Public Insurance and Mortality: Evidence from Medicaid Implementation

Abstract

Abstract:This paper provides new evidence that Medicaid's introduction reduced mortality among nonwhite infants and children in the 1960s and 1970s. Mandated coverage of all cash welfare recipients induced substantial cross-state variation in the share of children immediately eligible for the program. Before Medicaid, higher-and lower-eligibility states had similar infant and child mortality trends. After Medicaid, public insurance utilization increased and mortality fell more rapidly among children and infants in high-Medicaid-eligibility states. Mortality among nonwhite children on Medicaid fell by 20 percent, leading to a reduction in aggregate nonwhite child mortality rates of 11 percent.JEL Codes: I13, J10, N32.

State Medicaid Expansions and Mortality, Revisited: A Cost-Benefit Analysis

“…This suggests that baseline mortality among those who actually enrolled in these states' Medicaid expansions was likely significantly higher. If adverse selection confers an additional 25% mortality risk, 21 this would imply an individual-level mortality reduction from gaining insurance of 38%, consistent with several prior estimates (Goodman-Bacon, 2013;Hadley, 2003;Wilper et al, 2009) from the admittedly conflicting literature on the topic. The 95% confidence intervals in Table 6 provide a lower-bound on the individual-level risk reduction of 25%.…”

The long-term impacts of Medicaid exposure in early childhood: Evidence from the program's origin

“…Goodman-Bacon (2015) suggests that the timing of Medicaid adoption was correlated with pre-treatment declines in non-white infant mortality (he could not reject the equality of pre-trends for white infants born in early versus late adopting states). However, he finds that pre-treatment changes in infant mortality, child poverty rates, single-parent households, and AFDC benefit standards, were not correlated with relative state-level participation rates for AFDC—the principal pathway through which people gained access to Medicaid.…”

“…Decker and Gruber (1993) using a difference-in-difference design, find that Medicaid's introduction reduced the incidence of low birth weight in the low-income population (less than $2,000, nominal dollars) by a striking 60%. 6 Using a different study deign, Goodman-Bacon (2015) finds that the introduction of Medicaid reduced mortality for non-white children under age 15 by 24 percent for groups that participated in the program. Both papers support the idea that the introduction of Medicaid improved children's health in ways that could be important over the long-term.…”

Medicaid's lasting impressions: Population health and insurance at birth

“…Goodman-Bacon (2016) and Currie and Gruber (1996) find convincing evidence that Medicaid expansions in the 1980s contributed to reductions in infant mortality rates. Goodman-Bacon (2016)'s analysis exploited variations in states' timing of Medicaid adoption and differences in shares of immediately eligible children throughout the 1960s and 1970s. He finds significant reductions in infant and child mortality associated with Medicaid especially among populations that were more likely to become eligible for public assistance.…”

“…A large body of literature examining the effects of Medicaid on its recipients has emerged since the program's inception (Baldwin et al 1998; Braveman et al 1993; Copeland and Meier 1987; Currie and Grogger 2002; Devany et al 1992; Goodman-Bacon 2016; Guyer 1990; Howell 2001; Lykens and Jargowsky 2002; Moss and Carver 1998; Schor et al 2007). However, relatively few studies examine Medicaid's contribution to general population health and its longer-term consequences.…”