Working Paper: NBER ID: w31491
Authors: Sarah Hamersma; Daniel S. Grossman; Sebastian Tellotrillo
Abstract: Evaluating insurance coverage at the individual level abstracts away from the family-level decision making behind healthcare utilization. While traditional private insurance tends to be offered to either adult individuals or whole families, public insurance eligibility is determined person-by-person. Income eligibility thresholds for public coverage can differ for parents and children, and even among children in different age groups. Having different insurance sources, or a mix of insured and uninsured members of a family, may be disruptive to consistent medical care. In this paper we investigate how changes in eligibility thresholds for adults and children are associated with mismatched patterns of insurance coverage. Using the Current Population Survey and the Survey of Income and Program Participation, we document the patterns of insurance mismatch over time and their relationship to Medicaid and State Children’s Health Insurance Program income eligibility thresholds. We find that expansions of parent thresholds can promote uniform insurance coverage for families. These results are driven by families led by single mothers, who are more likely to be affected by Medicaid expansions for parents. Treating a family as the main unit of observation provides important insights and details potential unintended consequences of individual-level public insurance policy.
Keywords: public health insurance; insurance uniformity; Medicaid; family coverage; healthcare access
JEL Codes: I01; I13; I18; I38
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Medicaid parental expansions (I18) | family insurance uniformity (G52) |
| Medicaid parental expansions (I18) | mismatched insurance coverage (G52) |
| children's Medicaid expansions (I18) | family insurance uniformity (G52) |
| policy changes (J18) | family insurance uniformity (G52) |