Department of Economics, University of Hawaii at Manoa, UHERO, IZA, Honolulu, HI, USA.
Luskin School of Public Affairs, UCLA, IZA, NBER, Los Angeles, CA, USA.
Health Econ. 2020 Oct;29(10):1231-1250. doi: 10.1002/hec.4132. Epub 2020 Jul 27.
In March 2015, the State of Hawaii stopped covering the majority of migrants from countries belonging to the Compact of Free Association (COFA) in its Medicaid program. COFA migrants were required to obtain private insurance in the exchanges established under the Affordable Care Act. Using statewide hospital discharge data, we show that Medicaid-funded hospitalizations and emergency room visits declined in this population by 31% and 19%, respectively. Utilization funded by private insurance did increase but not enough to offset the declines in Medicaid-funded utilization. We show that the expiration of benefits increased uninsured ER visits. Finally, we exploit a feature of the policy change to provide evidence that the declines in utilization are due to higher rates of uninsured migrants rather than higher levels of cost sharing on private plans.
2015 年 3 月，夏威夷州停止在其医疗补助计划中为来自自由联系条约（COFA）国家的大多数移民提供保障。COFA 移民被要求在平价医疗法案（Affordable Care Act）下设立的交易所购买私人保险。利用全州范围的医院出院数据，我们发现，这部分人群的医疗补助计划资助的住院治疗和急诊就诊分别下降了 31%和 19%。私人保险支付的利用率确实有所增加，但不足以抵消医疗补助计划资助利用率的下降。我们发现，福利的终止增加了无保险的急诊就诊人数。最后，我们利用政策变化的一个特点提供证据表明，利用率的下降是由于未参保移民的比例较高，而不是私人计划的成本分担水平较高。
