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

Timothy Halliday, Randall Akee (), Tetine Sentell, Megan Inada 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

No 2019-1, Working Papers from University of Hawaii Economic Research Organization, University of Hawaii at Manoa

Abstract: In March of 2015, the State of Hawaii stopped covering the vast majority of migrants from countries belonging to the Compact of Free Association (COFA) in the state Medicaid program. As a result COFA migrants were required 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. In addition, we show that uninsured ER visits increased as a consequence of the expiration of Medicaid benefits. 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)
Pages: 51 pages
Date: 2019-04
New Economics Papers: this item is included in nep-hea, nep-ias and nep-mig
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Working Paper: The Impact of Public Health Insurance on Medical Utilization in a Vulnerable Population: Evidence from COFA Migrants (2019) Downloads
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