Job Market Paper
Subsidies, taxes, premiums, and eligibility for health insurance can potentially cause “marriage lock,” in which couples stay married for the sake of health insurance coverage. In addition, marriage lock may change as health insurance exchanges increase health insurance options under the Affordable Care Act. In this paper, marriage lock is examined under two key insurance decisions: divorce decisions due to qualification for Medicare at age 65, and marriage and divorce decisions caused by the introduction of the Massachusetts insurance mandate and health insurance exchange market under the 2006 healthcare reform. Using the Health and Retirement Study for adults aged 60–70, I first examine whether employer-based health insurance coverage for the spouse discourages divorce for spousal health insurance coverage-dependent individuals by reviewing the discontinuity created at age 65 through qualification for Medicare. Diverse difference-in-difference models provide evidence of a 7 percent larger positive effect of Medicare eligibility on late life divorce for people with spousal insurance coverage dependence than for those without it. Next, using American Community Survey data, I examine how marriage behavior changed when the health insurance exchange market and individual mandate were introduced to Massachusetts in 2006 relative to control states. I find that the 2006 Massachusetts healthcare reform increased incentives for marriage in the health insurance exchanges market. Specifically, the Massachusetts reform appears to have reduced the divorce rates by approximately 0.5 percent and increased marriage rates by approximately 1.4 percent. My estimates in the paper provide some evidence that “marriage lock” exists and further suggest that health insurance coverage could serve as a marriage lock and the price of health insurance also plays an important role.
“Comparisons of Health Insurance Systems in Developed Countries” Joint with Randall P. Ellis and Calvin E. Luscombe Forthcoming in Anthony J. Culyer (ed) Encyclopedia of Health Economics, Elsevier Press.
Health insurance systems in developed countries vary in many dimensions. We develop a frame work for discussing these dimensions and then use this framework to compare the health insurance systems of Canada, Germany, Japan, Singapore and the US. These countries span a wide array of dimensions, including who in the system bears risk, what choices are allowed, how much health spending burdens are redistributed, sources of revenue, cost saving strategies, and use of specialized and secondary insurance.
Other Working Papers
- Preference Heterogeneity and Medical Expenditures: A Case Study of Medical Saving Accounts in China
By forcing patients to be responsible for their own medical expenditures, Medical Savings Accounts (MSAs) have been presented as appealing health care financing alternatives in times of rising health care expenses. However, in order for MSAs to be functional, an important assumption is that enrollees treat balance in their MSAs the same as their pocket money. Using the China Household Finance Survey (CHFS), some interesting findings are discovered in this paper. Opposing correlations were found between medical expenditures and the MSA balance and the after-tax income, while an inverse correlation was found between medical expenditures and certain risky behaviors. First, individuals with MSAs incurred about 2% more medical expenses per unit of MSAs balance as compared to individuals without MSAs. At the same time, only about 0.1% less medical expenses were incurred per unit of increase in after-tax income. Second, certain risky behavior, e.g. lower seat-belt use and ignoring traffic lights, are correlated with about 27% and 15% lower medical expenditures, respectively; while other behaviors, e.g. undertaking risky investments, are correlated with about 30% more medical expenditures. However, unlike the findings of Cutler, et al.( 2008), my estimates suggest that individuals who always wear a seat belt tend to have 29% higher medical expenditures covered by insurance with MSAs. A likely explanation is that individuals who always wear a seat belt tend to use more preventive health services with their MSAs. These findings suggest that preference heterogeneity plays an important role in the medical expenditures incurred in health insurance markets, while the effects of various risky behaviors on medical expenses are even more mixed under the MSA scheme.
- Economic Stress, Rising Housing Prices, and Mortality in China
The length of a person’s life is believed to depend on a mixture of economic and social factors. This paper provides evidence that high levels of economic stress associated with the rising price of housing play an important role in longevity. This research, which focuses on 31 Chinese provinces and municipalities during the country’s rapid development from 1995 to 2003, investigates whether major stressors, such as rising housing prices, lead to an increase in mortality. Housing is an important prerequisite for marriage in the Chinese culture, and the traditional Chinese value of buying property before getting married still has a significant effect on the young generation. As such, owning a home is important especially for young men eager to get married and start a family, and its reduced accessibility and declining affordability in times of rising housing price may be a significant source of stress. On one hand, estimates of a simple regression report that the mortality rate decreases by about 8.2% as housing price increases by one unit (¥100/m²), which supports the argument that lasting economic growth leads to better health in developing countries. On the other hand, this research demonstrates that long-term high levels of stress from rising housing prices in China contribute to an increase of 2.8% in mortality rate, and is dependent on an individual’s average savings. These findings suggest that an individual’s longevity increases along with rapid economic growth and improved quality of life in developing countries; however, elevated stress levels associated with rising housing prices may increase the risk of death in the long term.