The Oregon Health Insurance Experiment: Evidence from the First Year*

Can Consumers Make Affordable Care Affordable? The Value of Choice Architecture

Tens of millions of people are currently choosing health coverage on a state or federal health insurance exchange as part of the Patient Protection and Affordable Care Act. We examine how well people make these choices, how well they think they do, and what can be done to improve these choices. We conducted 6 experiments asking people to choose the most cost-effective policy using websites modeled on current exchanges. Our results suggest there is significant room for improvement. Without interventions, respondents perform at near chance levels and show a significant bias, overweighting out-of-pocket expenses and deductibles. Financial incentives do not improve performance, and decision-makers do not realize that they are performing poorly. However, performance can be improved quite markedly by providing calculation aids, and by choosing a “smart” default. Implementing these psychologically based principles could save purchasers of policies and taxpayers approximately 10 billion dollars every year.

Choose to Lose: Health Plan Choices from a Menu with Dominated Option*

Abstract We examine the health plan choices that 23,894 employees at a U.S. firm made from a large menu of options that differed only in financial cost-sharing and premium. These decisions provide a clear test of the predictions of the standard economic model of insurance choice in the absence of choice frictions because plans were priced so that nearly every plan with a lower deductible was financially dominated by an otherwise identical plan with a high deductible. We document that the majority of employees chose dominated plans, which resulted in excess spending equivalent to 24% of chosen plan premiums. Low-income employees were significantly more likely to choose dominated plans, and most employees did not switch into more financially efficient plans in the subsequent year. We show that the choice of dominated plans cannot be rationalized by standard risk preference or any expectations about health risk. Testing alternative explanations with a series of hypothetical-choice experiments, we find that the popularity of dominated plans was not primarily driven by the size and complexity of the plan menu, nor informed preferences for avoiding high deductibles, but by employees’ lack of understanding of health insurance. Our findings challenge the standard practice of inferring risk preferences from insurance choices and raise doubts about the welfare benefits of health reforms that expand consumer choice.

Taxpayers spend about $2 billion annually on Medicaid for Amazon and Walmart employees

American taxpayers are spending billions every year providing Medicaid benefits to hundreds of thousands of employees of Amazon and Walmart, a new analysis by Popular Information reveals.

Why Do Americans Have Shorter Life Expectancy and Worse Health Than Do People in Other High-Income Countries?

Americans lead shorter and less healthy lives than do people in other high-income countries. We review the evidence and explanations for these variations in longevity and health. Our overview suggests that the US health disadvantage applies to multiple mortality and morbidity outcomes. The American health disadvantage begins at birth and extends across the life course, and it is particularly marked for American women and for regions in the US South and Midwest. Proposed explanations include differences in health care, individual behaviors, socioeconomic inequalities, and the built physical environment. Although these factors may contribute to poorer health in America, a focus on proximal causes fails to adequately account for the ubiquity of the US health disadvantage across the life course. We discuss the role of specific public policies and conclude that while multiple causes are implicated, crucial differences in social policy might underlie an important part of the US health disadvantage.

How Are SNAP Benefits Spent? Evidence from a Retail Panel

We use a novel retail panel with detailed transaction records to study the effect of the Supplemental Nutrition Assistance Program (SNAP) on house-hold spending. We use administrative data to motivate three approaches to causal inference. The marginal propensity to consume SNAP-eligible food (MPCF) out of SNAP benefits is 0.5 to 0.6. The MPCF out of cash is much smaller. These patterns obtain even for households for whom SNAP benefits are economically equivalent to cash because their benefits are below their food spending. Using a semiparametric framework, we reject the hypothesis that households respect the fungibility of money. A model with mental accounting can match the facts.

Unconditional cash transfers reduce homelessness

Homelessness is an economic and social crisis. In a cluster-randomized controlled trial, we address a core cause of homelessness—lack of money—by providing a one-time unconditional cash transfer of CAD$7,500 to each of 50 individuals experiencing homelessness, with another 65 as controls in Vancouver, BC. Exploratory analyses showed that over 1 y, cash recipients spent fewer days homeless, increased savings and spending with no increase in temptation goods spending, and generated societal net savings of $777 per recipient via reduced time in shelters. Additional experiments revealed public mistrust toward the ability of homeless individuals to manage money and demonstrated interventions to increase public support for a cash transfer policy using counter-stereotypical or utilitarian messaging. Together, this research offers a new approach to address homelessness and provides insights into homelessness reduction policies.

Behaviorally Informed Policies for Household Financial Decisionmaking

Low incomes, limited financial literacy, fraud, and deception are just a few of the many intractable economic and social factors that contribute to the financial difficulties that households face today. Addressing these issues directly is difficult and costly. But poor financial outcomes also result from systematic psychological tendencies, including imperfect optimization, biased judgments and preferences, and susceptibility to influence by the actions and opinions of others. Some of these psychological tendencies and the problems they cause may be countered by policies and interventions that are both low cost and scalable. We detail the ways that these behavioral factors contribute to consumers’ fiancial mistakes and suggest a set of interventions that the federal government, in its dual roles as regulator and employer, could feasibly test or implement to improve household financial outcomes in a variety of domains: retirement, short-term savings, debt management, the take-up of government benefits, and tax optimization.

Behavioral Impediments to Valuing Annuities: Complexity and Choice Bracketing

Abstract This paper examines two behavioral factors that diminish people's ability to value a lifetime income stream or annuity, drawing on a randomized experiment with about 4,000 adults in a U.S. nationally representative sample. We find that increasing the complexity of the annuity choice reduces respondents' ability to value the annuity, measured by the difference between the sell and buy values they assign to the annuity. When we limit narrow choice bracketing by inducing people to think first about how quickly or slowly to spend down assets in retirement, their ability to value an annuity increases.

US Domestic Policy Dashboard - Impact Counter | Impact Counter

Explore US domestic policies and their impact on public health across all branches of government.

Psychological ownership interventions increase interest in claiming government benefits

Significance Most government benefits programs exhibit a sizable participation gap, with eligible individuals forgoing billions of dollars in government benefits each year. Many policymakers have focused on addressing this participation gap, as receiving government benefits has been shown to reduce poverty, childhood hunger, educational gaps, and physical and mental illness. The current work presents psychological ownership framing as a behavioral science intervention, and we show that it can help address this benefits participation gap. These interventions are subtle, simple to implement, and cheaper to execute relative to logistical interventions. Moreover, the data show that psychological ownership interventions can be more efficacious than other common psychological interventions such as social norms and urgency. , Each year, eligible individuals forgo billions of dollars in financial assistance in the form of government benefits. To address this participation gap, we identify psychological ownership of government benefits as a factor that significantly influences individuals’ interest in applying for government benefits. Psychological ownership refers to how much an individual feels that a target is their own. We propose that the more individuals feel that government benefits are their own, the less likely they are to perceive applying for them as an aversive ask for help, and thus, the more likely they are to pursue them. Three large-scale field experiments among low-income individuals demonstrate that higher psychological ownership framing of government benefits significantly increases participants’ pursuit of benefits and outperforms other common psychological interventions. An additional experiment shows that this effect occurs because greater psychological ownership reduces people’s general aversion to asking for assistance. Relative to control messages, these psychological ownership interventions increased interest in claiming government benefits by 20% to 128%. These results suggest that psychological ownership framing is an effective tool in the portfolio of potential behavioral science interventions and a simple way to stimulate interest in claiming benefits.

Most Community Health Centers Provide Prenatal Care, But One-Third Still Lack Services | HPHCI: Department of Population Medicine

Boston, MA—A new national study provides the first comprehensive look at prenatal care services offered by federally qualified health centers (FQHCs), revealing that while these safety-net providers play a critical role in caring for low-income and racially diverse pregnant populations, significant gaps in access remain.

Estimating Causal Effects of Treatments in Randomized and Nonrandomized Studies

Presents a discussion of matching, randomization, random sampling, and other methods of controlling extraneous variation. The objective was to specify the benefits of randomization in estimating causal effects of treatments. It is concluded that randomization should be employed whenever possible but that the use of carefully controlled nonrandomized data to estimate causal effects is a reasonable and necessary procedure in many cases.

Claim denial rates from health insurers have been declining (maybe) - Kevin Drum

I'll have our last ACS chart later, but in the meantime I happened to run across some actual data about health insurer claim denial rates, the topic du jour since UnitedHealthcare CEO Brian Thompson was gunned down in broad daylight, allegedly in part because of his company's astronomical denial rate. These figures come from ACA transparency data and is limited…

UnitedHealth pushed employees to follow an algorithm to cut off Medicare patients' rehab care

UnitedHealth executives pressured clinical staff to follow an algorithm to cut off patients’ rehab care, leading to coverage decisions that may violate Medicare regulations.

The persistence of cognitive biases in financial decisions across economic groups

While economic inequality continues to rise within countries, efforts to address it have been largely ineffective, particularly those involving behavioral approaches. It is often implied but not tested that choice patterns among low-income individuals may be a factor impeding behavioral interventions aimed at improving upward economic mobility. To test this, we assessed rates of ten cognitive biases across nearly 5000 participants from 27 countries. Our analyses were primarily focused on 1458 individuals that were either low-income adults or individuals who grew up in disadvantaged households but had above-average financial well-being as adults, known as positive deviants. Using discrete and complex models, we find evidence of no differences within or between groups or countries. We therefore conclude that choices impeded by cognitive biases alone cannot explain why some individuals do not experience upward economic mobility. Policies must combine both behavioral and structural interventions to improve financial well-being across populations.

Do people like financial nudges?

Do people like financial nudges? To answer that question we conducted a pre-registered survey presenting people with 36 hypothetical scenarios describing financial interventions. We varied levels of transparency (i.e., explaining how the interventions worked), framing (interventions framed in terms of spending, or saving), and ‘System’ (interventions could target either System 1 or System 2). Participants were a random sample of 2,100 people drawn from a representative Australian population. All financial interventions were tested across six dependent variables: approval, benefit, ethics, manipulation, the likelihood of use, as well as the likelihood of use if the intervention were to be proposed by a bank. Results indicate that people generally approve of financial interventions, rating them as neutral to positive across all dependent variables (except for manipulation, which was reverse coded). We find effects of framing and System. People have strong and significant preferences for System 2 interventions, and interventions framed in terms of savings. Transparency was not found to have a significant impact on how people rate financial interventions. Financial interventions continue to be rated positive, regardless of the messenger. Looking at demographics, we find that participants who were female, younger, living in metro areas and earning higher incomes were most likely to favor financial interventions, and this effect is especially strong for those aged under 45. We discuss the implications for these results as applied to the financial sector.