Robin McKnight

The Importance of the Individual Mandate — Evidence from Massachusetts

The most contentious aspect of the recent national health care reform is the individual insurance mandate. Data from Massachusetts may predict the mandates additive effect on reducing adverse selection, beyond simply offering subsidized, community-rated insurance.

The impact of patient cost-sharing on low-income populations: Evidence from Massachusetts ☆

Greater patient cost-sharing could help reduce the fiscal pressures associated with insurance expansion by reducing the scope for moral hazard. But it is possible that low-income recipients are unable to cut back on utilization wisely and that, as a result, higher cost-sharing will lead to worse health and higher downstream costs through increased use of inpatient and outpatient care. We use exogenous variation in the copayments faced by low-income enrollees in the Massachusetts Commonwealth Care program to study these effects. We estimate separate price elasticities of demand by type of service. Overall, we find price elasticities of about -0.16 for this low-income population - similar to elasticities calculated for higher-income populations in other settings. These elasticities are somewhat smaller for the chronically sick, especially for those with asthma, diabetes, and high cholesterol. These lower elasticities are attributable to lower responsiveness to prices across all categories of service, and to some statistically insignificant increases in inpatient care.

Firearms and accidental deaths: Evidence from the aftermath of the Sandy Hook school shooting

One cause of accidental deaths The number of accidental deaths involving a firearm might be expected to correlate with the number of firearms, but claims that a causal relationship exists have not been persuasive (see the Policy Forum by Cook and Donohue). The 2012 mass shooting at an elementary school in the eastern United States resulted in the deaths of 20 children. Levine and McKnight used the random timing of this event and the subsequent increase in gun purchases (as recorded by an increased number of background checks) to show that the increased exposure to guns resulted in ∼60 accidental deaths. Science, this issue p. 1324 see also p. 1259 Exposure to firearms increased substantially after the December 2012 shooting at Sandy Hook Elementary School in Newtown, Connecticut, where 20 children and 6 adults were killed. Gun sales spiked by 3 million, on the basis of the increase in the number of background checks for firearm purchases. Google searches for buying and cleaning guns increased. We used Vital Statistics mortality data to examine whether a spike in accidental firearm deaths occurred at the same time as the greater exposure to firearms. We also assessed whether the increase in these deaths was larger in those states where the spike in gun sales per capita was larger. We find that an additional 60 deaths overall, including 20 children, resulted from unintentional shootings in the immediate aftermath of Sandy Hook.