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Health Insurance and Mortality: Experimental Evidence from Taxpayer Outreach

Author

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  • Jacob Goldin
  • Ithai Z Lurie
  • Janet McCubbin

Abstract

We evaluate a randomized outreach study in which the IRS sent informational letters to 3.9 million households that paid a tax penalty for lacking health insurance coverage under the Affordable Care Act. Drawing on administrative data, we study the effect of this intervention on taxpayers’ subsequent health insurance enrollment and mortality. We find the intervention led to increased coverage during the subsequent two years and reduced mortality among middle-aged adults over the same time period. The results provide experimental evidence that health insurance coverage can reduce mortality in the United States.

Suggested Citation

  • Jacob Goldin & Ithai Z Lurie & Janet McCubbin, 2021. "Health Insurance and Mortality: Experimental Evidence from Taxpayer Outreach," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 136(1), pages 1-49.
    • Handle: RePEc:oup:qjecon:v:136:y:2021:i:1:p:1-49.
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    File URL: http://hdl.handle.net/10.1093/qje/qjaa029
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    Cited by:

    1. Abe Dunn & Joshua D. Gottlieb & Adam Shapiro & Daniel J. Sonnenstuhl & Pietro Tebaldi, 2021. "A Denial a Day Keeps the Doctor Away," NBER Working Papers 29010, National Bureau of Economic Research, Inc.
    2. Drake, Coleman & Ryan, Conor & Dowd, Bryan, 2022. "Sources of inertia in the individual health insurance market," Journal of Public Economics, Elsevier, vol. 208(C).
    3. Wendy Netter Epstein & Christopher T. Robertson & David Yokum & Hansoo Ko & Kevin H. Wilson & Monica Ramos & Katherine Kettering & Margaret Houtz, 2022. "Can moral framing drive insurance enrollment in the United States?," Journal of Empirical Legal Studies, John Wiley & Sons, vol. 19(4), pages 804-843, December.
    4. Drake, Coleman & Anderson, David & Cai, Sih-Ting & Sacks, Daniel W., 2023. "Financial transaction costs reduce benefit take-up evidence from zero-premium health insurance plans in Colorado," Journal of Health Economics, Elsevier, vol. 89(C).
    5. Chaoran Chen & Zhigang Feng & Jiaying Gu, 2022. "Health, Health Insurance, and Inequality," Working Papers tecipa-730, University of Toronto, Department of Economics.
    6. Dunn, Abe & Knepper, Matthew & Dauda, Seidu, 2021. "Insurance expansions and hospital utilization: Relabeling and reabling?," Journal of Health Economics, Elsevier, vol. 78(C).
    7. Black, Bernard & Hollingsworth, Alex & Nunes, Letícia & Simon, Kosali, 2022. "Simulated power analyses for observational studies: An application to the Affordable Care Act Medicaid expansion," Journal of Public Economics, Elsevier, vol. 213(C).
    8. Lin Lin & Xianhua Zai, 2022. "The role of supply responses in public insurance expansion: evidence from China's New Cooperative Medical Scheme," MPIDR Working Papers WP-2022-025, Max Planck Institute for Demographic Research, Rostock, Germany.
    9. Lin, Lin & Zai, Xianhua, 2022. "The Power of Public Insurance With Limited Benefits: Evidence from China's New Cooperative Medical Scheme," GLO Discussion Paper Series 1180, Global Labor Organization (GLO).
    10. Sarah E. Dehry & Patrick M. Krueger, 2023. "Excess Deaths in the United States Compared to 18 Other High-Income Countries," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 42(2), pages 1-14, April.
    11. Keith Marzilli Ericson & Timothy J. Layton & Adrianna McIntyre & Adam Sacarny, 2023. "Reducing Administrative Barriers Increases Take-up of Subsidized Health Insurance Coverage: Evidence from a Field Experiment," NBER Working Papers 30885, National Bureau of Economic Research, Inc.
    12. Lindsey Rose Bullinger & Maithreyi Gopalan & Caitlin McPherran Lombardi, 2023. "Impacts of publicly funded health insurance for adults on children's academic achievement," Southern Economic Journal, John Wiley & Sons, vol. 89(3), pages 860-884, January.
    13. Claire E. Boone & Pablo A. Celhay & Paul Gertler & Tadeja Gracner, 2023. "Encouraging Preventative Care to Manage Chronic Disease at Scale," NBER Working Papers 31643, National Bureau of Economic Research, Inc.
    14. Dauth, Christine, 2021. "The effects of private versus public health insurance on health and labor market outcomes," IAB-Discussion Paper 202103, Institut für Arbeitsmarkt- und Berufsforschung (IAB), Nürnberg [Institute for Employment Research, Nuremberg, Germany].
    15. Son, Jinyeong, 2022. "Do mandated health insurance benefits for diabetes save lives?," Journal of Public Economics, Elsevier, vol. 216(C).
    16. Engy Ziedan & Kosali I. Simon & Coady Wing, 2022. "Mortality Effects of Healthcare Supply Shocks: Evidence Using Linked Deaths and Electronic Health Records," NBER Working Papers 30553, National Bureau of Economic Research, Inc.
    17. J Dustin Tracy & Kevin A James & Hillard Kaplan & Stephen Rassenti, 2021. "An investigation of health insurance policy and behavior in a virtual environment," PLOS ONE, Public Library of Science, vol. 16(4), pages 1-26, April.
    18. Hamid Noghanibehambari & Jason Fletcher, 2023. "Childhood exposure to birth registration laws and old‐age mortality," Health Economics, John Wiley & Sons, Ltd., vol. 32(3), pages 735-743, March.
    19. Benjamin Ly Serena, 2021. "Revisiting Offsets of Psychotherapy Coverage," CEBI working paper series 21-05, University of Copenhagen. Department of Economics. The Center for Economic Behavior and Inequality (CEBI).

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