The dynamic fiscal costs of outsourcing health insurance-evidence from Medicaid

• 成果类型: Article
• 署名作者: Layton, Timothy J.; Politzer, Eran
• 署名单位: University of Virginia; National Bureau of Economic Research; Hebrew University of Jerusalem
• 刊物名称: JOURNAL OF PUBLIC ECONOMICS
• ISSN/ISSBN: 0047-2727
• DOI: 10.1016/j.jpubeco.2025.105417
• 发表日期: 2025
• 关键词: Outsourcing; medicaid; Medicaid managed care; Disabled

摘要

We study the dynamics of fiscal costs following the outsourcing of Medicaid provision to private health insurers by states. We focus on beneficiaries with disabilities who account for a third of Medicaid's spending. Using a national administrative database, we identify county-level private plan enrollment mandates and exploit them as an instrument for individuals' transition to managed care plans. These transitions, while initially slightly reducing fiscal costs, lead to a continuous increase in Medicaid's costs over subsequent years. Counties subject to mandates experience a 9.8 % higher cost 4 years post-mandate compared to those without mandates. Actuarially sound endogenous payment rates, that are based on past costs in the market, may serve as a mechanism underlying the rising spending.