nep-ias New Economics Papers
on Insurance Economics
Issue of 2019‒09‒09
nineteen papers chosen by
Soumitra K. Mallick
Indian Institute of Social Welfare and Business Management

  1. Did the ACA Medicaid Expansion Save Lives? By Borgschulte, Mark; Vogler, Jacob
  2. The Impact of the ACA Medicaid Expansion on Disability Program Applications By Lucie Schmidt; Lara Shore-Sheppard; Tara Watson
  3. Regulating Insurance Markets: Multiple Contracting and Adverse Selection By Attar, Andrea; Mariotti, Thomas; Salanié, François
  4. End-of-Life Medical Expenses By French, Eric Baird; Jones, John Bailey; Kelly, Elaine; McCauley, Jeremy
  5. Trends in Opioid Use Among Social Security Disability Insurance Applicants By April Yanyuan Wu; Denise Hoffman; Paul O'Leary
  6. Consequences of Parental Job Loss on the Family Environment and on Human Capital Formation: Evidence from Plant Closures By Mörk, Eva; Sjögren, Anna; Svaleryd, Helena
  7. Improving Behavioral Health Care for Medicare Beneficiaries: Atrius Health (Case Study) By Elyse Pegler; Nikki McKoy; Ethan Jacobs; Kate D'Anello
  8. Yield Risk, Price Risk, and Demand for Crop Insurance By Rosch, Stephanie D.; Crane-Droesch, Andrew
  9. Long-Term Care Insurance: Information Frictions and Selection By Boyer, Martin; De Donder, Philippe; Fluet, Claude; Leroux, Marie-Louise; Michaud, Pierre-Carl
  10. Inadvertent returns through crop insurance contract selection By Sharma, Sankalp; Walters, Cory G.
  11. The Challenges of Universal Health Insurance in Developing Countries: Evidence from a Large-scale Randomized Experiment in Indonesia By Abhijit Banerjee; Amy Finkelstein; Rema Hanna; Benjamin A. Olken; Arianna Ornaghi; Sudarno Sumarto
  12. Creative Destruction, Social Security Uptake and Union Networks By Dale-Olsen, Harald
  13. Boulder Valley Care Network’s Provider Engagement Strategy (Case Study) By Ethan Jacobs; Denise Stone
  14. Long-term Effects of National Health Insurance on Improving Health Status and Reducing Financial Burden: Evidence from China By Xing, Yuying
  15. UnityPoint ACO's Home Visit Program (Case Study) By Natalie Graves; Sonya Streeter
  16. The Impact of the Great Recession on SSDI Awards: A Birth-Cohort Analysis By Michael Anderson; Yonatan Ben-Shalom; David Stapleton; Emily Roessel
  17. Rocky Mountain ACO’s Approach to Care Coordination in Rural Areas (Case Study) By Rivka Weiser
  18. The Evolution of Annual Wellness Visits at Bellin Health Partners Next Generation Accountable Care Organization (Case Study) By Natalie Graves
  19. Montefiore Accountable Care Organization's Provider Engagement Strategy (Case Study) By Ethan Jacobs

  1. By: Borgschulte, Mark (University of Illinois at Urbana-Champaign); Vogler, Jacob (University of Illinois at Urbana-Champaign)
    Abstract: We estimate the effect of the Affordable Care Act Medicaid expansion on county-level mortality in the first four years following expansion. We find a reduction in all-cause mortality in ages 20 to 64 equaling 11.36 deaths per 100,000 individuals, a 3.6 percent decrease. This estimate is largely driven by reductions in causes of death likely to be influenced by access to health care, and equates to one life saved per 310 newly covered individuals. A cost-benefit analysis shows that the improvement in welfare due to mortality responses may offset the entire net-of-transfers expenditure associated with the expansion.
    Keywords: health insurance, Medicaid, mortality, public health insurance, healthcare, Affordable Care Act
    JEL: H75 I13 I14 I18 I38
    Date: 2019–08
  2. By: Lucie Schmidt; Lara Shore-Sheppard; Tara Watson
    Abstract: The Affordable Care Act (ACA) expanded the availability of public health insurance, decreasing the relative benefit of participating in disability programs but also lowering the cost of exiting the labor market to apply for disability program benefits. In this paper, we explore the impact of expanded access to Medicaid through the ACA on applications to the Supplemental Security Income (SSI) and Social Security Disability Income (SSDI) programs. Using the fact that the Supreme Court decision of June 2012 made the Medicaid expansion optional for the states, we compare changes in county-level SSI and SSDI caseloads in contiguous county pairs across a state border. We find no significant effects of the Medicaid expansion on applications or awards to either SSI or SSDI, and can reject economically meaningful impacts of Medicaid expansions on applications to disability programs.
    JEL: I10 I13
    Date: 2019–08
  3. By: Attar, Andrea; Mariotti, Thomas; Salanié, François
    Abstract: We study insurance markets in which privately informed consumers can purchase coverage from several firms whose pricing strategies are subject to an anti-dumping regulation. The resulting regulated game supports a single allocation in which each layer of coverage is fairly priced given the consumer types who purchase it. This competitive allocation cannot be Pareto-improved by a social planner who can neither observe consumer types nor monitor their trades with firms. Accordingly, we argue that public intervention under multiple contracting and adverse selection should penalize firms that cross-subsidize between contracts, while leaving consumers free to choose their preferred amount of coverage.
    Keywords: Insurance Markets, Regulation, Multiple Contracting, Adverse Selection.
    JEL: D43 D82 D86
    Date: 2019–08
  4. By: French, Eric Baird; Jones, John Bailey; Kelly, Elaine; McCauley, Jeremy
    Abstract: In this review, we document end-of-life medical spending: its level, composition, funding and contribution to aggregate medical spending, both for the US and abroad. We discuss how end-of-life expenses affects household savings and other financial behaviour such as insurance choices. Lastly, we review economic evidence on the efficacy of medical spending at the end of life, assessing the value of palliative and other care for both longevity and patient satisfaction.
    Keywords: End of Life; Insurance; medical spending; Savings
    JEL: I12 I13
    Date: 2019–08
  5. By: April Yanyuan Wu; Denise Hoffman; Paul O'Leary
    Abstract: The prevalence of opioid use nationwide, coupled with the large share of new Social Security Disability Insurance (SSDI) awardees who have conditions associated with opioid use, suggests that opioid use may be common and increasing among SSDI applicants.
    Keywords: Opioid use, SSDI applicants, disability
  6. By: Mörk, Eva (Uppsala University); Sjögren, Anna (IFAU); Svaleryd, Helena (Uppsala University)
    Abstract: We study the consequences of mothers' and fathers' job loss for parents, families, and children. Rich Swedish register data allow us to identify plant closures and account for non-random selection of workers to closing plants by using propensity score matching and controlling for pre-displacement outcomes. Our overall conclusion is positive: childhood health, educational and early adult outcomes are not adversely affected by parental job loss. Parents and families are however negatively affected in terms of parental health, labor market outcomes and separations. Limited effects on family disposable income suggest that generous unemployment insurance and a dual-earner norm shield families from financial distress, which together with universal health care and free education is likely to be protective for children.
    Keywords: parental unemployment, workplace closure, family environment, child health, human capital formation
    JEL: I12 J1
    Date: 2019–08
  7. By: Elyse Pegler; Nikki McKoy; Ethan Jacobs; Kate D'Anello
    Abstract: This case study describes how Atrius Health, a participant in the Pioneer Accountable Care Organization (ACO) model, has worked to improve behavioral health care for Medicare beneficiaries.
    Keywords: Pioneer ACO, Behavioral Health, Atrius Health, Case Study, Multi-Specialty Medical Practice, Evidence-Based Practices, Care Transformation
  8. By: Rosch, Stephanie D.; Crane-Droesch, Andrew
    Keywords: Agricultural and Food Policy
    Date: 2019–06–25
  9. By: Boyer, Martin; De Donder, Philippe; Fluet, Claude; Leroux, Marie-Louise; Michaud, Pierre-Carl
    Abstract: We conduct a stated-choice experiment where respondents are asked to rate various insurance products aimed to protect against financial risks associated with long-term care needs. Using exogenous variation in prices from the survey design and individual cost estimates, these stated-choice probabilities are used to predict market equilibrium for long-term care insurance. We find that information frictions are pervasive. We measure the welfare losses associated with these three causes in a framework that also allows for selection. We show that information frictions reduce equilibrium take-up and lead to large welfare loss while selection plays little role.
    Keywords: Long-term care insurance; adverse selection; stated-preference; health; insurance
    Date: 2019–09–03
  10. By: Sharma, Sankalp; Walters, Cory G.
    Keywords: Agricultural and Food Policy
    Date: 2019–06–25
  11. By: Abhijit Banerjee; Amy Finkelstein; Rema Hanna; Benjamin A. Olken; Arianna Ornaghi; Sudarno Sumarto
    Abstract: To assess ways to achieve widespread health insurance coverage with financial solvency in developing countries, we designed a randomized experiment involving almost 6,000 households in Indonesia who are subject to a nationally mandated government health insurance program. We assessed several interventions that simple theory and prior evidence suggest could increase coverage and reduce adverse selection: substantial temporary price subsidies (which had to be activated within a limited time window and lasted for only a year), assisted registration, and information. Both temporary subsidies and assisted registration increased initial enrollment. Temporary subsidies attracted lower-cost enrollees, in part by eliminating the practice observed in the no subsidy group of strategically timing coverage for a few months during health emergencies. As a result, while subsidies were in effect, they increased coverage more than eightfold, at no higher unit cost; even after the subsidies ended, coverage remained twice as high, again at no higher unit cost. However, the most intensive (and effective) intervention – assisted registration and a full one-year subsidy – resulted in only a 30 percent initial enrollment rate, underscoring the challenges to achieving widespread coverage.
    JEL: I13 O15
    Date: 2019–08
  12. By: Dale-Olsen, Harald (Institute for Social Research, Oslo)
    Abstract: Does the creative destruction induced by unions entail increased social security uptake? Creative destruction implies the closures of less productive workplaces, and if the regional benefits from this process is not large enough, the displacements caused by workplace closures cause increased social security uptake. In this paper we apply a shift-share approach and historical unionisation data from 1918 to study the impact of regional unionisation changes in Norway on regional social security uptake during the period 2003-2012. As regional unionisation increases, inflows to regional unemployment and disability decrease, but the outflow to retirement increases.
    Keywords: trade unions, creative destruction, unemployment, disability insurance, retirement
    JEL: D24 J30 J51
    Date: 2019–08
  13. By: Ethan Jacobs; Denise Stone
    Abstract: This case study describes the strategy used by Boulder Valley Care Network (BVCN) to design a governance structure for its Accountable Care Organization (ACO) that promotes physician engagement.
    Keywords: Learning System for Accountable Care Organizations (LSACO), Accountable Care Organization (ACO), Boulder Valley Care Network (BVCN), Medicare Shared Savings Program (SSP), provider engagement, governance, case study
  14. By: Xing, Yuying
    Keywords: Community/Rural/Urban Development
    Date: 2019–06–25
  15. By: Natalie Graves; Sonya Streeter
    Abstract: This case study describes UnityPoint Accountable Care’s approach to implementing a home visit program to improve the care experience and health outcomes of beneficiaries.
    Keywords: Next Generation ACO, home visit, home visit waiver, benefit enhancement
  16. By: Michael Anderson; Yonatan Ben-Shalom; David Stapleton; Emily Roessel
    Abstract: Awards of Social Security Disability Insurance (SSDI) benefits to disabled workers increased rapidly and then declined in the decade after the Great Recession began.
    Keywords: great recession, SSDI awards, Birth-cohort analysis, disability
  17. By: Rivka Weiser
    Abstract: This case study describes the care coordination initiative for rural providers developed by Rocky Mountain Accountable Care Organization (RMACO).
    Keywords: Learning System for Accountable Care Organizations (LSACO), Accountable Care Organization (ACO), Rocky Mountain Accountable Care Organization (RMACO), ACO Investment Model (AIM), rural health, care coordination, care management, case study
  18. By: Natalie Graves
    Abstract: This case study describes the strategy that Bellin Health Partners Accountable Care Organization (Bellin ACO) developed to maximize the effectiveness of annual wellness visits (AWVs).
    Keywords: annual wellness visit, AWV, Next Generation ACO, NGACO
  19. By: Ethan Jacobs
    Abstract: This case study describes the strategy used by Montefiore Accountable Care Organization (ACO) to engage physician practices in quality improvement activities.
    Keywords: Montefiore provider engagement, Next Generation Accountable Care Organization, NGACO, provider engagement, Montifiore ACO, quality measures

This nep-ias issue is ©2019 by Soumitra K. Mallick. It is provided as is without any express or implied warranty. It may be freely redistributed in whole or in part for any purpose. If distributed in part, please include this notice.
General information on the NEP project can be found at For comments please write to the director of NEP, Marco Novarese at <>. Put “NEP” in the subject, otherwise your mail may be rejected.
NEP’s infrastructure is sponsored by the School of Economics and Finance of Massey University in New Zealand.