences of Hospital Admissions," American Economic Review, American Economic Association, vol. 108(2), pages 308-352, February.
    14. Gross, Tal & Notowidigdo, Matthew J., 2011. "Health insurance and the consumer bankruptcy decision: Evidence from expansions of Medicaid," Journal of Public Economics, Elsevier, vol. 95(7-8), pages 767-778, August.
    15. Nathan Blascak & Vyacheslav Mikhed, 2018. "Did the ACA's Dependent Coverage Mandate Reduce Financial Distress for Young Adults?," Working Papers 18-3, Federal Reserve Bank of Philadelphia.
    16. Gallagher, Emily A. & Gopalan, Radhakrishnan & Grinstein-Weiss, Michal & Sabat, Jorge, 2020. "Medicaid and household savings behavior: New evidence from tax refunds," Journal of Financial Economics, Elsevier, vol. 136(2), pages 523-546.
    17. Amy Finkelstein & Sarah Taubman & Bill Wright & Mira Bernstein & Jonathan Gruber & Joseph P. Newhouse & Heidi Allen & Katherine Baicker, 2012. "The Oregon Health Insurance Experiment: Evidence from the First Year," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 127(3), pages 1057-1106.
    18. Charles Courtemanche & James Marton & Benjamin Ukert & Aaron Yelowitz & Daniela Zapata, 2017. "Early Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non‐Expansion States," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 36(1), pages 178-210, January.
    19. Ning Zhu, 2011. "Household Consumption and Personal Bankruptcy," The Journal of Legal Studies, University of Chicago Press, vol. 40(1), pages 1-37.
    20. repec:mpr:mprres:1699 is not listed on IDEAS
    21. Sebastian Tello Trillo & Ausmita Ghosh & Kosali Simon & Johanna Catherine Maclean, 2015. "Losing Medicaid: What happens to hospitalizations?," NBER Working Papers 21580, National Bureau of Economic Research, Inc.
    22. Charles Courtemanche & James Marton & Aaron Yelowitz, 2016. "Who Gained Insurance Coverage in 2014, the First Year of Full ACA Implementation?," Health Economics, John Wiley & Sons, Ltd., vol. 25(6), pages 778-784, June.
    23. Neale Mahoney, 2015. "Bankruptcy as Implicit Health Insurance," American Economic Review, American Economic Association, vol. 105(2), pages 710-746, February.
    24. Hu, Luojia & Kaestner, Robert & Mazumder, Bhashkar & Miller, Sarah & Wong, Ashley, 2018. "The effect of the affordable care act Medicaid expansions on financial wellbeing," Journal of Public Economics, Elsevier, vol. 163(C), pages 99-112.
    25. Miller, Sarah, 2012. "The effect of insurance on emergency room visits: An analysis of the 2006 Massachusetts health reform," Journal of Public Economics, Elsevier, vol. 96(11), pages 893-908.
    26. Christopher Mayer & Karen Pence & Shane M. Sherlund, 2009. "The Rise in Mortgage Defaults," Journal of Economic Perspectives, American Economic Association, vol. 23(1), pages 27-50, Winter.
    27. Gary V. Engelhardt & Jonathan Gruber, 2011. "Does Medicare Part D Protect the Elderly from Financial Risk?," Issues in Brief ib2011-8, Center for Retirement Research, revised Jun 2011.
    28. Courtemanche, Charles & Marton, James & Ukert, Benjamin & Yelowitz, Aaron & Zapata, Daniela, 2018. "Effects of the Affordable Care Act on Health Behaviors after Three Years," IZA Discussion Papers 11468, Institute of Labor Economics (IZA).
    29. repec:mpr:mprres:3123 is not listed on IDEAS
    30. Donghoon Lee & Wilbert Van der Klaauw, 2010. "An introduction to the FRBNY Consumer Credit Panel," Staff Reports 479, Federal Reserve Bank of New York.
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    Cited by:

    1. Sarah Miller & Luojia Hu & Robert Kaestner & Bhashkar Mazumder & Ashley Wong, 2021. "The ACA Medicaid Expansion in Michigan and Financial Health," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 40(2), pages 348-375, March.
    2. Joseph Benitez & Kevin Callison & E. Kathleen Adams, 2024. "Joint effects of Medicaid eligibility and fees on recession‐linked declines in healthcare access and health status," Health Economics, John Wiley & Sons, Ltd., vol. 33(7), pages 1426-1453, July.
    3. Christa N. Gibbs & Benedict Guttman-Kenney & Donghoon Lee & Scott Nelson & Wilbert Van der Klaauw & Jialan Wang, 2024. "Consumer Credit Reporting Data," Staff Reports 1114, Federal Reserve Bank of New York.
    4. Lindsey Rose Bullinger & Sebastian Tello-Trillo, 2021. "Connecting Medicaid and child support: evidence from the TennCare disenrollment," Review of Economics of the Household, Springer, vol. 19(3), pages 785-812, September.
    5. Josh Blonz & Brigitte Roth Tran & Erin E. Troland, 2023. "The Canary in the Coal Decline: Appalachian Household Finance and the Transition from Fossil Fuels," NBER Working Papers 31072, National Bureau of Economic Research, Inc.
    6. Nathan Blascak & Vyacheslav Mikhed, 2023. "Health Insurance and Young Adult Financial Distress," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 42(2), pages 393-423, March.
    7. Daniel Sebastian Tello‐Trillo, 2021. "Effects of losing public health insurance on preventative care, health, and emergency department use: Evidence from the TennCare disenrollment," Southern Economic Journal, John Wiley & Sons, vol. 88(1), pages 322-366, July.
    8. Gangopadhyaya, Anuj & Schiman, Jeffrey C., 2023. "Does subsidized public health insurance for parents improve children's human capital and close achievement gaps?," Economics of Education Review, Elsevier, vol. 93(C).
    9. Viviano, Davide & Bradic, Jelena, 2023. "Synthetic Learner: Model-free inference on treatments over time," Journal of Econometrics, Elsevier, vol. 234(2), pages 691-713.
    10. Seonghoon Kim & Kanghyock Koh, 2022. "Health insurance and subjective well‐being: Evidence from two healthcare reforms in the United States," Health Economics, John Wiley & Sons, Ltd., vol. 31(1), pages 233-249, January.
    11. Michael R. Richards & Sebastian Tello‐Trillo, 2021. "Private coverage mandates, business cycles, and provider treatment intensity," Health Economics, John Wiley & Sons, Ltd., vol. 30(5), pages 1200-1221, May.
    12. Martin Andersen & Johanna Catherine Maclean & Michael F. Pesko & Kosali Simon, 2023. "Does paid sick leave encourage staying at home? Evidence from the United States during a pandemic," Health Economics, John Wiley & Sons, Ltd., vol. 32(6), pages 1256-1283, June.
    13. Christine L. Dobridge & Joanne W. Hsu & Mike Zabek, 2024. "Personal Tax Changes and Financial Well-being: Evidence from the Tax Cuts and Jobs Act," Finance and Economics Discussion Series 2024-029, Board of Governors of the Federal Reserve System (U.S.).
    14. Lennon, Conor, 2021. "Are the costs of employer-sponsored health insurance passed on to workers at the individual level?," Economics & Human Biology, Elsevier, vol. 41(C).

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    More about this item

    Keywords

    Medicaid; Public assistance; Household finance; Debt; Bankruptcy;
    All these keywords.

    JEL classification:

    • D14 - Microeconomics - - Household Behavior - - - Household Saving; Personal Finance
    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private

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