Yes, Mr. Romney. I Expect You to Agree That Health Insurance Does Save Lives. Why Do You Ask

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Health insurance and outcomes: As a health outcome, mortality has its advantages: apart from zombies, it’s a relatively unambiguous condition, and it’s unambiguously bad. In contrast, hospitalization, even emergency department use, can be good or bad, depending on the circumstances.... It’s hard to know the effect of health insurance on mortality with great precision. One reason is that other things, like poor health and low income, lead to both increased mortality and uninsurance.... I am going to summarize a relatively recent NBER paper that uses a clever technique.... Bruce Meyer and Laura Wherry....

This paper provides new evidence.... [S]everal early Medicaid expansions... extended eligibility only to children born after September 30, 1983.... Children in families with incomes at or just below the poverty line gained close to five additional years of eligibility if they were born in October 1983 rather than just one month before....

[T]here is no reason to believe that kids born just before the September 30, 1983 cutoff are different from those born just after.... [Y]our understanding of randomized controlled trials applies.... The authors argue that this regression discontinuity design is stronger than relying on state variation in Medicaid eligibility....

The regression estimates indicate a 13-18 percent decrease in the internal mortality rate of black teens born after September 30, 1983.... Early evidence indicates that this gain in health is not reversed during the early adult years. We find no evidence of an improvement in the mortality of white children under the expansions. Furthermore, we are unable to detect mortality improvements among children residing in those states with the largest gains in public health insurance eligibility under the expansions.

Why wouldn’t mortality improvements be larger in states with larger gains in public health insurance eligibility? The authors explanation boils down to, eligibility isn’t everything:

One potential explanation for this result is that larger expansions in eligibility do not directly translate into higher levels of enrollment or improvements in access to medical care for children. Increases in enrollment require outreach by states and the dissemination of eligibility information... larger numbers of new beneficiaries may strain limited supply-side resources...

Article Via http://delong.typepad.com

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