Steven C. Hill

The Effect of Health on the Work Effort of Single Mothers

Data from the Survey of Income and Program Participation are used to investigate ways in which health influences a single mothers decision whether to work: the direct effect of a womans health on work effort and potential wage; the impact of her childrens health on hours available to work; and the impact of health on the values of health insurance and Medicaid associated with work and AFDC participation, respectively. Simulations suggest that wage subsidies and decreases in AFDC benefits are unlikely to increase the labor force participation of single mothers in poor health or with disabled children, as they face limitations on work hours and the kinds of work they can perform that prohibit them from earning enough to stay out of poverty. Extending health insurance coverage to all children of single mothers regardless of AFDC status would induce a large percentage of these mothers to seek and accept employment, as would a pay-or-play insurance plan covering all workers (and their dependents) who work 15 or more hours a week.

Health expenditure estimation and functional form: applications of the generalized gamma and extended estimating equations models.

Health-care expenditure regressions are used in a wide variety of economic analyses including risk adjustment and program and treatment evaluations. Recent articles demonstrated that generalized gamma models (GGMs) and extended estimating equations (EEE) models provide flexible approaches to deal with a variety of data problems encountered in expenditure estimation. To date there have been few empirical applications of these models to expenditures. We use data from the US Medical Expenditure Panel Survey to compare the bias, predictive accuracy, and marginal effects of GGM and EEE models with other commonly used regression models in a cross-validation study design. Health-care expenditure distributions vary in the degree of heteroskedasticity, skewness, and kurtosis by type of service and population. To examine the ability of estimators to address a range of data problems, we estimate models of total health expenditures and prescription drug expenditures for two populations, the elderly and privately insured adults. Our findings illustrate the need for researchers to examine their assumptions about link functions: the appropriate link function varies across our four distributions. The EEE model, which has a flexible link function, is a robust estimator that performs as well, or better, than the other models in each distribution.

Testing the HMO competitive strategy: An analysis of its impact on medical care resources

Competitive approaches to health care reform, including managed competition, are hypothesized to reduce health care expenditures and the resources devoted to medical care. Empirical evidence has been limited. The short- and long-run effects of an experiment closely resembling managed competition are analyzed. We examine effects on hospitals, technology diffusion, physicians, and health insurance premiums. The strategy reduces capital in hospitals, has minor effects on physicians and technology, and has only initial effects on average premiums.

Adults in the income range for the Affordable Care Act's Medicaid expansion are healthier than pre-ACA enrollees.

The Affordable Care Act (ACA) has dramatically increased the number of low-income nonelderly adults eligible for Medicaid. Starting in 2014, states can elect to cover individuals and families with modified adjusted gross incomes below a threshold of 133 percent of federal poverty guidelines, with a 5 percent income disregard. We used simulation methods and data from the Medical Expenditure Panel Survey to compare nondisabled adults enrolled in Medicaid prior to the ACA with two other groups: adults who were eligible for Medicaid but not enrolled in it, and adults who were in the income range for the ACAs Medicaid expansion and thus newly eligible for coverage. Although differences in health across the groups were not large, both the newly eligible and those eligible before the ACA but not enrolled were healthier on several measures than pre-ACA enrollees. Twenty-five states have opted not to use the ACA to expand Medicaid eligibility. If these states reverse their decisions, their Medicaid programs might not enroll a population that is sicker than their pre-ACA enrollees. By expanding Medicaid eligibility, states could provide coverage to millions of healthier adults as well as to millions who have chronic conditions and who need care.

The Health, Earnings Capacity, and Poverty of Single-mother Families

Approximately 1.4 million single mothers have substantial health problems. Even if they were to work full time, they would be unlikely to earn enough to adequately provide for themselves and their children. Many of these women are not likely to find employment that offers health insurance coverage for themselves or their children. Employment is thus not an option that would provide sufficient resources--in terms of income or insurance--for them to live at or above the poverty line. Those single mothers who have a disabled child are at additional disadvantage. These children may require increased time from an adult and are likely to have considerable medical care needs and expenditures. For these families, employment of the mother may not provide adequate resources in terms of either time available to meet the disabled childs special needs, income, or adequate health insurance. We explore these issues, first examining the health status of single mothers compared to other women. We next estimate their earnings capacity--the amount they would earn were they to join the work force on a full-time basis, taking into account their health status and that of their children. We then investigate the percentage of single mothers and their children who would be poor if they had to rely on the earnings capacity of the women (working 40 hours per week, adjusting for health). Finally, we explore the policy implications of our findings, which seem particularly timely in the face of the new work requirements of the 1988 Family Support Act. The act requires most single mothers currently receiving or applying for Aid to Families with DependentChildren (AFDC) to enroll in training or register to work.

Medicaid Expansion In Opt-Out States Would Produce Consumer Savings And Less Financial Burden Than Exchange Coverage

In the twenty-three states that have decided against expanding Medicaid under the Affordable Care Act, uninsured adults who would have been eligible for Medicaid and have incomes at or above the federal poverty guidelines are generally eligible for Marketplace (insurance exchange) premium tax credits and plans with generous benefits. This study compared estimated out-of-pocket spending for care and premiums, as well as the financial burdens they impose, for the families of these adults under two simulation scenarios: obtaining coverage through a silver plan with subsidized cost sharing and enrolling in expanded Medicaid. Compared with Marketplace coverage, Medicaid would more than halve average annual out-of-pocket spending (

Risk Selection among SSI Enrollees in TennCare

938 versus

Does increased adherence to medications change health care financial burdens for adults with diabetes

1,948), while dramatically reducing the percentage of adults in families with out-of-pocket expenses exceeding 10 percent or 20 percent of income (6.0 percent versus 17.1 percent and 0.9 percent versus 3.7 percent, respectively). Larger reductions would be seen for families with smokers, who under Medicaid would no longer be subject to Marketplace tobacco user surcharges. Medicaid expansion may offer a greater opportunity than access to Marketplace insurance to promote the financial well-being of previously uninsured low-income adults.

Validity of Reported Medicare Part D Enrollment in the Medical Expenditure Panel Survey

The issue of risk selection is especially important for states that enroll blind and disabled beneficiaries of Supplemental Security Income (SSI) in Medicaid managed care. SSI beneficiaries have persistent needs for care, have a wide variety of chronic conditions, and often need atypical and complex services. Risk selection occurs when the health care needs of beneficiaries enrolled in a specific plan differ systematically from the needs of the overall beneficiary population and payments do not reflect those needs. We assess the extent of risk selection among managed care plans for SSI beneficiaries over the first three years of Tennessees Medicaid managed care program, TennCare. Using claims data containing fee-for-service expenditures prior to enrollment in managed care, we find substantial evidence of persistent risk selection among plans. Results are robust to most alternative measures of risk selection for most plans.

Individual Insurance and Access to Care

The aim of the present study was to investigate increased out‐of‐pocket drug costs and financial burdens of achieving adherence to oral antidiabetic medications and medications for prevalent comorbidities.