Medicaid and Ethnic Networks
Gee, Emily R. and Giuntella, G. Osea (2011), "Medicaid and Ethnic Networks," The B.E. Journal of Economic Analysis & Policy: vol. 11 : iss. 1 (Contributions), art. 77.
Many low-income immigrants are uninsured yet eligible for public health insurance. In this paper, we examine whether language barriers and network effects can explain disparities in insurance Medicaid participation. Using the 2008 and 2009 American Community Survey, we show that linguistic networks facilitate Medicaid enrollment among non-English speaking adults. Our identification method follows Bertrand et al. (2000) and employs local variation in the density of immigrant populations and nationwide variation in Medicaid participation among ethnic groups. Given a hypothetical policy to increase Medicaid enrollment, for every 1 percentage point of direct increase, networks generate a multiplier effect that boosts participation by an additional 0.26 percentage points. Networks have greatest influence on individuals who are not proficient in English or who arrived in the United States more recently. Our results are robust to alternative specifications, including using an ex ante indicator of group-level participation. We also find that the availability of foreign-language Medicaid information online is associated with significantly higher participation.
Among the earliest coverage-related provisions of the Affordable Care Act to take effect was the extension of health insurance coverage to child dependents up to age 26. This paper analyzes how the young adult coverage provision affected the extent of coverage among young adults and the risk mix of young adult enrollees in the private insurance market, and is, to the best of my knowedge, among the first to use medical claims data to gauge the health status of young adults newly enrolled as dependents.
High-deductible health plans, also referred to as "consumer-driven" or "consumer-directed", are believed to attract healthier, younger consumers of health insurance. Using data from the Federal Employees Health Benefits plans, one of the first health insurance exchange programs in the nation, I explore the extent of adverse selection generated by the sudden introduction of CDHPs into the system in 2004.