Health insurance reform and bankruptcy

Kuklik, Michal (2010): Health insurance reform and bankruptcy.

Abstract

Abstract Medical bankruptcy was at the heart of the health care reform debate. According to Himmelstein et al. (2009), 62.1 percent of bankruptcies in the United States in 2007 were due to medical reasons. At the same time over 15 percent of Americans had no health insurance. The 2010 health care reform was designed to address the lack of health coverage and medical bankruptcies. In this paper, we employ a dynamic stochastic general equilibrium overlapping generations model with incomplete markets to quantitatively evaluate the impact of the health care reform on the health insurance market and the bankruptcy rate. We find that (i) the reform fails to address the bankruptcy problem as it cuts the bankruptcy rate by only 0.06 percentage point to 0.94 percent and the medical bankruptcy rate by 0.07 percentage point to 0.70 percent; (ii) the reform succeeds in providing almost universal insurance coverage with only 4.1 percent remaining uninsured; (iii) the average tax rate has to increase by 1.1 percent to finance the reform; (iv) the reform increases welfare by 5.2 percent; (v) the redistribution component of the reform drives the welfare gain by 5.8 percent, and the insurance market restructuring decreases welfare by 1.6 percent.

• Item Type: MPRA Paper
• Language: English
• Keywords: unsecured credit, bankruptcy, default, health insurance, health care reform, risk sharing, dynamic stochastic general equilibrium model, overlapping generations, heterogeneous agents
• Subjects: I - Health, Education, and Welfare > I1 - Health > I11 - Analysis of Health Care Markets; G - Financial Economics > G2 - Financial Institutions and Services > G22 - Insurance ; Insurance Companies ; Actuarial Studies; D - Microeconomics > D5 - General Equilibrium and Disequilibrium > D52 - Incomplete Markets; E - Macroeconomics and Monetary Economics > E2 - Consumption, Saving, Production, Investment, Labor Markets, and Informal Economy > E21 - Consumption ; Saving ; Wealth; G - Financial Economics > G3 - Corporate Finance and Governance > G33 - Bankruptcy ; Liquidation; D - Microeconomics > D6 - Welfare Economics > D60 - General; E - Macroeconomics and Monetary Economics > E6 - Macroeconomic Policy, Macroeconomic Aspects of Public Finance, and General Outlook > E60 - General

References

Patricia F. Adams and Patricia M. Barnes. Summary health statistics for the U.S. population: National health inteview survey, 2004. Vital Health Statatistics, 10(229), 2006.

S Rao Aiyagari. Uninsured idiosyncratic risk and aggregate saving. The Quarterly Journal of Economics, 109(3):659–84, August 1994.

Kartik Athreya. Welfare implications of the bankruptcy reform act of 1999. Journal of Monetary Economics, 49(8):1567–1595, November 2002.

Kartik Athreya. Default, insurance, and debt over the life-cycle. Journal of Monetary Economics, 55 (4):752–774, May 2008.

Kartik Athreya, Xuan S. Tam, and Eric R. Young. Unsecured credit markets are not insurance markets. Journal of Monetary Economics, 56(1):83–103, January 2009.

Orazio Attanasio, Sagiri Kitao, and Gianluca L. Violante. Financing Medicare: A General Equilibrium Analysis. 2008.

Orazio P. Attanasio. Consumption. In J. B. Taylor and M. Woodford, editors, Handbook of Macroeco- nomics, volume 1 of Handbook of Macroeconomics, chapter 11, pages 741–812. Elsevier, April 1999.

Felicitie C. Bell and Michael L. Miller. Life tables for the United States Social Security area, 1900-2100. Social Security Administration, Office of the Chief Actuary, 2002.

Ana Castaneda, Javier Diaz-Gimenez, and Jose-Victor Rios-Rull. Accounting for the U.S. earnings and wealth inequality. Journal of Political Economy, 111(4):818–857, August 2003.

Satyajit Chatterjee, Dean Corbae, Makoto Nakajima, and José-Víctor Ríos-Rull. A quantitative theory of unsecured consumer credit with risk of default. Econometrica, 75(6):1525–1589, November 2007.

Gary Claxton, Jon Gabel, Bianca DiJulio, Jeremy Pickreign, Heidi Whitmore,

Benjamin Finder, Paul Jacobs, and Samantha Hawkins. Health benefits in 2007: Premium increases fall to an eight-year low, while offer rates and enrollment remain stable. Health Affair, 26(5):1407–1416, 2007.

Janet Currie and Brigitte C. Madrian. Chapter 50 Health, health insurance and the labor market. In Orley C. Ashenfelter and David Card, editors, Handbook of Labor Economics, volume 3, Part 3 of Handbook of Labor Economics, pages 3309 – 3416. Elsevier, 1999.

David Dranove and Michael L Millenson. Medical bankruptcy: myth versus fact. Health Affair, 25(2): w74–w83, 2006.

Scott Fay, Erik Hurst, and Michelle J. White. The household bankruptcy decision. American Economic Review, 92(3):706–718, June 2002.

Eric A. Finkelstein, Ian C. Fiebelkorn, and Guijing Wang. National medical spending attributable to overweight and obesity: How much, and who’s paying? Health Affair, pages W3.219–226, 2003.

Katherine M. Flegal, Margaret D. Carroll, Cynthia L. Ogden, and Lester R. Curtin. Prevalence and trends in obesity among us adults, 1999-2008. JAMA, 303(3):235–241, 2010.

Paul Frijters, John P. Haisken-DeNew, and Michael A. Shields. The causal effect of income on health: Evidence from German reunification. Journal of Health Economics, 24(5):997 – 1017, 2005.

Miguel Gouveia and Robert P. Strauss. Effective federal individual tax functions: an exploratory empirical analysis. National Tax Journal 317-339 (June 1994), 47:317–339, June 1994.

Michael Grossman. On the concept of health capital and the demand for health. Journal of Political Economy, 80(2):223–55, March-Apr 1972.

David U. Himmelstein, Elizabeth Warren, Deborah Thorne, and Steffie Woolhandler. Illness and injury as contributors to bankruptcy. Health Affair, 24:w63–w73, 2005.