Health insurance, socioeconomic status, and government regulation: An empirical analysis.

摘要

While public concern about the “uninsured problem” appears to have waxed and waned over the past decade, the number of Americans lacking health insurance coverage has increased steadily. The three essays of this dissertation investigate the determinants of private health insurance coverage and the effects of policies aimed at expanding coverage.; In the 1990's, nearly every state enacted health insurance reform legislation. Two of the three essays assess the impact of these laws. The first is a critical review of the growing economics literature on the effect of these reforms. The essay compares and critiques the methodologies of the various studies and synthesizes and interprets their results. The main finding is that reforms had little effect on the percentage of Americans with private health insurance, but may have had some effect on the type of coverage purchased by increasing the market share of managed care plans.; The second essay is an econometric analysis of the varying levels of reform enacted by states using data from the March Current Population Survey (CPS) from 1987 to 1996. To control for other factors, trends in New York are compared to those in two neighboring “control” states, Pennsylvania and Connecticut. The results indicate that while coverage did fall in New York after its reforms were enacted, similar trends were observed in Pennsylvania (which enacted no reform) and Connecticut (which enacted moderate reform). Overall, the econometric results provide no evidence that reforms had any effect on coverage, positive or negative.; The third essay uses CPS data on California from 1987 to 1996 to investigate trends in insurance coverage across different racial groups. The analysis uses non-parametric regression techniques to investigate the extent to which racial/ethnic differences in health insurance coverage are a function of income, how they vary along the income distribution, and how they have changed over time. The results indicate considerable heterogeneity across racial groups and income levels. While there is evidence that the white/nonwhite gap in overall insurance coverage has grown over time, racial/ethnic differences in coverage by employer-sponsored policies—the most prevalent source of insurance in the US—appear to have narrowed.