Health Insurance and Young Adult Financial Distress

We study how health insurance eligibility affects financial distress for young adults using the Affordable Care Act's (ACA) dependent coverage mandate─the part of the ACA that requires private health insurance plans to cover individuals up to their 26th birthday. We examine the effects of both gaining and losing eligibility by exploiting the mandate's implementation in 2010 and its automatic disenrollment mechanism at age 26. Our estimates show that increasing access to health insurance lowers young adults’ out-of-pocket medical expenditures and debt in third-party collections. However, reductions in financial distress are transitory, as they diminish after an individual loses access to parental insurance when they age out of the mandate at age 26.     

进一步完善我国失业保险制度的几点思考

失业保险制度,在我国才有19年的历史.19年来,它保障了失业人员的基本生活,促进了失业人员的再就业,有力地支持了企业改革.但它还很不完善.本文从我国实际出发,借鉴国外一些好的做法,对如何进一步完善我国的失业保险制度做出几点思考.     

Firm size and regulatory compliance costs: The case of workers' compensation insurance

This paper examines the relative costs of workers' compensation insurance across firm-size groups, with particular focus on administrative scale economies (“compliance effects”) and biases in rate-setting (“enforcement effects”). Analyzing data on premiums and losses from the insurance industry, the authors find that the costs of insurance per dollar of loss are relatively high for very small firms. These higher costs reflect certain fixed administrative costs insurance companies must bear, but for extremely small firms these higher costs tend to be mitigated by an “enforcement” bias in state rate-setting outcomes. Due to imperfect experience-rating of insurance premiums, middle-sized firms—which have the highest losses—pay less per dollar of loss than either the smallest or largest firms. Indeed, it appears that large firms purchasing commercial workers' compensation insurance subsidize other size groups.     

The government behind insurance governance: Lessons for ransomware

The insurance as governance literature focuses on the ability of private enterprises to collectively regulate, pool, and distribute risks. This paper analyzes how governments support insurance markets to maintain insurability and limit risks to society. We propose a new conceptual framework grouping government interventions into three dimensions: regulation of risky activity, public investment in risk reduction, and co-insurance. We apply this framework to six case studies, describing insurance markets' reliance on public support in more analytically precise terms. We analyze how mature insurance markets overcame insurability challenges akin to those currently presented by extortive cybercrime. Private governance struggled when markets grew too big for informal coordination or when (tail) risks escalated. Government interventions vary widely. Some governments prioritize supporting economic activity while others concentrate on containing risks. Governments also choose between risk reduction and ex post socialization of losses. We apply these insights to the market for ransomware insurance, discussing the merits and potential hazards of current proposals for government intervention.     

Revealed preferences of a state bureau: Case of New Mexico's underground storage tank program

Leaking underground storage tanks (USTs) are a pervasive national environmental problem. Cleanup of leaking USTs is largely publicly financed and under the control of state agencies. In the transition to new compliance standards, individual states have taken advantage of provisions in federal regulations to implement their own programs. This raises the policy question of environmental federalism and the appropriate locus of government control. The objectives of this study are to examine the revealed preferences of a state UST bureau. New Mexico was one of the first state programs to use risk assessments in setting funding priorities. We analyze the statistical determinants of funding decisions and find strong evidence that risk information is used. Although our case study provides a measure of support for state control, the argument is strengthened if public financing is limited to the cleanup of historical pollution, rather than a means for providing insurance for prospective pollution. ©1999 by the Association for Public Policy Analysis and Management.     

The Coexistence of Different Welfare Regimes in the Same Country: A Comparative Analysis of the Brazilian Municipalities Heterogeneity

Abstract

This paper demonstrates that heterogeneous countries such as Brazil have vast differences in welfare arrangements at the sub-national level. A number of social policies (social insurance, education, health and social assistance) were analysed in 5,565 Brazilian municipalities along five dimensions: expenditure, coverage, share of private spending, family structure and poverty. The grade of membership method was used to cluster municipalities and identify the main differences in their welfare regimes. Factor analysis was also used to explore which dimensions are most relevant in characterizing these sub-national regimes. The results show highly heterogeneous institutional forms of social protection across municipalities, which are classified as social assistance, quasi-social assistance, corporative, quasi-corporative, family insurance and intermediary welfare regimes.     

Early Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non‐Expansion States

The Affordable Care Act (ACA) aimed to achieve nearly universal health insurance coverage in the United States through a combination of insurance market reforms, mandates, subsidies, health insurance exchanges, and Medicaid expansions, most of which took effect in 2014. This paper estimates the causal effects of the ACA on health insurance coverage in 2014 using data from the American Community Survey. We utilize difference‐in‐difference‐in‐differences models that exploit cross‐sectional variation in the intensity of treatment arising from state participation in the Medicaid expansion and local area pre‐ACA uninsured rates. This strategy allows us to identify the effects of the ACA in both Medicaid expansion and non‐expansion states. Our preferred specification suggests that, at the average pre‐treatment uninsured rate, the full ACA increased the proportion of residents with insurance by 5.9 percentage points compared to 2.8 percentage points in states that did not expand Medicaid. Private insurance expansions from the ACA were due to increases in both employer‐provided and non‐group coverage. The coverage gains from the full ACA were largest for those without a college degree, non‐whites, young adults, unmarried individuals, and those without children in the home. We find no evidence that the Medicaid expansion crowded out private coverage.     

How Pollution Taxes may Increase Pollution and Reduce Net Revenues

This paper develops a positive theory of pollution taxation by a federal authority when pollution abatement subsidies are used by local governments. Environmental and industry lobby groups influence governments with campaign contributions. First, pollution may increase in the pollution tax because the abatement subsidy increases (decreases) with the tax, and pollution increases (decreases) in the abatement subsidy. This occurs because the lobbying incentives change at a pollution tax reform. Second, pollution taxes may reduce net revenues because subsidy expenditures rise. Third, pollution may increase simultaneously as net revenues fall. Finally, the welfare effect of a pollution tax may be negative.     

多类别养老保险对居民家庭消费影响的对比研究

在老龄化不断加深、居民消费率增长缓慢、消费需求日益多元化的背景下,研究不同类别养老保险对居民家庭消费水平和消费结构的影响日益重要。采用CGSS(2015)调查数据,使用倾向值匹配(PSM)回归模型,分析不同类别养老保险对居民家庭消费水平和消费结构的影响及内在机制,研究发现:参加基本养老保险和商业性养老保险均会显著增加居民家庭总消费、生存性消费和发展性消费,基本养老保险和商业性养老保险对发展性消费的增加效应均大于生存性消费;参加商业性养老保险对居民家庭总消费、生存性消费和发展性消费的增加效应大于基本养老保险;养老保险影响居民家庭消费的核心机制是居民的总收入以及再分配偏好。为拉动居民消费,应把第三支柱的个人养老金缴费纳入个人所得税专项或专项附加扣除;提高基础养老金的水平,进一步落实养老金水平的动态调整机制。     

Redlining or risk? A spatial analysis of auto insurance rates in Los Angeles

Auto insurance rates can vary dramatically, with much higher premiums in poor and minority areas than elsewhere, even after accounting for individual characteristics, driving history, and coverage. This paper uses a unique data set to examine the relative influence of place‐based socioeconomic characteristics (or redlining) and place‐based risk factors on the place‐based component of automobile insurance premiums. We use a novel approach of combining tract‐level census data and car insurance rate quotes from multiple companies for sub‐areas within the city of Los Angeles. The quotes are for a hypothetical individual with identical demographic and auto characteristics, driving records, and insurance coverage. This method allows the individual demographic and driving record to be fixed. Multivariate models are then used to estimate the independent contributions of these risk and redlining factors to the place‐based component of the car insurance premium. We find that both risk and redlining factors are associated with variations in insurance costs in the place‐based component, with black and poor neighborhoods being adversely affected, although risk factors are stronger predictors. However, even after risk factors are taken into account in the model specification, SES factors remain statistically significant. Moreover, simulations show that redlining factors explain more of the gap in auto insurance premiums between black (and Latino) and white neighborhoods and between poor and nonpoor neighborhoods. The findings do not appear sensitive to the individual characteristics of the hypothetical driver. © 2007 by the Association for Public Policy Analysis and Management     

Child Support and the Affordable Care Act's Medicaid Expansions

A quickly developing literature has shown that the Affordable Care Act's (ACA) Medicaid expansions have improved health insurance coverage, health, and financial well‐being among low‐income adults without dependent children. This population includes noncustodial parents. With substantial overlap in the population that is typically obligated to pay child support and the population that has strongly benefited from the expansions, there may be potential implications for child support enforcement. In this paper, I examine the effect of public health insurance eligibility to low‐income adults on child support outcomes. I find that the ACA Medicaid expansions increased child support distributed to custodial families as arrears by 8.5 percent. Evidence also suggests current support distributions increased by about 2 percent. There were no significant effects on paying toward a child support order. Among unmarried mothers, the likelihood of child support receipt increased by 8 percent. These results imply that access to public health insurance can increase the ability of noncustodial parents to pay child support.     

Does Medicare Coverage Improve Cancer Detection and Mortality Outcomes?

Medicare is a large government health insurance program in the United States that covers about 60 million people. This paper analyzes the effects of Medicare insurance on health for a group of people in urgent need of medical care: people with cancer. We used a regression discontinuity design to assess impacts of near-universal Medicare insurance at age 65 on cancer detection and outcomes, using population-based cancer registries and vital statistics data. Our analysis focused on the three tumor sites for which screening is recommended both before and after age 65: breast, colorectal, and lung cancer. At age 65, cancer detection increased by 72 per 100,000 population among women and 33 per 100,000 population among men; cancer mortality also decreased by nine per 100,000 population for women but did not significantly change for men. In a placebo check, we found no comparable changes at age 65 in Canada. This study provides the first evidence to our knowledge that near-universal access to Medicare at age 65 is associated with improvements in population-level cancer mortality.     

我国医疗保障制度改革的公平性与效率性探讨

本文主要从公平性与效率性两个方面对我国改革开放以来的医疗保障制度改革进行了探讨。本文认为我国改革开放以来的医疗保障制度改革从总体上看表现为公平性不足,效率性较差。在此基础上,本文就提高我国医疗保障制度改革的公平性与效率性提出一些政策性的建议。     

Justifying Public Provision of Social Security

The enormous expansion of the Social Security system over the last four decades has left the government very heavily involved in determining the savings and insurance of American households. While the growth of Social Security has been very substantial, it has also been gradual; this may explain the lack of focused debate on the pros and cons of government intervention in private saving and insurance decisions. This paper discusses the rationale for government intervention in this area as well as the evidence supporting the need for such intervention. While arguing the case for government provision of Social Security, the paper also points out significant shortcomings in the current system and suggests several needed reforms.     

公务员参加养老保险统一改革的思路——“混合型”统账结合制度下的测算

中国当前的机关事业单位基本养老保险制度对保障退休人员待遇、稳定机关事业单位职工队伍、促进经济社会文化各项事业全面发展发挥了重要作用,但还存在很多问题,如单位保险的性质未变、碎片化倾向严重、政企待遇差过大、财政负担沉重等.提出了中国机关事业单位养老保险制度改革的基本思路和原则,即从新入职的人员开始,逐步把机关事业单位工作人员纳入全国统一的基本养老保险制度,在此基础上建立职业年金,以避免其待遇下降.最后,测算了改革和不改革情况下机关事业单位养老金支出对财政负担的不同影响.测算结果发现,虽然改革初期会增加财政负担,但是到2061年开始将会大大降低财政负担.     

Public Health Insurance and Medical Spending: The Incidence of the ACA Medicaid Expansion

This paper examines the incidence of the cost burden associated with expanding public health insurance to low-income adults in the context of the Affordable Care Act. Using data from the Medical Expenditures Panel Survey (MEPS), I exploit exogenous variation in Medicaid eligibility rules across states, income groups and time. I find that public insurance eligibility reduced mean out-of-pocket spending by 19.6 percent among targeted households, but it did not causally increase total expenditures among beneficiaries. Rather, Medicaid expansion shifted the burden of payment from eligible households and private insurance (21.5 percent reduction) to taxpayers in the form of public insurance (46.6 percent increase). The efficiency of these public funds can be summarized by a mean Marginal Value of Public Funds of 0.70 in the full sample, 0.99 among households with at least one pre-existing condition, and 1.26 in states with an above-median number of public hospitals.     

Explaining variation and change in supervisory confidentiality in the European Union

Abstract

Some European Union member states’ financial regulators choose to make some of the data they routinely collect on individual banks publicly available. Others treat this data as confidential. What explains this difference? This paper considers the possible effects of crises, path-dependent legal institutions, and the design of deposit insurance schemes. At the national level, the paper focuses on contrasting German and Dutch cases. After the recent economic crisis, the Dutch released more data while the German authorities maintained strict confidentiality rules. The design of deposit insurance schemes provides a key reason why the level of secrecy varies, with the Dutch move from an ex post to an ex ante scheme where the government served as the ultimate backstop leading to questions about the accounts of individual banks while the German system favoured continued secrecy. The paper also describes the level of transparency at the EU level. Multilevel legal restrictions and bureaucratic capacity tilt EU banking union practices towards member states that treat financial supervisory data as confidential.     

Health Insurance in Transition: The Health Insurance Portability and Accountability Act of 1996

The Health Insurance Portability and Accountability Act (HIPAA)of 1996 (PL. 104–191) brings the federal government fullyinto insurance regulation for the first time. Despite the Republicanmajority's rhetoric about state control, election-year politicstrumped federalism. HIPAA's immediate impact oncoverage maybe modest, but its ultimate significance is great because itcreates a template for more farreaching federal involvementin regulating insurance. HIPAA amends the Employee RetirementIncome Security Act (ERISA), the Public Health Service Act,and the Internal Revenue Code, creating a complicatedstructuredictated by efforts to avoid an unfunded mandate. The historyof insurance regulation and the activity surrounding the enactmentof PL. 104–191 suggest that HIPAA continues an incrementalprocess of transition between state insurance regulation andfederal oversight driven by recent and accelerating changesin the structure of the health-care marketplace.     

Polanyi in Brussels or Luxembourg? Social rights and market regulation in European insurance

The decision of the Court of Justice of the European Union to ban sex discrimination in insurance has shown the potential reach of the principle of non‐discrimination. This paper discusses the different positions taken by participants in the policy process leading up to the decision, in order to reveal the potential and limitations of non‐discrimination as the basis for market‐regulatory social policy. It is shown that the European Commission's initial support for prohibiting insurance discrimination faltered with the realization that the measure would have little efficacy as a distributive social policy. It was left to the Court to assert that non‐discrimination rights are constitutive for European markets, regardless of their functional and instrumental limitations. The Court's focus was on the market‐integrative potential of rights as sources of norms for the conduct of insurance relationships. It is argued that this form of constitutive regulation is distinct from distributive social policy as it does not require that outcomes are egalitarian, but, rather, that the processes governing market relations should respect fundamental rights.     

Governable catastrophes: a comment on Bougen

Bougen's analysis of catastrophe insurance has considerable and damaging implications for the 'risk society' thesis. First, it outlines how insurance 'imaginaries' render even catastrophic and 'incalculable' modernization risks insurable. It also highlights the fact that such insurance has been mobilized and shaped by specific forms of political rationality, something which falls beneath the gaze of grand theory. Finally, the paper indicates that risk and uncertainty - far from being mutually exclusive - are frequently assembled together into governing technologies, and that uncertainty may denote a variable set of technologies through which catastrophes can be and are managed.