Effects of losing public health insurance on preventative care, health, and emergency department use: Evidence from the TennCare disenrollment

Abstract

This paper studies the effect of losing public health insurance eligibility on preventative care, self-reported health, and emergency department use. I exploit the 2005 TennCare disenrollment in which 190,000 residents-mainly non-elderly childless adults-lost public health insurance eligibility due to budget cuts. I use two surveys, the Behavioral Factor Surveillance System and the National Health Interview Survey, in a difference-in-difference methodology to study the effects of the reform. I find that the reform lead to a 4%-5% reduction in reporting having mammograms and breast exams. An increase of 20% in number of days with health incapacitation and no strong evidence of changes of emergency department visits (nor number of visits). I document margins of heterogeneity of the effects across demographic characteristics. Finally, I explore the margins of symmetry between gaining and losing public insurance by comparing estimates to those from the Affordable Care Act Medicaid Expansions.

Losing Insurance and Behavioral Health Hospitalizations: Evidence from a Large-Scale Medicaid Disenrollment

“…The TennCare disenrollment reduced Medicaid coverage and overall insurance coverage with some private insurance substitution (Tarazi, Green, and Sabik 2017, Garthwaite, Gross, and Notowidigdo 2014, Tello-Trillo 2016, DeLeire 2018. For instance, Garthwaite, Gross, and Notowidigdo (2014) find that, post-disenrollment, the probability of having Medicaid declined by 4.6 percentage points (33%) among low-income, childless, and non-disabled adults.…”

“…Garthwaite, Gross, and Notowidigdo (2018) use American Hospital Association data to confirm that uncompensated care increased in Tennessee post-disenrollment. Tello-Trillo (2016) leverages survey data from the National Health Interview Survey (NHIS) and Behavioral Risk Factor Surveillance Survey (BRFSS) to study TennCare's effects on healthcare access and health. The author finds that postdisenrollment, primary care visits declined and reported physical health problems increased in Tennessee.…”

“…An important contribution of our study is that we are able to test the effect of losing, as opposed to gaining, insurance. The prior literature has focused primarily on the effect of insurance gains due to available sources of exogenous variation, but the effects of insurance gains and losses are not likely symmetric (Tello-Trillo 2016, Ghosh and Simon 2015, Argys et al 2017. For instance, an individual who loses insurance will likely retain accumulated 'patient education,' which includes information on one's health stock, how to manage chronic conditions, the importance of a healthy lifestyle, how to interact with the healthcare system, and so forth.…”

“…We simply note that researchers, when faced with this empirical challenge, could more carefully note this limitation. SeeCurrie and Gruber (1996),Schmeiser (2009),Kahn (2010),Kaestner and Yarnoff (2011),Kolstad and Kowalski (2012), Miller (2012b),Hamersma and Kim (2013),Maclean (2013),Anderson, Hansen, and Rees (2015),Pacula et al (2015),Tello-Trillo (2016),Miller and Wherry (2017),Nicholas andDeLeire (2018).…”

Health insurance and subjective well‐being: Evidence from two healthcare reforms in the United States

“…and labor market outcomes (Baicker et al, 2013;Borgschulte & Vogler, 2020;Brevoort et al, 2020;Chay et al, 2012;Courtemanche et al, 2018;Finkelstein et al, 2012;Kim & Koh, 2021;Kolstad & Kowalski, 2012, 2016Leung & Mas, 2018;Mazumder & Miller, 2016). While these outcome measures can proxy different aspects of well-being, healthcare reforms can have a broader impact on overall well-being, which are not fully captured by these objective measures.…”