Estimates of Crowd-Out from a Public Health Insurance Expansion Using Administrative Data

Abstract

We use a combination of administrative and survey data to estimate the fraction of individuals newly enrolled in public health coverage (Wisconsin's combined Medicaid and CHIP program) that had access to private, employer-sponsored health insurance at the time of their enrollment and the fraction that dropped this coverage. We estimate that after expansion of eligibility for public coverage, approximately 20% of new enrollees had access to private health insurance at the time of enrollment and that only 8% dropped this coverage (with the remaining 12% having both private and public coverage). We also identify an "upper bound" estimate, which suggests that the percentage of new enrollees with private insurance coverage at the time of enrollment is, at most, 27%. These estimates of crowd-out are relatively low compared with estimates from the literature based on Medicaid and CHIP expansions, although based both on different data and on a different method.

Wisconsin’s Experience with Medicaid Auto-Enrollment: Lessons for Other States

“…Because we are unable to observe which members of a case with a DOL match obtain their health insurance from the self-insured firm, we impute insured status for these enrollees using data from the Current Population Survey. Details of this data matching and imputation process are available in Dague et al, (2011).…”

“…In addition to the severe economic downturn, a number of policy factors have been credited for this dramatic expansion. Examples include: clear branding, simplified application processes, reductions or eliminations of deductibles for some low-income children, easing of "anti-crowd-out" provisions, availability of a user-friendly online application, and extensive community outreach (Leininger et al, 2011). Beyond these factors, however, an important reason why Wisconsin was so successful in its enrollment efforts was that it auto-enrolled over 44,000 individuals at the time of program launch, including over 26,000 parents and 18,000 children.…”

Crowd‐Out or Affordability? The Lifeline Expansion's Effect on Wireless Service Spending

“…In addition to measuring the Lifeline expansion's effect on household spending, this paper adds to the broader empirical literature on the public provision of private goods, particularly regarding how the provision mechanism affects crowd‐out and consumer benefits. Numerous examples of in‐kind provision, in which the government directly provides the good or service, have been studied in markets for health insurance (Card & Shore‐Sheppard, ; Cutler & Gruber, ; Dague et al., ; Gruber & Simon, ; Koch, ), lotteries (Kearney, ), radio (Berry & Waldfogel, ), higher education (Cellini, ; Cohodes & Goodman, ), and substance abuse treatment (Cohen, Freeborn, & McManus, ) . More similar to the Lifeline provision mechanism, crowd‐out effects have also been found in programs where subsidies are given to competing private providers based on the number of households enrolled.…”

Crowd-Out or Affordability? The Lifeline Expansion's Effect on Wireless Service Spending

“…In addition to measuring the Lifeline expansion's effect on household spending, this paper adds to the broader empirical literature on the public provision of private goods, particularly regarding how the provision mechanism affects crowd-out and consumer benefits. Numerous examples of in-kind provision, in which the government directly provides the good or service, have been studied in markets for health insurance (Card & Shore-Sheppard, 2004;Cutler & Gruber, 1996;Dague et al, 2011;Gruber & Simon, 2008;Koch, 2013), lotteries (Kearney, 2005), radio (Berry & Waldfogel, 1999), higher education (Cellini, 2009;Cohodes & Goodman, 2014), and substance abuse treatment (Cohen, Freeborn, & McManus, 2013). 7 More similar to the Lifeline provision mechanism, crowd-out effects have also been found in programs where subsidies are given to competing private providers based on the number of households enrolled.…”