Social and demographic consequences of health insurance

Scholars are eager to evaluate the effects of health policy on health, but they often neglect that policies are intricately connected to marriage, family structure, and social standing. The three chapters of this dissertation study unintended consequences of health insurance policies in the United States. How people gain private health insurance is connected to divorce (chapter 1) and availability of a public insurance program at birth is associated with lower mortality not only in infanthood but also in adulthood (chapter 2). US health policies that tie health insurance coverage to socioeconomic status add dimensions to racial and ethnic inequality. Minorities spend more years without insurance due to their greater probabilities of losing coverage (chapter 3). These chapters provide national landscapes of health insurance coverage and inequality in the years prior to the Patient Protection and Affordable Care Act of 2010 setting the baseline for post-reform comparisons. In Chapter 1, I apply hazard models to the nationally representative longitudinal Survey of Income and Program Participation (2004 panel) to find lower divorce rates among people who are enrolled in their spouses’ health insurance policies. Women who depend on their husbands for health insurance had the lowest rates of divorce. This chapter highlights how family- and employment-based insurance coverage could create inequalities between families and between men and women. In Chapter 2, I use US Vital Statistics data to compare changes in age-specific mortality rates between cohorts born in states with Medicaid and cohorts born in states without Medicaid. I exploit the variation in the timing of States’ Medicaid participation to establish a connection between the availability of public insurance at birth to improvements in later life mortality. This chapter underscores the lasting consequences of having access to medical care during critical periods in the life-course. Chapter 3 examines the dynamics of gaining and losing health insurance across the life course and how it contributes to racial and ethnic disparities in coverage. African Americans, Hispanics, and Asians have high uninsurance rates mostly due to their greater likelihoods of losing the insurance that they already have. Life-table simulations show that simply increasing the accessibility of health insurance does surprisingly little to reduce disparities in insurance coverage. This paper draws attention to the importance of developing policies that stabilize existing insurance