[Toshi]

Download the paper here (link only good for 7 days/100 downloads): https://www.yousendit.com/download/YWhNYlJlcTJ3NUx2Wmc9PQ

NBER WORKING PAPER SERIES
THE IMPACT OF AN INDIVIDUAL HEALTH INSURANCE MANDATE ON HOSPITAL AND PREVENTIVE CARE:
EVIDENCE FROM MASSACHUSETTS

Jonathan T. Kolstad
Amanda E. Kowalski
(© 2010 by Jonathan T. Kolstad and Amanda E. Kowalski. All rights reserved.)

Working Paper 16012
http://www.nber.org/papers/w16012

NATIONAL BUREAU OF ECONOMIC RESEARCH
1050 Massachusetts Avenue
Cambridge, MA 02138
May 2010

In April 2006, the state of Massachusetts passed legislation aimed at achieving near universal health
insurance coverage. A key provision of this legislation, and of the national legislation passed in March
2010, is an individual mandate to obtain health insurance. In this paper, we use hospital data to examine
the impact of this legislation on insurance coverage, utilization patterns, and patient outcomes in Massachusetts.
We use a difference-in-difference strategy that compares outcomes in Massachusetts after the reform
to outcomes in Massachusetts before the reform and to outcomes in other states. We embed this strategy
in an instrumental variable framework to examine the effect of insurance coverage on outcomes. Among
the population discharged from the hospital in Massachusetts, the reform decreased uninsurance by
28% relative to its initial level. Increased coverage affected utilization patterns by decreasing length
of stay and the number of inpatient admissions originating from the emergency room. We also find
evidence that outpatient care reduced hospitalizations for preventable conditions. At the same time
we find no evidence that the cost of hospital care increased. The reform affected nearly all age, gender,
income, and race categories. We identify some populations for which insurance had the greatest direct
impact on outcomes and others for which the impact on outcomes appears to have occurred through
spillovers.

Key findings, in my opinion:

Among the population of hospital discharges in Massachusetts, the reform decreased
uninsurance by 28% relative to its initial level. We see some evidence of crowd of out private
coverage by subsidized coverage for the hospitalized population but we do not find evidence for
crowd out in the general population, suggesting the incidence of crowd out is not uniform. We also
find that the reform affected utilization patterns through decreased length of stay and a decrease
in the number of inpatient admissions originating from the emergency room. Furthermore, we
find evidence of increases in preventive care outside of the hospital setting. Our results indicate
that hospital costs did not increase following the expansion in coverage. We also find evidence for
declines in the intensity of treatment and weaker evidence for declines in prices paid by private
payers. We make several attempts to investigate and address potential selection of healthier or
sicker patients into or out of hospitals after the reform. We do not find evidence of a change in the
composition of the patient pool large enough to affect the robustness of our findings.

From the bottom rows of Table 6, we see that decreases in uninsurance were largest among
individuals aged 19-26. These individuals predominantly obtained coverage through Medicaid and
CommCare. Individuals of all ages obtained CommCare, and CommCare’s share of coverage is
largest among the near elderly population, aged 55-64. All nonelderly age groups experienced a
statistically significant decline in private coverage, suggesting that other types of coverage crowed
out private coverage within the hospitalized population.25

In the second panel of Table 8, we report difference-in-difference results for insurance coverage
by the income quartile of the patient’s zip code.27 People from the lowest income zip codes are
over-represented in hospital discharges, making up 29% of the sample. People from these poorest
zip codes experienced the largest gains in coverage, mostly driven by increases in Medicaid and
CommCare. People from the richest zip codes were the only group to experience gains in private
coverage, perhaps because means-tested coverage from other sources was not available. The largest
increases in CommCare coverage occurred for patients in the second lowest income quartile, which
seems plausible because Medicaid was aimed at the poor, and CommCare was particularly targeted
at the near poor.

Seems like pretty good results to me in terms of outcomes--this analysis is not about the pricetag but instead about what it achieved in terms of uninsurance, length of stay, etc.

 

[narlus]

pinko.

 

[$tinkle]

can't dl from work (file sharing nazis)

this seems almost not worth mentioning

decreases in uninsurance were largest among individuals aged 19-26. These individuals predominantly obtained coverage through Medicaid and CommCare.

who among us was insured during this time when it cost us money? like a true dumbass, i was an uninsured bike msgr at this age, but when you're making only $300/wk, premiums come at a premium, esp when you say you play in traffic for a living.

so my question is, are these 19-26 ppl, getting it for free, or heavily subsidized? either way, it comes at great tax payer cost, perhaps at some benefit (preventative care, *mayyyybe*)

ultimate point is this: whenever entity A has access to entity B's money, it gets spent more frivolously than if it were its own. i know of no example which is counter to this. and i know of no example where spending other people's money is some sort of wise investment in the greater good in the long run.

 

[berkshire_rider]

so my question is, are these 19-26 ppl, getting it for free, or heavily subsidized?

Yes. Medicaid is subsidized by federal and state taxes. Commonwealth care is paid for from a fee/tax levied on employers based on the number of employees.

 

[$tinkle]

Yes. Medicaid is subsidized by federal and state taxes. Commonwealth care is paid for from a fee/tax levied on employers based on the number of employees.

so is it reasonable to expect that as more become part of the pool, the fewer businesses are able to keep afloat (or pay current salaries/wages)? either that or *the businesses* will have to be gov't subsidized.

maybe i've oversimplified it, but if i haven't, i'd rather not ignore the 'berg off the bow

 

[Silver]

ultimate point is this: whenever entity A has access to entity B's money, it gets spent more frivolously than if it were its own. i know of no example which is counter to this. and i know of no example where spending other people's money is some sort of wise investment in the greater good in the long run.

Fvck off, you're smarter than that. Stop pretending to be a total idiot, none of your conservative friends will ever read past the first two lines of Toshi's post anyways, you don't have to save face for them.

 

[$tinkle]

Fvck off, you're smarter than that. Stop pretending to be a total idiot, none of your conservative friends will ever read past the first two lines of Toshi's post anyways, you don't have to save face for them.

do you even understand (to the point of articulating) the long-term fiscal concerns?

part of being pro-life is being pro-quality-of-life

and you can kiss my ironic natural black ass

 

[Silver]

do you even understand (to the point of articulating) the long-term fiscal concerns?

part of being pro-life is being pro-quality-of-life

and you can kiss my ironic natural black ass

Of course. There were healthcare reform threads, remember? IIRC, I was so happy with the Romney-style reforms that I said it was worse than Bush's Katrina.

If you want to cut costs in healthcare, the last thing you can do is let the market decide when the providers of the service set the demand for it...

 

[$tinkle]

Of course. There were healthcare reform threads, remember? IIRC, I was so happy with the Romney-style reforms that I said it was worse than Bush's Katrina.

but will it be worse than obama's gulf?

If you want to cut costs in healthcare, the last thing you can do is let the market decide when the providers of the service set the demand for it...

profits in this industry are - what - 2-5%?

and how does that compare w/ taxes? but don't worry: while taxes are always collected from profitable corps, taxes are only collected from you if you work, lazy fat nagger.

 

[Silver]

but will it be worse than obama's gulf?

profits in this industry are - what - 2-5%?

and how does that compare w/ taxes? but don't worry: while taxes are always collected from profitable corps, taxes are only collected from you if you work, lazy fat nagger.

Ah yes, just like the horrible profit margins pharma companies face? Doesn't have anything to do with the 25 year old blonde pharma rep with the bolt ons and the 6 digit expense account cockteasing guys like Toshi, right? They spend it all on R+D...

 

[$tinkle]

Ah yes, just like the horrible profit margins pharma companies face? Doesn't have anything to do with the 25 year old blonde pharma rep with the bolt ons and the 6 digit expense account cockteasing guys like Toshi, right? They spend it all on R+D...

one man's pharma rep is another man's lobbyist.