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Newsletter
The Impact of the Covid-19 Pandemic on Health Insurers
Shrivatsa, Ishira (2022-09)
The U.S. health insurance industry, which owns over $380 billion in financial assets, was placed in the spotlight when the Covid-19 pandemic began in the spring of 2020.1 The pandemic led to health-care-specific changes, such an increase in Covid-19 testing and related hospitalizations, as well as a temporary postponement or cancellation of elective procedures to make space for Covid-19 patients. It also led to changes in financial markets, notably a decrease in interest rates. These changes affected the risks that health insurers are subject to and the overall profitability of the industry.
Chicago Fed Letter , Volume No 471

Report
Access to medication-assisted treatment for opioid use disorder: is Rhode Island different, and why?
Burke, Mary A. (2019-11-01)
This paper assesses the prevalence of medication-assisted treatment (MAT) among treatment episodes for opioid use disorder (OUD) in Rhode Island, as compared with the remaining New England states and the United States as a whole. Based on the Treatment Episode Data Set (TEDS-A), a national census of admissions into publicly funded treatment facilities for substance use disorders, we find that during the period beginning in 2000 through 2017, Rhode Island exhibited a greater tendency to use MAT as part of OUD treatment compared with the average state in the United States and compared with the ...
Current Policy Perspectives , Paper 19-2

Working Paper
Losing Public Health Insurance: TennCare Disenrollment and Personal Financial Distress
Tello-Trillo, D. Sebastian; Argys, Laura; Friedson, Andrew; Pitts, M. Melinda (2017-08-01)
A main goal of health insurance is to smooth out the financial risk that comes with health shocks and health care. Nevertheless, there has been relatively sparse evidence on how health insurance affects financial outcomes. The few studies that exist focus on the effect of gaining health insurance. This paper explores the effect of losing public health insurance on measures of individual financial well-being. In 2005, the state of Tennessee dropped about 170,000 individuals from Medicaid, resulting in a plausibly exogenous shock to health insurance status. Both across- and within-county ...
FRB Atlanta Working Paper , Paper 2017-6

Working Paper
Missouri’s Medicaid Contraction and Consumer Financial Outcomes
Bailey, James; Blascak, Nathan; Mikhed, Vyacheslav (2020-11-02)
In July 2005, a set of cuts to Medicaid eligibility and coverage went into effect in the state of Missouri. These cuts resulted in the elimination of the Medical Assistance for Workers with Disabilities program, more stringent eligibility requirements, and less generous Medicaid coverage for those who retained their eligibility. Overall, these cuts removed about 100,000 Missourians from the program and reduced the value of the insurance for the remaining enrollees. Using data from the Medical Expenditure Panel Survey, we show how these cuts increased out-of-pocket medical spending for ...
Working Papers , Paper 20-42

Report
Implications of Increasing College Attainment for Aging in General Equilibrium
Kehoe, Timothy J.; Nygaard, Vegard; Conesa, Juan Carlos; Raveendranathan, Gajendran (2019-05-08)
We develop and calibrate an overlapping generations general equilibrium model of the U.S. economy with heterogeneous consumers who face idiosyncratic earnings and health risk to study the implications of exogenous trends in increasing college attainment, decreasing fertility, and increasing longevity between 2005 and 2100. While all three trends contribute to a higher old age dependency ratio, increasing college attainment has different macroeconomic implications because it increases labor productivity. Decreasing fertility and increasing longevity require the government to increase the ...
Staff Report , Paper 583

Report
The Affordable Care Act and the COVID-19 Pandemic: A Regression Discontinuity Analysis
Pinkovskiy, Maxim L.; Chakrabarti, Rajashri; Nober, William; Meyerson, Lindsay; Avtar, Ruchi (2020-11-01)
Did Medicaid expansion under the Affordable Care Act affect the course of the COVID-19 pandemic? We answer this question using a regression discontinuity design for counties near the borders of states that expanded Medicaid with states that did not. Relevant covariates change continuously across the Medicaid expansion frontier. We find that (1) health insurance changes discontinuously at the frontier, (2) COVID-19 testing is discontinuously larger in Medicaid-expanding states, and (3) the fraction of beds occupied in ICUs is discontinuously smaller in Medicaid-expanding states. We also find ...
Staff Reports , Paper 948

Working Paper
The effect of ending the pandemic-related mandate of continuous Medicaid coverage on health insurance coverage
Dasgupta, Kabir; Solomon, Keisha T. (2025-02-03)
The Medicaid continuous enrollment provision, which ensured uninterrupted coverage for beneficiaries during the COVID-19 pandemic, was ended in March 2023. This unwinding process has led to large-scale Medicaid disenrollments, as states resumed their standard renewal process to evaluate enrolled individuals' eligibility status. Our analysis investigates whether resumption of states' renewal process has led to an increase in the risk of becoming uninsured for adults aged under 65 and affected their household economic well-being. Using state-month variation in the timing of the first round of ...
Finance and Economics Discussion Series , Paper 2025-008

Working Paper
Health Insurance and Young Adult Financial Distress
Blascak, Nathan; Mikhed, Vyacheslav (2022-08-22)
We study the ﬁnancial eﬀects of health insurance for young adults using the Aﬀordable Care Act’s dependent coverage mandate as a source of exogenous variation. Using nationally repre-sentative, anonymized credit report and publicly available survey data on medical expenditures, we exploit the mandate’s implementation in 2010 and its automatic disenrollment mechanism at age 26. Our estimates show that increasing access to health insurance lowered young adults’ out-of-pocket medical expenditures, debt in third-party collections, and the probability of per-sonal bankruptcy. However, ...
Working Papers , Paper 19-54

Working Paper
Did the Affordable Care Act Affect Access to Medications for Opioid Use Disorder among the Already Insured? Evidence from the Rhode Island All-payer Claims Database
Burke, Mary A.; Carman, Katherine Grace; Sullivan, Riley; Wen, Hefei; Wharam, James Frank; Yu, Hao (2021-10-01)
Previous research suggests that state Medicaid expansions implemented under the Patient Protection and Affordable Care Act (ACA) helped large numbers of patients suffering from opioid use disorder (OUD) gain access to life-saving medications, including buprenorphine. However, Medicaid expansions could have impeded access to care among individuals already enrolled in Medicaid, as new enrollees would have placed added demands on a limited supply of buprenorphine providers. Using a panel data set of medical claims from Rhode Island, we estimate the causal effects of the state’s January 2014 ...
Working Papers , Paper 21-17

Working Paper
Preventive vs. Curative Medicine: A Macroeconomic Analysis of Health Care over the Life Cycle
Ozkan, Serdar (2023-09-23)
This paper studies differences in health care usage and health outcomes between low- and high-income individuals. Using data from the Medical Expenditure Panel Survey (MEPS) I find that early in life the rich spend significantly more on health care, whereas from middle to very old age medical spending of the poor surpasses that of the rich by 25%. In addition, low-income individuals are less likely to incur any medical expenditures in a given year, yet, when they do, their expenses are more likely to be extreme. To account for these facts, I develop and estimate a life-cycle model of two ...
Working Papers , Paper 2023-025

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