Journal of Economic Literature (JEL) Code(s)
I aim to shed light on why emergency room (ER) utilization increased following the Oregon Health Insurance Experiment but decreased following a Massachusetts policy. To do so, I unite the literatures on insurance and treatment eﬀects. Under an MTE model that assumes no more than the LATE assumptions, comparisons across always takers, compliers, and never takers can inform the impact of polices that expand and contract coverage. Starting from the Oregon experiment as the “gold standard,” I make comparisons within Oregon and extrapolate my ﬁndings to Massachusetts. Within Oregon, I ﬁnd adverse selection and heterogeneous moral hazard. Although previous enrollees increased their ER utilization, evidence suggests that subsequent enrollees will be healthier, and they will decrease their ER utilization. Accordingly, I can reconcile the Oregon and Massachusetts results because the Massachusetts policy expanded coverage from a higher baseline, and new enrollees reported better health.
Kowalski, Amanda E., "Extrapolation using Selection and Moral Hazard Heterogeneity from within the Oregon Health Insurance Experiment" (2018). Cowles Foundation Discussion Papers. 136.