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Costs of Health Insurance Demand for Health Insurance Employment-Based Coverage Labor Markets Near Elderly Population Vulnerable Populations Welfare, Medicaid, and SCHIP

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Home > Funded Research Home > All > Sort by Author (A-Z) > Chernew, Cutler & Keenan / Chernew & Hirth / Hirth, Baughman, Chernew & Shelton

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Author: Chernew, Michael E. ; Frick, Kevin D.

Working Paper: Beneficial Moral Hazard And The Theory Of The Second Best (PDF) ; 8/08

Summary: (PDF)

Author: Chernew, Michael ; Cutler, David ; Keenan, Patricia
Working Paper: Rising Health Care Costs and the Decline in Insurance Coverage (PDF) ; March 2005

Research Highlight 10 (HTML) (PDF) ; December 2005
Q & A with Michael Chernew, Ph.D. (HTML) ; December 2005
Research Findings (HTML)

Abstract:
Objective: To determine the impact of rising health care premiums on coverage rates. An accurate assessment of the impact of rising health care costs on health insurance coverage rates is an important component of policy debates surrounding efforts to reduce the number of uninsured.

Data Sources & Study Setting: Our analysis is based on two cohorts of non-elderly Americans residing in 64 large MSAs surveyed in the Current Population Survey in 1989-1991 and 1998- 2000. Measures of premiums are based on data from the Health Insurance Association of America and the Kaiser Family Foundation/Health Research and Educational Trust Survey of Employer-Sponsored Health Benefits.

Study Design: Probit regression and instrumental variable techniques, are used to estimate the association between rising local health insurance costs and the falling propensity for individuals to have any health insurance coverage, controlling for a rich array of economic, demographic, and policy covariates.

Principal Findings: Over half of the decline in coverage rates experienced over the 1990s is attributable to the increase in health insurance premiums (1.6 percentage points of the 3.1 percentage point decline). Medicaid expansions led to a 1 percentage point increase in coverage. Changes in economic and demographic factors had little net effect. The number of people uninsured could increase by 1.8 to 6 million in the next decade if real, per capita medical costs increase at a rate 1 to 3 percentage points above the GDP growth rate.

Conclusions: Initiatives aimed at reducing the number of uninsured must confront the growing pressure on coverage rates generated by rising costs. Policy has traditionally focused on the need to limit the growth of costs, but this may not be desirable if medical cost increases are buying 3 valuable services. The design of health benefits, balancing valuable innovation against expense, is thus a central policy concern.

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Author: Chernew, Michael ; Hirth, Richard
Working Paper: Modeling the Causes and Consequences of Lack of Health Insurance Coverage: Gaps in the Literature (PDF) ; January 2002

Abstract:
Our key unresolved theoretical and methodological issues that limit the ability of researchers to prescribe effective policies or predict the effect of market and policy changes that relate to health insurance: 1) the appropriate price of insurance; 2) the endogeneity of workers sorting into firms and firm decisions regarding benefit packages; 3) the frequency of transitions into and out of insurance coverage and the length of spells without coverage; and 4) the impact of labor market competition on firm behavior. In each case we give examples from the literature and illustrations of the limitation. This paper is one of six papers commissioned at the outset of ERIU to provide a critical synthesis of the existing literature on who does not have health insurance, why they do not have health insurance, and what difference health insurance makes. The papers appeared in final form in Health Policy and the Uninsured published by Urban Institute Press in 2004

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Author: Hirth, Richard ; Baughman, Reagan ; Chernew, Michael ; Shelton, Emily C.
Working Paper: The Prevalence of Mismatches between Workers' Preferences and Employers' Insurance Offers (PDF) ; February 2006

Abstract:
To assess the performance of the employment-based health insurance system, it is necessary to understand how well workers sort into jobs that offer their desired mix of cash wages relative to benefits. However, few studies directly measure the extent of sorting. We quantify the prevalence of mismatches between workers' preferences and firms' insurance offerings, considering two types of mismatch, 1) workers who would desire coverage through their employer, but work for firms that do not offer coverage, and 2) workers who do not desire coverage through their employer, but work for firms that offer coverage. Most workers (78.1 percent) enjoy labor market matches that appear consistent with their preferences. The remaining 21.9 percent of workers are mismatched. For most of these mismatches, the primary consequence is lower cash earnings or higher insurance premiums than they would face if they were better matched in the labor market. However, a minority of the identified mismatches appear to be "involuntarily uninsured" workers who would gain insurance if they were to find a better match. Extrapolating from the analysis sample, these involuntarily uninsured workers and their uninsured dependents may represent more than one in six uninsured individuals in the United States.