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Saving Teens: Using a Policy Discontinuity to Estimate the Effects of Medicaid Eligibility

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  • Bruce D. Meyer
  • Laura R. Wherry

Abstract

This paper uses a policy discontinuity to identify the immediate and long-term effects of public health insurance coverage during childhood. Our identification strategy exploits a unique feature of several early Medicaid expansions that extended eligibility only to children born after September 30, 1983. This feature resulted in a large discontinuity in the lifetime years of Medicaid eligibility of children at this birthdate cutoff. Those with family incomes at or just below the poverty line had close to five more years of eligibility if they were born just after the cutoff than if they were born just before. We use this discontinuity in eligibility to measure the impact of public health insurance on mortality by following cohorts of children born on either side of this cutoff from childhood through early adulthood. We examine changes in rates of mortality by the underlying causes of death, distinguishing between deaths due to internal and external causes. We also examine outcomes separately for black and white children. Our analysis shows that black children were more likely to be affected by the Medicaid expansions and gained twice the amount of eligibility as white children. We find a substantial effect of public eligibility during childhood on the later life mortality of black children at ages 15-18. The estimates indicate a 13-20 percent decrease in the internal mortality rate of black teens born after September 30, 1983. We find no evidence of an improvement in the mortality of white children under the expansions.

Suggested Citation

  • 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.
  • Handle: RePEc:nbr:nberwo:18309
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    References listed on IDEAS

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    1. Janet Currie & Jonathan Gruber, 1996. "Health Insurance Eligibility, Utilization of Medical Care, and Child Health," The Quarterly Journal of Economics, Oxford University Press, vol. 111(2), pages 431-466.
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    10. David W. Brown & Amanda E. Kowalski & Ithai Z. Lurie, 2015. "Medicaid as an Investment in Children: What is the Long-Term Impact on Tax Receipts?," Cowles Foundation Discussion Papers 1979, Cowles Foundation for Research in Economics, Yale University.
    11. James Marton & Aaron Yelowitz, 2015. "Health insurance generosity and conditional coverage: Evidence from medicaid managed care in Kentucky," Southern Economic Journal, Southern Economic Association, vol. 82(2), pages 535-555, October.
    12. Laura R. Wherry & Bruce D. Meyer, 2016. "Saving Teens: Using a Policy Discontinuity to Estimate the Effects of Medicaid Eligibility," Journal of Human Resources, University of Wisconsin Press, vol. 51(3), pages 556-588.
    13. Sarah R. Cohodes & Daniel S. Grossman & Samuel A. Kleiner & Michael F. Lovenheim, 2016. "The Effect of Child Health Insurance Access on Schooling: Evidence from Public Insurance Expansions," Journal of Human Resources, University of Wisconsin Press, vol. 51(3), pages 727-759.
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    16. Laura R. Wherry & Sarah Miller & Robert Kaestner & Bruce D. Meyer, 2018. "Childhood Medicaid Coverage and Later-Life Health Care Utilization," The Review of Economics and Statistics, MIT Press, vol. 100(2), pages 287-302, May.
    17. Kaestner, R. & Joyce, T. & Racine, A., 2001. "Medicaid eligibility and the incidence of ambulatory care sensitive hospitalizations for children," Social Science & Medicine, Elsevier, vol. 52(2), pages 305-313, January.
    18. Lee, David S. & Card, David, 2008. "Regression discontinuity inference with specification error," Journal of Econometrics, Elsevier, vol. 142(2), pages 655-674, February.
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    Cited by:

    1. Douglas Almond & Janet Currie & Valentina Duque, 2018. "Childhood Circumstances and Adult Outcomes: Act II," Journal of Economic Literature, American Economic Association, vol. 56(4), pages 1360-1446, December.
    2. Tzu-Ting Yang & Hsing-Wen Han & Hsien-Ming Lien, 2014. "Patient Cost-Sharing and Healthcare Utilization in Early Childhood: Evidence from a Regression Discontinuity Design," Working Papers 14C003, Canadian Centre for Health Economics.
    3. Marianne P. Bitler & Madeline Zavodny, 2014. "Medicaid: A Review of the Literature," NBER Working Papers 20169, National Bureau of Economic Research, Inc.
    4. Leah K. Lakdawala & David Simon, 2016. "The Intergenerational Consequences of Tobacco Policy," Working papers 2016-27, University of Connecticut, Department of Economics.
    5. Rossin-Slater, Maya & Wüst, Miriam, 2016. "What is the Added Value of Preschool? Long-Term Impacts and Interactions with a Health Intervention," IZA Discussion Papers 10254, Institute of Labor Economics (IZA).
    6. Étienne Gaudette & Gwyn C. Pauley & Julie Zissimopoulos, 2016. "Long-term Individual and Population Consequences of Early-life Access to Health Insurance," Working Papers wp355, University of Michigan, Michigan Retirement Research Center.
    7. Hilary Hoynes & Diane Whitmore Schanzenbach & Douglas Almond, 2016. "Long-Run Impacts of Childhood Access to the Safety Net," American Economic Review, American Economic Association, vol. 106(4), pages 903-934, April.
    8. repec:eee:jhecon:v:63:y:2019:i:c:p:100-113 is not listed on IDEAS
    9. repec:spr:jopoec:v:32:y:2019:i:2:d:10.1007_s00148-018-0714-z is not listed on IDEAS
    10. Thompson, Owen, 2017. "The long-term health impacts of Medicaid and CHIP," Journal of Health Economics, Elsevier, vol. 51(C), pages 26-40.
    11. Chloe N. East & Sarah Miller & Marianne Page & Laura R. Wherry, 2017. "Multi-generational Impacts of Childhood Access to the Safety Net: Early Life Exposure to Medicaid and the Next Generation’s Health," NBER Working Papers 23810, National Bureau of Economic Research, Inc.
    12. repec:bla:coecpo:v:36:y:2018:i:1:p:7-23 is not listed on IDEAS
    13. Michael Baker & Janet Currie & Hannes Schwandt, 2017. "Mortality Inequality in Canada and the U.S.: Divergent or Convergent Trends?," NBER Working Papers 23514, National Bureau of Economic Research, Inc.
    14. Laura R. Wherry & Sarah Miller & Robert Kaestner & Bruce D. Meyer, 2018. "Childhood Medicaid Coverage and Later-Life Health Care Utilization," The Review of Economics and Statistics, MIT Press, vol. 100(2), pages 287-302, May.
    15. Janet Currie & Hannes Schwandt, 2016. "Mortality Inequality: The Good News from a County-Level Approach," Journal of Economic Perspectives, American Economic Association, vol. 30(2), pages 29-52, Spring.
    16. repec:bin:bpeajo:v:49:y:2019:i:2018-01:p:89-150 is not listed on IDEAS
    17. Laura R. Wherry & Bruce D. Meyer, 2016. "Saving Teens: Using a Policy Discontinuity to Estimate the Effects of Medicaid Eligibility," Journal of Human Resources, University of Wisconsin Press, vol. 51(3), pages 556-588.
    18. Hilary W. Hoynes & Diane Whitmore Schanzenbach, 2018. "Safety Nets Investments in Children," Brookings Papers on Economic Activity, Economic Studies Program, The Brookings Institution, vol. 49(1 (Spring), pages 89-150.
    19. Maya Rossin-Slater & Miriam Wüst, 2016. "What is the Added Value of Preschool for Poor Children? Long-Term and Intergenerational Impacts and Interactions with an Infant Health Intervention," NBER Working Papers 22700, National Bureau of Economic Research, Inc.
    20. Thomas Buchmueller & John C. Ham & Lara D. Shore-Sheppard, 2015. "The Medicaid Program," NBER Chapters,in: Economics of Means-Tested Transfer Programs in the United States, Volume 1, pages 21-136 National Bureau of Economic Research, Inc.
    21. Michael Levere & Sean Orzol & Lindsey Leininger & Nancy Early, "undated". "Contemporaneous and Long-Term Effects of Children's Public Health Insurance Expansions on Supplemental Security Income Participation," Mathematica Policy Research Reports 92d140d1a39741c481c4630bb, Mathematica Policy Research.
    22. Andrew Goodman-Bacon, 2016. "The Long-Run Effects of Childhood Insurance Coverage: Medicaid Implementation, Adult Health, and Labor Market Outcomes," NBER Working Papers 22899, National Bureau of Economic Research, Inc.

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    JEL classification:

    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality

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