Income Responses to the Affordable Care Act: Evidence from a Premium Tax Credit Notch.

We examine responses to the ACA subsidy for Marketplace health insurance in the first year of subsidy availability. Drawing on federal tax data and focusing on a notch in the schedule where eligibility is lost, we document that taxpayers lowered their income to remain eligible for the subsidy. The observed bunching is modest relative to the size of the notch, which, consistent with larger responses we detect in additional analyses among certain subgroups, is likely explained by significant optimization frictions.

Long-Term Impacts of Childhood Medicaid Expansions on Outcomes in Adulthood.

We use administrative data from the IRS to examine long-term impacts of childhood Medicaid eligibility expansions on outcomes in adulthood at each age from 19-28. Greater Medicaid eligibility increases college enrollment and decreases fertility, especially through age 21. Starting at age 23, females have higher contemporaneous wage income, although male increases are imprecise.

The Impact of the ACA on Premiums: Evidence from the Self-Employed.

This article examines the impact of the Affordable Care Act on premiums by studying a segment of the nongroup market, the self-employed. Because self-employed health insurance premiums are deductible, tax data contain comprehensive individual-level information on the premiums paid by this group prior to the establishment of health insurance exchanges. We compare these prior premiums to reference silver premiums available on the exchanges and find that exchange premiums are 4.

Did reform of the non-group health insurance market affect the decision to be self-employed? Evidence from state reforms in the 1990s.

This paper estimates whether state-level implementation of community rating and guaranteed issue regulations in the non-group health insurance market during the 1990s affected the decision of taxpayers to be self-employed. Using a panel of tax returns that span 1987-2000, we find no statistically significant effect of the reforms on the propensity to be self-employed overall, although we find evidence of an increase in self-employment among older taxpayers and weaker evidence of decreases among younger cohorts.

Understanding the increasingly popular itemized deduction for medical expenses.

Itemized deduction for medical expenses has existed in one form or another for more than 60 years. One justification for this tax deduction is that it reduces the burden for taxpayers with catastrophic expenses. Currently it shields more out-of-pocket spending on health care from taxes than any other tax provision.

Do increased premium subsidies affect how much health insurance is purchased? Evidence from the self-employed.

This paper estimates the effect of recent federal and state level increases in the deductibility of health insurance premiums for self-employed individuals, which reduced the after-tax price of health insurance, on both the take-up of coverage and the amount of insurance purchased. Using a panel of tax returns filed by self-employed taxpayers from 1999 to 2004, we estimate a take-up elasticity of -0.316 overall, with significantly higher elasticities for single taxpayers.

Differential effect of the state children's health insurance program expansions by children's age.

Research Objective: This paper tests for differences in the effect of State Children's Health Insurance Program (SCHIP) on children's insurance coverage and physician visits across three age groups: pre-elementary school-aged children (pre-ESA), ESA children, and post-ESA children.

Data Source: The study uses two cross sections of the Survey of Income and Program Participation (SIPP) from the 1996 and 2001 panels.

Study Design: A difference-in-differences approach is used to estimate the effect of SCHIP on coverage and physician visits of newly eligible children of different age groups.

Differences in medical care expenditures for adults with depression compared to adults with major chronic conditions.

Background: Approximately 17.1 million adults report having a major depressive episode in 2004 which represents 8% of the adult population in the U.S.

Trends in out-of-pocket medical care expenditures for Medicare-age adults with arthritis between 1998 and 2004.

Objective: To provide estimates of the growth in out-of-pocket (OOP) medical expenditures for persons with arthritis.

Methods: OOP medical expenditures were estimated for 1998-2004 based on 7 panels of the Medical Expenditures Panel Survey, which provide nationally representative data. A simple simulation then extrapolated the data through 2006, for which the potential effects of Medicare Part D drug coverage were computed.

Welfare reform and the decline in the health-insurance coverage of children of non-permanent residents.

The 1996 Welfare Reform Act tightened public health-insurance coverage restrictions for non-permanent residents (NPRs) and altered the eligibility of newly permanent residents (PRs). By drawing on data from the SIPP, this paper explores to what extent welfare reform led to a decline in health-insurance coverage for children of NPRs. This paper proposes that the proportion of uninsured children of NPRs with low social economic status (SES) increased by approximately 10 percentage points relative to their PR counterparts.

The effects of expanded mental health benefits on treatment costs.

Background: Mental health disorders represent one of the most common problems facing adults in the labor force. It is estimated that within a 12-month period nearly 30% of the US population experiences some diagnosable mental health or addictive disorder. This study examines the impact that corporate benefit policies can have on mental health treatment costs.

The effect of distance to provider on employee response to changes in mental health benefits.

We assess whether distance to provider moderates the effect of a change in mental health benefits on treatment initiation of employees of a large US-based company for psychiatric disorders. Mental health treatment administrative claims data plus eligibility information provided by a Fortune 50 company for the years 1995-1998 are used for the analysis. The effect of distance is measured using the relative effect of the initiative on residents living far from providers compared to those living close to providers.

Expanded mental health benefits and outpatient depression treatment intensity.

Background: The justification for higher cost-sharing for behavioral health treatment is its greater price sensitivity relative to general healthcare treatment. Despite this, recent policy efforts have focused on improving access to behavioral health treatment.

Objectives: We measured the effects on outpatient treatment of depression of a change in mental health benefits for employees of a large U.

The effect of expanded mental health benefits on treatment initiation and specialist utilization.

Objective: To measure the effects of a mental health benefit design change on treatment initiation for psychiatric disorders of employees of a large U.S.-based company.