Essays in Health Economics and Health Policy
Freed, Salama Salihah
This dissertation consists of three essays in health economics and policy. In the first essay, “Health Insurance Take-up Among the Near-Elderly in the Age of the Affordable Care Act,” I pair the exogenous transition of near-elderly people aging into Medicare eligibility with the enactment of the Affordable Care Act (ACA) and find that the insurance coverage gap between 64- and 65-year olds declines by nearly half. Consistent with these changes being attributable to the ACA, I also find that most coverage gains come from Medicaid in states that expanded Medicaid eligibility, while coverage gains in non-Medicaid-expansion states come from the kinds of insurance plans available on the exchanges. These results raise questions about the extent to which increasing coverage for the near-elderly may ease demand upon their entry into Medicare. The second essay, “Understanding Trends in Medicare Spending, 2007-2014,” explores factors that contribute to the recent Medicare spending growth slowdown. We examine changes in demographics, chronic condition prevalence, and extent of Medicare coverage between two periods--2007-2010 vs 2011-2014—and conduct an Oaxaca decomposition on spending levels. We find that spending declined by $180, composed of a $245 decline in the cost of treatment and a $97 increase attributed to changes in the population demographics. Further, we found that a majority of the change in spending is related to declines in spending to treat chronic conditions, even with an increased prevalence of chronic conditions. Understanding these trends are useful to inform policymakers as Medicare transitions to value-based payment systems. Finally, in “Diff'rent Votes, Same Strokes: Did the ACA's Benefits Cross Kentucky's Political Aisle?,” we explore partisanship and favorability of the Affordable Care Act in after the Kentucky implementation, which is often touted as a highly successful ACA program. We pair the date of implementation of the ACA with county and individual level data on political leanings to determine whether the favorability of the law is connected to the perceived benefits in each county. We found no difference in insurance take-up among Democratic- versus Republican-leaning counties. This speaks to the strong effect of partisanship and messaging on perception of new policies.