Anthony T. LoSasso, PhD
Associate Professor, Health Policy & Administration
School of Public Health, University of Illinois at Chicago

The Health Care Safety Net and Crowd-Out of
Private Health Insurance


November 17, 2006
12:00 - 1:30 PM

Colonial Penn Center Auditorium

Abstract Paper

Biosketch:
Dr. Lo Sasso is an economist and applied econometrician whose research spans several dimensions of health and labor economics and health services research. He is currently in the final year of a 5-year Independent Scientist Award from the Agency for Healthcare Research and Quality studying workplace health benefits and how they affect employee health. As part of this broad research agenda, Dr. Lo Sasso has recently completed a study funded by the National Institute of Mental Health to examine the impact of an expansion of mental health benefits on cost and quality of care at a Fortune 50 manufacturing firm. In addition, Dr. Lo Sasso is currently studying the nascent consumer-driven health care movement and its potential impact on employer-sponsored health insurance and employee health. Other recent research has examined the effect of copayment levels on the use of employer-provided substance abuse benefits. Additionally, he has explored the extent of so-called “responsible purchasing” by employers: the degree to which employers collect and use non-financial information in selecting and managing employee health care plans. Dr. Lo Sasso is also keenly interested in how government policies affect private sector decisions. He has studied the impact of the State Children’s Health Insurance Program on uninsurance among children and the extent to which public coverage may have “crowded out” private coverage of children. He currently has a grant to study how community rating provisions in state non-group health insurance markets affect non-group health insurance coverage and uninsurance. Dr. Lo Sasso also has recently completed a project funded by the Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization initiative to study how the availability of safety net health care services affects the willingness of firms to offer health insurance and the willingness of employees to take-up health insurance when it is offered.

Abstract:
There is an extensive literature on the extent to which public health insurance coverage through Medicaid induces less private health insurance coverage. However, little is known about the effect of other components of the health care safety net in crowding out private coverage. We examine the effect of Medicaid and uncompensated care provided by clinics and hospitals on insurance coverage. We construct a long panel of state-level data on hospital uncompensated care and free and reduced price care offered by Federally Qualified Health Centers. We match this information to individual level data on coverage from the Current Population Survey for two distinct groups: children aged 14 and under and single, childless adults aged 18 to 64. Our results provide mixed evidence on the extent of crowd-out. Hospital uncompensated care does not appear to crowd-out health insurance coverage and health center uncompensated care appears to crowd-out private coverage for adults and, in some specifications, children.

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The Leonard Davis Institute of Health Economics.
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