OBJECTIVE:To investigate the effects of local labor market conditions and the availability of employer-sponsored health insurance on exits from the Medicaid program. DATA SOURCE:Data for this project come from a unique administrative database containing a 2 percent sample of all cases on California's Medicaid program in 1987 and a 2 percent sample of all new cases starting each year between 1987 and 1995. STUDY DESIGN:The results are estimated using a discrete duration model where the monthly exit probability is a function of demographic characteristics, local labor market variables, the probability of having employer-sponsored insurance, and fixed year and county effects. PRINCIPAL FINDINGS:Improvements in labor market opportunities (i.e., employment growth, wage growth, and increases in the availability of employer-sponsored health insurance) promote exits off the Medicaid program. A 2.5 percentage point increase in the availability of employer-sponsored insurance leads to a 6 percent increase in the probability that a completed spell lasts no more than 2 years. It would take a 2 percentage point decrease in unemployment rates or a 10 percent increase in average quarterly earnings to yield an equivalent increase in the likelihood of exiting Medicaid within 2 years. These effects are robust to the inclusion of county-level fixed effects and time effects. CONCLUSIONS:Medicaid expenditures and caseloads are sensitive to local economic fluctuations and secular trends in the availability of health insurance. Continued decreases in employer-based health insurance coverage will greatly increase the demand for public insurance coverage and the financial pressures on state governments.

译文

目的:调查当地劳动力市场状况以及雇主赞助的医疗保险对医疗补助计划退出的影响。
数据来源:该项目的数据来自一个独特的管理数据库,该数据库包含1987年加利福尼亚州医疗补助计划所有病例的2%样本,以及从1987年至1995年每年开始的所有新病例的2%样本。
研究设计:使用离散持续时间模型估算结果,其中每月退出概率是人口统计学特征,当地劳动力市场变量,拥有雇主赞助的保险的概率以及固定的年度和县级影响的函数。
主要发现:劳动力市场机会的增加(即就业增长,工资增长以及雇主赞助的健康保险的增加)促使人们退出了医疗补助计划。雇主赞助的保险的可用性增加2.5个百分点,则完整的持续时间不超过2年的概率将增加6%。失业率降低2个百分点或平均季度收入提高10%,才能在2年内退出医疗补助计划。这些效应对于将县级固定效应和时间效应包括在内是有力的。
结论:医疗补助支出和病案量对当地经济波动和健康保险可及性的长期趋势很敏感。基于雇主的健康保险覆盖率的持续下降将大大增加对公共保险覆盖率的需求以及州政府的财务压力。

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