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The Health Care Safety Net and Crowd-Out of Private Health Insurance

Author

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  • Anthony T. Lo Sasso
  • Bruce D. Meyer

Abstract

There is an extensive literature on the extent to which public health insurance coverage through Medicaid induces less private health insurance coverage. However, little is known about the effect of other components of the health care safety net in crowding out private coverage. We examine the effect of Medicaid and uncompensated care provided by clinics and hospitals on insurance coverage. We construct a long panel of metropolitan area and state-level data on hospital uncompensated care and free and reduced price care offered by Federally Qualified Health Centers. We match this information to individual level data on coverage from the Current Population Survey for two distinct groups: children aged 14 and under and single, childless adults aged 18 to 64. Our results provide mixed evidence on the extent of crowd-out. Hospital uncompensated care does not appear to crowd-out health insurance coverage and health center uncompensated care appears to crowd-out private coverage for adults and, in some specifications, children.

Suggested Citation

  • Anthony T. Lo Sasso & Bruce D. Meyer, 2006. "The Health Care Safety Net and Crowd-Out of Private Health Insurance," Working Papers 0417, Harris School of Public Policy Studies, University of Chicago.
    • Handle: RePEc:har:wpaper:0417
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    File URL: http://harrisschool.uchicago.edu/about/publications/working-papers/pdf/wp_04_17.pdf
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    Cited by:

    1. is not listed on IDEAS
    2. Jonathan Gruber, 2008. "Covering the Uninsured in the United States," Journal of Economic Literature, American Economic Association, vol. 46(3), pages 571-606, September.
    3. Brendan Saloner & Yaa Akosa Antwi & Johanna Catherine Maclean & Benjamin Lê Cook, 2015. "Access to health insurance and utilization of public sector substance use treatment: Evidence from the Affordable Care Act dependent coverage provision," DETU Working Papers 1509, Department of Economics, Temple University.
    4. Johanna Catherine Maclean & Brendan Saloner, 2019. "The Effect of Public Insurance Expansions on Substance Use Disorder Treatment: Evidence from the Affordable Care Act," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 38(2), pages 366-393, March.
    5. Marianne Bitler & Christopher Carpenter, 2019. "Effects of Direct Care Provision to the Uninsured: Evidence from Federal Breast and Cervical Cancer Programs," NBER Working Papers 26140, National Bureau of Economic Research, Inc.
    6. Brenna, Elenka, 2025. "Public versus private access in the Italian NHS - The use of propensity score matching to provide more insight on the increasing adoption of voluntary health insurance," Health Policy, Elsevier, vol. 154(C).
    7. Xuezheng Qin & Gordon Liu, 2013. "Does the US health care safety net discourage private insurance coverage?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(3), pages 457-469, June.
    8. Craig Garthwaite & Tal Gross & Matthew J. Notowidigdo, 2018. "Hospitals as Insurers of Last Resort," American Economic Journal: Applied Economics, American Economic Association, vol. 10(1), pages 1-39, January.
    9. Brenna, Elenka & Giammanco, Maria Daniela, 2024. "The use of voluntary health insurance in the access to specialist care: Evidence from the Italian NHS," Socio-Economic Planning Sciences, Elsevier, vol. 93(C).

    More about this item

    Keywords

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    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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