Welfare Effects of Health Policies through Coverage, Financing and Access to Medical Care

Session Submission Type: Panel

Abstract

Americans typically finance their medical care through a mixture of self payment and contributions made through health insurance. Whether commercially insured or covered through a public program such as Medicare, the interactions between coverage and financial security can significantly determine whether a person can access their needed medical care. This panel contains four papers that directly investigate the role that public policies play in affecting the coverage, financing and ultimately access to medical care.

State policies intended to provide financial relief can have direct effects on medical care use through their improved financial security and time availability. State-based paid family leave policies may affect healthcare use through these pathways. Eisenberg, Ge, Golberstein and Maclean, use all payer claims data available from IQVIA to identify the effect of state paid family leave policies on the use of mental healthcare. They find a small but imprecise effect of any mental health treatment after the adoption of a state paid sick leave mandate. However, they find significant declines in dispensed mental health medications and increases in both outpatient and inpatient mental health use following adoption of a state paid sick leave mandate, suggesting that consumers are more likely to substitute into outpatient mental health therapy from prescription drug treatment after a paid sick leave mandate.

Improved access to mental healthcare medication can have significant effects on social well being. Stanley and Harrell synthesize vital statistics, census, and health survey data to study how the introduction of Medicare Part D, comprehensive drug coverage for seniors, affected deaths of despair among the elderly through increased access to psychotropic medications as well as prescription opioids. They find that overall, Part D led to modest reductions in deaths by suicide, as well as an improvement self-reported mental health status in Medicare-eligible elders.

Medicare has broad coverage for medical care and prescription drugs. However, improvements in beneficiaries' access may accompany substantial changes to their cost sharing and or the availability of covered providers, especially if enrolled in Medicare Advantage (MA) over Traditional Medicare (TM). Xu and Biener use data from the Medical Expenditure Panel Survey to investigate whether aging into Medicare is associated with increased financial burden or difficulty affording needed medical services and prescription drugs. They find that, while Medicare overall reduces financial burdens, some beneficiaries may experience greater difficulty affording prescription medications due to income based subsidies only available to some beneficiaries through Part D.

Recent policies, including the Part D Senior Savings (PDSS) Model test (2021-2023) and the 2022 Inflation Reduction Act (IRA) may have affected the way Part D plans design their drug benefits, potentially affecting beneficiaries' access. In a study of the benefit design of Medicare Part D with regard to insulin to treat diabetes, Christine Buttorff finds that recently, plans are moving insulin to a single tier on their formularies, but not altering other plan design elements to limit utilization such as the use of prior authorizations. These findings demonstrate the strategic adjustments insurers may be making in response to policy changes.

Policy Area

• Health Policy

Secondary Policy Area

• Poverty and Income Policy

Chair

• Kosali Simon, Indiana University

Discussants

• David M Anderson, University of South Carolina

• Benjamin Jacob Harrell, Trinity College

Organizer

• Adam Ira Biener, Lafayette College

Individual Presentations

• Time for mental health care: Evidence from paid sick leave mandates - Presenting Author: Ezra Golberstein, University of Minnesota

• Medicare Part D and Senior Deaths of Despair - Presenting Author: Bryce Stanley, Brown University; Non-Presenting Co-Author: Benjamin Jacob Harrell, Trinity College

• Aging into Medicare and Financial Burdens and Affordability of Medical Care and Prescription Drugs - Non-Presenting Co-Author: Wendy Yi Xu, The Ohio State University; Presenting Author: Adam Ira Biener, Lafayette College

• Medicare Part D Insulin Coverage: Formulary Strategies Amid Policy Headwinds - Presenting Author: Christine Buttorff, RAND Corporation