Research

This paper studies how Medicare and Medicaid jointly shape patients' access to healthcare, by estimating the effect of gaining additional Medicaid coverage for Medicare beneficiaries. While dual coverage eliminates out-of-pocket costs, providers face lower reimbursement rates and higher administrative burdens associated with Medicaid. I leverage an expansion in dual-Medicaid eligibility and find that dual enrollment increases patients' total health care utilization by 51 percent, largely driven by a higher use of the emergency department. Dual enrollment simultaneously leads to a 24 percent decline in the number of physician visits, concentrated among providers with a low share of Medicaid patients.

The delayed retirement credit (DRC) increases monthly OASI (Old Age and Survivors Insurance) benefits for primary beneficiaries who claim after their full retirement age (FRA). For many years, the DRC was set at 3.0 percent per year (0.25 percent monthly). The 1983 amendments to Social Security more than doubled this actuarial adjustment to 8.0 percent per year. These changes were phased in gradually, so that those born in 1924 or earlier retained a 3.0 percent DRC while those born in 1943 or later had an 8.0 percent DRC. In this paper, we use administrative data from the Social Security Administration (SSA) to estimate the effect of this policy change on individual claiming behavior. We focus on the first half of the DRC increase (from 3.0 to 5.5 percent) given changes in other SSA policies that coincided with the later increases. Our findings demonstrate that the increase in the DRC led to a significant increase in delayed claiming of social security benefits and strongly suggest that the effects were larger for those with higher lifetime incomes, who would have a greater financial incentive to delay given their longer life expectancies.

We seek to understand how the labor market decisions of the family adjust in response to plausibly exogenous health shocks. Family members might seek to work less to provide caregiving, or work more in response to medical expenditures and loss of income by the ill individual. We use records of emergency department (ED) visits and hospitalizations to empirically determine the size of these effects. Using ED events we find evidence of intra-family insurance. By exploring how insurance varies by the severity of the health shock, we find evidence that family labor supply responses decrease as the caregiving need increases.

The Affordable Care Act (ACA) not only changed the landscape of health insurance coverage in the United States, but also affected the relationship between working decisions and health insurance. In this paper, we estimate the impact of the ACA on the near-elderly (ages 60- 64) in the five years after the implementation of its key provisions in early 2014. We exploit variation across geographic areas in the pre-existing level of uninsurance and use 65-69 year olds, whose insurance coverage was unaffected by the ACA, as a within-region control group. Our findings indicate that the ACA increased health insurance coverage among the near elderly by 4.5 percentage points and reduced their labor force participation rate by 0.6 percentage points.