Working Paper: NBER ID: w26030
Authors: Timothy J. Halliday; Randall Q. Akee; Tetine Sentell; Megan Inada; Jill Miyamura
Abstract: In March 2015, the State of Hawaii stopped covering the vast majority of migrants from countries belonging to the Compact of Free Association (COFA) in the state Medicaid program. COFA migrants were instead required to obtain private insurance in the exchanges established under the Affordable Care Act. Using statewide administrative hospital discharge data, we show that Medicaid-funded hospitalizations and emergency room visits declined in this population by 69% and 42% after the expiration of Medicaid eligibility. This decrease occurred despite the fact that low-income COFA households were eligible for state-funded premium coverage for private insurance. Utilization funded by private insurance did increase, but not enough to offset the declines in Medicaid-funded utilization. Uninsured ER visits increased as a consequence of the expiration of Medicaid benefits. Paradoxically, we also find a substantial increase in Medicaid-funded ER visits by infants after the expiration of benefits.
Keywords: Medicaid; medical utilization; COFA migrants; health insurance; emergency room visits
JEL Codes: I10; I14; J61
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Medicaid expiration (I18) | decline in Medicaid-funded hospitalizations (I18) |
| Medicaid expiration (I18) | decline in emergency room (ER) visits (I19) |
| Medicaid expiration (I18) | increased out-of-pocket costs (G52) |
| Medicaid expiration (I18) | lower take-up of private insurance (G52) |
| lower take-up of private insurance (G52) | decline in medical utilization (I11) |
| increased out-of-pocket costs (G52) | decline in medical utilization (I11) |
| Medicaid expiration (I18) | paradoxical increase in Medicaid-funded ER visits by infants (I18) |