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Using Discontinuous Eligibility Rules to Identify the Effects of the Federal Medicaid Expansions

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  • David Card
  • Lara Dawn Shore-Sheppard

Abstract

This paper exploits the discrete nature of the eligibility criteria for two major federal expansions of Medicaid to discern the effects of the expansions on Medicaid coverage, overall health insurance coverage, and coverage by private and other non-Medicaid sources. Using data from the Survey of Income and Program Participation, we examine the "133 percent" program, which covered children under the age of six in families with incomes up to 133 percent of the poverty line, and the "100 percent" program, which covered children in poor families born after September 30, 1983. Graphical and conventional difference-in-differences methods suggest that the 100 percent program led to a 10-15 percentage point rise in Medicaid coverage among the targeted group, with a small decline in non-Medicaid coverage and a rise in the incidence of dual coverage. The newly covered group includes children in families further from the AFDC income cutoffs and closer to the poverty line than the traditional Medicaid caseload, and includes more children in dual-headed families. By comparison, we are unable to find much evidence that the 133 percent program had any effect on Medicaid coverage of children in families with incomes from 100 to 133 percent of the poverty line. This negative finding is confirmed in data from the March Current Population Survey.

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Bibliographic Info

Paper provided by Northwestern University/University of Chicago Joint Center for Poverty Research in its series JCPR Working Papers with number 248.

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Date of creation: 03 Dec 2001
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Handle: RePEc:wop:jopovw:248

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  1. John C. Ham & Lara D. Shore-Sheppard, 2001. "The Effect of Medicaid Expansions for Low-Income Children on Medicaid Participation and Insurance Coverage: Evidence from the SIPP," NBER Working Papers 8063, National Bureau of Economic Research, Inc.
  2. M. Keane & R. Moffitt, . "A structural model of multiple welfare program participation and labor supply," Institute for Research on Poverty Discussion Papers 1080-96, University of Wisconsin Institute for Research on Poverty.
  3. Pischke, Jörn-Steffen, 1991. "Individual income, incomplete information, and aggregate consumption," ZEW Discussion Papers 91-07, ZEW - Zentrum für Europäische Wirtschaftsforschung / Center for European Economic Research.
  4. Cutler, David M & Gruber, Jonathan, 1996. "Does Public Insurance Crowd Out Private Insurance?," The Quarterly Journal of Economics, MIT Press, vol. 111(2), pages 391-430, May.
  5. Lara D. Shore-Sheppard, 2000. "The Effect of expanding medicaid eligibility on the distribution of childrenÆs health insurance coverage," Industrial and Labor Relations Review, ILR Review, Cornell University, ILR School, vol. 54(1), pages 59-77, October.
  6. Esel Y. Yazici & Robert Kaestner, 1998. "Medicaid Expansions and The Crowding Out of Private Health Insurance," NBER Working Papers 6527, National Bureau of Economic Research, Inc.
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Cited by:
  1. Cynthia Bansak & Steven Raphael, 2005. "The Effects of State Policy Design Features on Take Up and Crowd Out Rates for the State Children’s Health Insurance Program," Working Papers 0002, San Diego State University, Department of Economics.
  2. Elizabeth Powers, 2002. "Did the Medicaid-Eligibility Expansions Increase the Reporting of Children's Health Problems? Evidence from the SIPP," JCPR Working Papers 270, Northwestern University/University of Chicago Joint Center for Poverty Research.
  3. David Card & Lara D. Shore-Sheppard, 2004. "Using Discontinuous Eligibility Rules to Identify the Effects of the Federal Medicaid Expansions on Low-Income Children," The Review of Economics and Statistics, MIT Press, vol. 86(3), pages 752-766, August.
  4. Lo Sasso, Anthony T. & Buchmueller, Thomas C., 2004. "The effect of the state children's health insurance program on health insurance coverage," Journal of Health Economics, Elsevier, vol. 23(5), pages 1059-1082, September.
  5. Datta, Anusua & Vandegrift, Donald, 2011. "Effects of welfare reform and the state children’s health insurance program on medicaid and total health expenditures," MPRA Paper 36486, University Library of Munich, Germany.
  6. Akinori Tomohara & Ho Lee, 2007. "Did State Children’s Health Insurance Program Affect Married Women’s Labor Supply?," Journal of Family and Economic Issues, Springer, vol. 28(4), pages 668-683, December.
  7. Bruce D. Meyer & Laura R. Wherry, 2012. "Saving Teens: Using a Policy Discontinuity to Estimate the Effects of Medicaid Eligibility," NBER Working Papers 18309, National Bureau of Economic Research, Inc.
  8. Anna Aizer & Jeffrey Grogger, 2003. "Parental Medicaid Expansions and Health Insurance Coverage," NBER Working Papers 9907, National Bureau of Economic Research, Inc.

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