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When the affordable has no value, and the valuable is unaffordable: The U.S. market for long-term care insurance and the role of Medicaid

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  • Fels, Markus

Abstract

I consider the popular argument of Medicaid crowding out demand for private long-term care insurance. I show that this argument rests on a wrong counterfactual comparison. Furthermore, I question the welfare-decreasing impact of Medicaid as it neglects a large value of the program in providing access to care. I show that private insurance is unable to offer a similar value. I posit that the low take-up of private insurance is due to a dilemma prevalent in - but not exclusive to - the market for long term care insurance: a dilemma between access and affordability. Several empirical patterns in insurance uptake and lapsing behavior can be explained by considering the issue of limited affordability.

Suggested Citation

  • Fels, Markus, 2016. "When the affordable has no value, and the valuable is unaffordable: The U.S. market for long-term care insurance and the role of Medicaid," Working Paper Series in Economics 84, Karlsruhe Institute of Technology (KIT), Department of Economics and Management.
    • Handle: RePEc:zbw:kitwps:84
    DOI: 10.5445/IR/1000055418
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    References listed on IDEAS

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    1. Jeffrey R. Brown & Norma B. Coe & Amy Finkelstein, 2007. "Medicaid Crowd-Out of Private Long-Term Care Insurance Demand: Evidence from the Health and Retirement Survey," NBER Chapters, in: Tax Policy and the Economy, Volume 21, pages 1-34, National Bureau of Economic Research, Inc.
    2. Anne Theisen Cramer & Gail A. Jensen, 2006. "Why Don't People Buy Long-Term-Care Insurance?," The Journals of Gerontology: Series B, The Gerontological Society of America, vol. 61(4), pages 185-193.
    3. Markus Fels, 2020. "Mental Accounting, Access Motives, and Overinsurance," Scandinavian Journal of Economics, Wiley Blackwell, vol. 122(2), pages 675-701, April.
    4. Jeffrey R. Brown & Amy Finkelstein, 2008. "The Interaction of Public and Private Insurance: Medicaid and the Long-Term Care Insurance Market," American Economic Review, American Economic Association, vol. 98(3), pages 1083-1102, June.
    5. Jeffrey R. Brown & Amy Finkelstein, 2009. "The Private Market for Long‐Term Care Insurance in the United States: A Review of the Evidence," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 76(1), pages 5-29, March.
    6. Pauly, Mark V, 1990. "The Rational Nonpurchase of Long-term-Care Insurance," Journal of Political Economy, University of Chicago Press, vol. 98(1), pages 153-168, February.
    7. David M. Cutler, 1993. "Why Doesn't the Market Fully Insure Long-Term Care?," NBER Working Papers 4301, National Bureau of Economic Research, Inc.
    8. Yong Li & Gail A. Jensen, 2012. "Why Do People Let Their Long-term Care Insurance Lapse? Evidence from the Health and Retirement Study," Applied Economic Perspectives and Policy, Agricultural and Applied Economics Association, vol. 34(2), pages 220-237.
    9. Yong Li & Gail A. Jensen, 2012. "Why Do People Let Their Long-term Care Insurance Lapse? Evidence from the Health and Retirement Study," Applied Economic Perspectives and Policy, Agricultural and Applied Economics Association, vol. 34(2), pages 220-237.
    10. Jeffrey R. Brown & Amy Finkelstein, 2011. "Insuring Long-Term Care in the United States," Journal of Economic Perspectives, American Economic Association, vol. 25(4), pages 119-142, Fall.
    11. Amy Finkelstein & Kathleen McGarry, 2006. "Multiple Dimensions of Private Information: Evidence from the Long-Term Care Insurance Market," American Economic Review, American Economic Association, vol. 96(4), pages 938-958, September.
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    Cited by:

    1. Fels, Markus, 2019. "Risk attitudes with state-dependent indivisibilities in consumption," Ruhr Economic Papers 805, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.

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    More about this item

    Keywords

    Aging; Insurance; Long term Care; Medicaid;
    All these keywords.

    JEL classification:

    • G22 - Financial Economics - - Financial Institutions and Services - - - Insurance; Insurance Companies; Actuarial Studies
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I38 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - Government Programs; Provision and Effects of Welfare Programs

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