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Politics, Hospital Behavior, and Health Care Spending

Listed author(s):
  • Zack Cooper
  • Amanda E Kowalski
  • Eleanor N Powell
  • Jennifer Wu

This paper examines the link between legislative politics, hospital behavior, and health care spending. When trying to pass sweeping legislation, congressional leaders can attract votes by adding targeted provisions that steer money toward the districts of reluctant legislators. This targeted spending provides tangible local benefits that legislators can highlight when fundraising or running for reelection. We study a provision - Section 508 – that was added to the 2003 Medicare Modernization Act (MMA). Section 508 created a pathway for hospitals to apply to get their Medicare payment rates increased. We find that hospitals represented by members of the House of Representatives who voted ‘Yea’ on the MMA were significantly more likely to receive a 508 waiver than hospitals represented by members who voted ‘Nay.’ Following the payment increase generated by the 508 program, recipient hospitals treated more patients, increased payroll, hired nurses, added new technology, raised CEO pay, and ultimately increased their spending by over $100 million annually. Section 508 recipient hospitals formed the Section 508 Hospital Coalition, which spent millions of dollars lobbying Congress to extend the program. After the vote on the MMA and before the vote to reauthorize the 508 program, members of Congress with a 508 hospital in their district received a 22% increase in total campaign contributions and a 65% increase in contributions from individuals working in the health care industry in the members’ home states. Our work demonstrates a pathway through which the link between politics and Medicare policy can dramatically affect US health spending.

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Paper provided by National Bureau of Economic Research, Inc in its series NBER Working Papers with number 23748.

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Date of creation: Aug 2017
Handle: RePEc:nbr:nberwo:23748
Note: HC
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  1. Martin S. Gaynor & Samuel A. Kleiner & William B. Vogt, 2015. "Analysis of Hospital Production: An Output Index Approach," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 30(3), pages 398-421, April.
  2. Leemore Dafny & Kate Ho & Robin S. Lee, 2016. "The Price Effects of Cross-Market Hospital Mergers," NBER Working Papers 22106, National Bureau of Economic Research, Inc.
  3. Aaron Henry J. & Reischauer Robert, 2015. "The Transformation of Medicare, 2015 to 2030," Forum for Health Economics & Policy, De Gruyter, vol. 18(2), pages 119-136, December.
  4. David Cutler & Jonathan Skinner & Ariel Dora Stern & David Wennberg, 2013. "Physician Beliefs and Patient Preferences: A New Look at Regional Variation in Health Care Spending," NBER Working Papers 19320, National Bureau of Economic Research, Inc.
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