The Impact of Public Health Insurance on Medical Utilization in a Vulnerable Population: Evidence from COFA Migrants

Timothy Halliday, Tetine Sentell (), Megan Inada (), Randall Akee and Jill Miyamura ()
Additional contact information
Tetine Sentell: University of Hawaii at Manoa
Megan Inada: Kokua Kalihi Valley Comprehensive Family Services
Jill Miyamura: Hawaii Health Information Corporation
Authors registered in the RePEc Author Service: James Roumasset

No 201905, Working Papers from University of Hawaii at Manoa, Department of Economics

Abstract: In March of 2015, the State of Hawaii stopped covering migrants from countries belonging to the Compact of Free Association (COFA) in the state Medicaid program, forcing COFA migrants to obtain private insurance in health insurance exchanges established under the Affordable Care Act. Using statewide administrative hospital discharge data, we show that Medicaid-funded hospitalizations and emergency room visits declined in this population by 69% and 42% after the expiration of Medicaid eligibility. Utilization funded by private insurance did increase but not enough to offset the declines in publicly-funded utilization. This resulted in a net decrease in utilization. Paradoxically, we also find a substantial increase in Medicaid-funded ER visits by infants after the expiration of benefits which is consistent with a substitution of ER visits for ambulatory care for the very young.

Keywords: Immigration; Health Insurance; Cost Sharing; Medicaid; Insurance Exchange (search for similar items in EconPapers)
JEL-codes: I10 I14 J61 (search for similar items in EconPapers)
Date: 2019-03
New Economics Papers: this item is included in nep-ene, nep-sea and nep-tid
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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http://www.economics.hawaii.edu/research/workingpapers/WP_19-05R.pdf First version, 2019 (application/pdf)

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Working Paper: The Impact of Public Health Insurance on Medical Utilization in a Vulnerable Population: Evidence from COFA Migrants (2019)
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