The role of asset testing in public health insurance reform

Abstract

Starting slowly with the 1996 Welfare Reform Act and culminating in the 2010 Affordable Care Act, means-tested public health insurance eligibility expanded to include adults in low-income families regardless of their asset holdings. This paper quantifies the effects of these eligibility expansions within the context of the 2010 Affordable Care Act. I construct a dynamic stochastic general equilibrium model with indivisible labor supply expanded to include an endogenous household choice of health insurance coverage and calibrate it to U.S. data. I establish that changes in the distribution of labor and welfare associated with removal of asset testing are driven by exit of high productivity and high wealth households from the labor market. I then expand my analysis to the 2010 Affordable Care Act to demonstrate that removal of asset testing is critical to the obtained results even when combined with other provisions of the Act. Finally, I find that a simple asset test for eligibility of health insurance transfers undoes the distortion to the household labor supply decision among high productivity types. These results are robust to the introduction of employer premium contributions, an independent health insurance market, and idiosyncratic shocks to eligibility for employment-based health insurance.