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Working Paper
Reforming the US Long-Term Care Insurance Market
Braun, R. Anton; Kopecky, Karen A. (2024-08-14)
Nursing home risk is significant and costly. Yet, most Americans pay for long-term care (LTC) expenses out-of-pocket. This chapter examines reforms to both public and private LTCI provision using a structural model of the US LTCI market. Three policies are considered: universal public LTCI, no public LTCI coverage, and a policy that exempts asset holdings from the public insurance asset test on a dollar-for-dollar basis with private LTCI coverage. We find that this third reform enhances social welfare and creates a vibrant private LTCI market while preserving the safety net provided by public ...
Working Papers , Paper 24-17

Working Paper
How Important Is Health Inequality for Lifetime Earnings Inequality?
Hosseini, Roozbeh; Kopecky, Karen A.; Zhao, Kai (2021-01-04)
Using a dynamic panel approach, we provide empirical evidence that negative health shocks reduce earnings. The effect is primarily driven by the participation margin and is concentrated in less educated individuals and those with poor health. We build a dynamic, general equilibrium, life cycle model that is consistent with these findings. In the model, individuals whose health is risky and heterogeneous choose to either work, or not work and apply for social security disability insurance (SSDI). Health affects individuals’ productivity, SSDI access, disutility from work, mortality, and ...
FRB Atlanta Working Paper , Paper 2021-1

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

Working Paper
Health Insurance and Hospital Supply: Evidence from 1950s Coal Country
http://fedora:8080/fcrepo/rest/objects/authors/; http://fedora:8080/fcrepo/rest/objects/authors/ (2020-04-17)
The United States government spends billions on public health insurance and has funded a number of programs to build health care facilities. However, the government runs these two types of programs separately: in different places, at different times, and for different populations. We explore whether access to both health insurance and hospitals can improve health outcomes and access to health care. We analyze a coal mining union health insurance program in 1950s Appalachia with and without a complementary hospital construction program. Our results show that the union insurance alone increased ...
Finance and Economics Discussion Series , Paper 2020-033

Working Paper
Measuring Interest Rate Risk in the Life Insurance Sector: The U.S. and the U.K.
Rosen, Richard J.; Hartley, Daniel; Paulson, Anna L. (2016-01-03)
We use a two factor model of life insurer stock returns to measure interest rate risk at U.S. and U.K. insurers. Our estimates show that interest rate risk among U.S. life insurers increased as interest rates decreased to historically low levels in recent years. For life insurers in the U.K., in contrast, interest rate risk remained low during this time, roughly unchanged from what it was in the period prior to the financial crisis when long-term interest rates were in their usual historical ranges. We attribute these differences to the heavier use of products that combine guarantees with ...
Working Paper Series , Paper WP-2016-2

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
Occupational hazards and social disability insurance
Wiczer, David; Michaud, Amanda M. (2014-08-26)
Using retrospective data, we introduce evidence that occupational exposure significantly affects disability risk. Incorporating this into a general equilibrium model, social disability insurance (SDI) affects welfare through (i) the classic, risk-sharing channel and (ii) a new channel of occupational reallocation. Both channels can increase welfare, but at the optimal SDI they are at odds. Welfare gains from additional risk-sharing are reduced by overly incentivizing workers to choose risky occupations. In a calibration, optimal SDI increases welfare by 2.6% relative to actuarially fair ...
Working Papers , Paper 2014-24

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

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
How do Doctors Respond to Incentives? Unintended Consequences of Paying Doctors to Reduce Costs
Alexander, Diane (2017-03-09)
Billions of dollars have been spent on pilot programs searching for ways to reduce healthcare costs. I study one such program, where hospitals pay doctors bonuses for reducing the total hospital costs of admitted Medicare patients (a ?bundled payment?). Doctors respond to the bonuses by becoming more likely to admit patients whose treatment can generate high bonuses, and sorting healthier patients into participating hospitals. Conditional on patient health, however, doctors do not reduce costs or change procedure use. These results highlight the ability of doctors to game incentive schemes, ...
Working Paper Series , Paper WP-2017-9

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