We use a regression discontinuity design to understand the impact of a sharp change in eligibility for Medicaid versus subsidized marketplace insurance at 138 percent of the federal poverty line on coverage, medical spending, health status, and other public program participation. We find a 5.5 percentage point shift from Medicaid to private insurance, with no net change in coverage. The shift increases individual health spending by $341 or 2 percent of income, with larger increases at higher points in the spending distribution. Two-thirds of the increase is from premiums and one-thirdfrom out-of-pocket medical spending. Self-rated health and other public program participation appear unchanged. We find no evidence of bunching below the eligibility threshold, which suggests either that individuals are willing to pay more for private insurance or that optimization frictions are high.
This study examines the long-term link between in-utero cigarette taxes and adult prenatal smoking. We use U.S. birth certificate records to demonstrate that exposure to higher in-utero cigarette taxes (over 1965-2001) reduces later-life adult pre-pregnancy and prenatal smoking. We also show that higher in-utero cigarette taxes have long-lasting effects on adult health, and intergenerational consequences for infant health. Finally, we demonstrate that larger in-utero tax responsiveness correlates with smaller contemporary cigarette tax responsiveness, suggesting that higher in-utero taxes may alter the composition of remaining smokers and contribute to reductions in contemporary cigarette tax responsiveness.
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