Laura Dague

Wisconsin Experience Indicates That Expanding Public Insurance To Low-Income Childless Adults Has Health Care Impacts

As states consider expanding Medicaid to low-income childless adults under the Affordable Care Act, their decisions will depend, in part, on how such coverage may affect the use of medical care. In 2009 Wisconsin created a new public insurance program for low-income uninsured childless adults. We analyzed administrative claims data spanning 2008 and 2009 using a case-crossover study design on a population of 9,619 Wisconsin residents with very low incomes who were automatically enrolled in this program in January 2009. In the twelve months following enrollment in public insurance, outpatient visits for the study population increased 29 percent, and emergency department visits increased 46 percent. Inpatient hospitalizations declined 59 percent, and preventable hospitalizations fell 48 percent. These results demonstrate that public insurance coverage expansions to childless adults have the potential to improve health and reduce costs by increasing access to outpatient care and reducing hospitalizations.

Wisconsin's BadgerCare Plus Reform: Impact on Low-Income Families' Enrollment and Retention in Public Coverage

OBJECTIVES To examine the impact of a Wisconsin health care reform enacted in early 2008 on public insurance enrollment and retention. DATA SOURCES Administrative data covering the period January 2007 to November 2009. STUDY DESIGN We calculate unadjusted enrollment trends and exit rates stratified by age, income group, and enrollment mode. Kaplan-Meier curves and Cox proportional hazards models are estimated to assess the impact of the reform on program exits. PRINCIPAL FINDINGS Overall enrollment increased by approximately one-third and exit rates decreased by approximately one-fifth. The majority of new enrollment came from the previously income eligible. CONCLUSIONS Wisconsins enactment of eligibility expansions coupled with administrative simplification and targeted marketing and outreach efforts were successful in enrolling and retaining low-income children and families in public coverage.

The Welfare Effects of Banning Risk-Rated Pricing in Health Insurance Markets: Evidence from Chile

We study the welfare consequences of a switch from risk-rated premiums to community-rated premiums using a two stage model of health insurance demand and detailed claims data from Chilean health insurers. In this context, because the consumers available choice set depends directly on income, effectively creating a minimum required plan, classical predictions of adverse selection models (in particular, unraveling of the market) may not obtain. Our results suggest that if insurers are not allowed to scale premiums based on age and sex (in accordance with a recent court ruling), a significant fraction of young, healthy consumers will opt out of the private insurance market, raising the average cost of insuring those who remain. Chilean consumers in aggregate are predicted to be worse off under community-rated premiums, with a total decline in consumer surplus of 1.3%. This result remains even when we do not allow consumers to choose their plans based on private information. While consumers may perceive uniform prices as more equitable, they are less efficient in this market.

What Fraction of Medicaid Enrollees Have Private Insurance Coverage at the Time of Enrollment? Estimates from Administrative Data

We use administrative data from Wisconsin to determine the fraction of new Medicaid enrollees who have private health insurance at the time of enrollment in the program. Through the linkage of several administrative data sources not previously used for research, we are able to observe coverage status directly for a large fraction of enrollees and indirectly for the remainder. We provide strict bounds for the percentages in each status and find that the percentage of new enrollees with private insurance coverage at the time of enrollment lies between 16 percent and 29 percent, and the percentage that dropped private coverage in favor of public insurance lies between 4 percent and 18 percent. Our point estimates indicate that, among all new enrollees, 21 percent had private health insurance at the time of enrollment and that 10 percent dropped this coverage. Our results show substantially lower rates than previous studies of crowd-out following public health insurance expansions and significant rates of dual coverage, whereby new enrollees into public insurance retain their previously held private insurance coverage.