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Medicaid Stigma




This paper uses the National Survey of America's Families (NSAF) to examine whether the low take-up rate for publicly provided health insurance is caused by welfare stigma that people associate with those programs. The NSAF asks several questions related to welfare stigma, including whether respondents believe that welfare makes people work less, or whether welfare helps people get back "on their feet." If stigma plays a role in take-up, then among eligible patients, those who neglect to enroll in Medicaid will have more negative attitudes towards welfare, all else equal. As a second approach, we test the predictions of a Moffitt (1983) utility function, with fixed and variable stigma from public benefits. In the end, we believe we can demonstrate that stigma plays a large and statistically significant role in deterring Medicaid take-up, but we cannot distinguish responses to Medicaid benefits (which should have no variable stigma) from responses to Food Stamps (which should have large variable stigma). Finally, the results of this research, while of academic interest in their own right, also have substantial policy implications. If low Medicaid take-up is caused by welfare stigma, the policy prescription is much different than if low take-up is caused by paperwork hassles, lack of information, or perceived low quality of care.

Suggested Citation

  • Arik Levinson and Sjamsu Rahardja, 2004. "Medicaid Stigma," Working Papers gueconwpa~04-04-06, Georgetown University, Department of Economics.
  • Handle: RePEc:geo:guwopa:gueconwpa~04-04-06

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    References listed on IDEAS

    1. Moffitt, Robert, 1983. "An Economic Model of Welfare Stigma," American Economic Review, American Economic Association, vol. 73(5), pages 1023-1035, December.
    2. repec:aph:ajpbhl:2003:93:1:67-74_9 is not listed on IDEAS
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    Cited by:

    1. Vanessa Ríos & Alberto E. Chong & Hugo R. Ñopo, 2009. "Do Welfare Programs Damage Interpersonal Trust?: Experimental Evidence from Representative Samples for Four Latin American Cities," IDB Publications (Working Papers) 1639, Inter-American Development Bank.
    2. Sean Orzol & Linda Barterian & Michael Barna, 2012. "Proven Strategies in Health Care Coverage Program Outreach and Enrollment," Mathematica Policy Research Reports 2f2980ef67654808b495e7782, Mathematica Policy Research.
    3. repec:mpr:mprres:7819 is not listed on IDEAS
    4. repec:mpr:mprres:7810 is not listed on IDEAS
    5. Ewoudou, Jacques & Tsimpo, Clarence & Wodon, Quentin, 2009. "Stigma and the take-up of social programs," Policy Research Working Paper Series 4962, The World Bank.
    6. Janicki, Hubert P., 2014. "The role of asset testing in public health insurance reform," Journal of Economic Dynamics and Control, Elsevier, vol. 44(C), pages 169-195.

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    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health


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