Benefit Generosity Research Articles

Dental Care Use Among Children and Adolescents in Medicaid: Associations With State-Level Medicaid Policy Factors and Provider Availability.

The aim of this study was to assess the relative strength of association of four state-level factors-Medicaid reimbursement, Medicaid adult dental benefit (MADB) generosity, dentist Medicaid participation, and dentist supply-on individual-level dental care use among children and adolescents in Medicaid. This national cross-sectional study used 2018-2019 National Survey of Children's Health data to estimate dental care utilizationamong children aged 1-17 enrolled in Medicaid. Subgroup analyses were conducted by child age group. A hierarchical regression approach was used; a series of logistic regression models assessed relative effect sizes among the four state-level variables. Among children aged 1-17, and the age 1-3 subgroup, dentist Medicaid participation was positively associated with dental care use. Among children aged 4-11, children in states with Emergency/No dental coverage for adults had greater odds of having a dental visit compared to children in states with Extensive dental coverage. Among adolescents aged 12-17, no state-level factors were associated with dental utilization. There was considerable variation by age group in the associations of state-level factors on dental care use among children and adolescents in Medicaid. Dentist participation in Medicaid was associated with dental care use among very young children. State-level policy levers have the potential to improve access to dental care for children enrolled in Medicaid, and are critical to achieve improvement toward oral health equity for children.

Cost-Associated Unmet Dental, Vision, And Hearing Needs Among Low-Income Medicare Advantage Beneficiaries.

Medicare Advantage (MA) supplemental benefits offered at no or low premiums are a key value proposition for low-income beneficiaries. Despite nearly $20billion in rebate payments to MA plans for funding supplemental benefits, their quality or enrollee access is not monitored. Using 2018-19 Medicare Current Beneficiary Survey data linked to MA plan data, we found that regardless of plan benefit generosity, low-income beneficiaries were more likely to report dental, vision, and hearing unmet needs because of cost. Enrollment in plans with higher corresponding-year (that is, the same year as unmet need measurement) star ratings was associated with lower dental unmet need. Income-related disparities in dental unmet needs were lower in the highest-rated plans. However, prior-year star ratings that determined plan payments were not associated with unmet needs or disparities in those needs. Policy makers should consider monitoring supplemental benefits for equity and access, and they should assess the value added by quality bonus payments to high-rated plans for beneficiaries' access.

His unemployment, her response, and the moderating role of welfare policies in European countries. Results from a preregistered study.

Recent changes in labour markets have increased employment instability. Under these conditions, in male breadwinner families women might increase their labour supply when their male partners become unemployed. Previous studies have extensively investigated the role played by household and individual characteristics in explaining such increases in the labour supply of women. However, studies which examine the moderating role of specific welfare policies are missing. Our study contributes to the literature by investigating the moderating effect of childcare and tax-benefit policies for the labour supply response of women following the unemployment of their partner. We focus on a sample of 24 EU member states and the UK, during the period 2009-2019, combining longitudinal microdata from EU-SILC with country-period specific policy indicators generated with the use of the tax-benefit simulation model EUROMOD, UKMOD and country-period specific indicators of childcare use. We find that women indeed respond to men's unemployment by increasing their labour supply though the response is fairly weak. We also find the response is not restricted by having children at home or availability of public childcare and does not depend on the generosity of unemployment benefits. It is, however, negatively affected by marginal tax rates.

Family structure and policy contexts: implications for tertiary education attainment in 25 European countries

Abstract This study examines how institutional contexts in 25 European countries moderate the association between family structure and tertiary education attainment. Previous research has proposed the resource deprivation perspective to explain lower educational outcomes among children from disrupted families, suggesting that policies addressing resource deprivation could mitigate these negative consequences. However, limited attention has been given to the role of policy contexts in shaping the educational outcomes of youth from disrupted families. This study focuses on two types of policies: the generosity of social benefits to single parents and financial support for students in tertiary education. Using data from the EU-SILC and employing multilevel regression models, the findings indicate that generous financial support for students reduces the tertiary education attainment gap between youth from separated and two-parent families. However, this effect is observed only among low-socioeconomic status (SES) and moderate-SES families. In contrast, the generosity of social benefits does not appear to moderate the association between family structure and tertiary education attainment, even when examining low-SES families or specifically considering benefits for low-earning single parents. Furthermore, the influence of these analysed policies is limited among young people from widowed families.

The Impact of Benefit Generosity on Workers’ Compensation Claims: Evidence and Implications

Leveraging unique administrative data and a sharp increase in benefit generosity in a difference-in-differences research design, we estimate the impact of workers’ compensation wage replacement benefits on individual behavior and program costs. We find that increased benefit generosity leads to longer income benefit durations and increased medical spending. Responses along these two margins are equally important drivers of increased program costs, collectively increasing program costs 1.4 times the mechanical increase in costs. Using these estimates and an estimate of the consumption drop among injured workers, our welfare calibrations suggest that a marginal increase in benefit generosity would not improve welfare. (JEL D91, I11, J28, J31)

Medicaid Dental Benefits for Pregnant People and Dental Care Use Among Very Young Children.

The aim of this study was to examine the association between Medicaid dental benefits for pregnant people and dental care use among very young children in Medicaid. We hypothesized that children living in states with more generous dental benefits for Medicaid-enrolled pregnant people would be more likely to have a recent dental visit. This national cross-sectional study used pooled2017-2019 data from the National Survey of Children's Health, as well as state Medicaid policy data. The study sample included children aged 0-2 enrolled in Medicaid. Multivariable logistic regression models estimated the association between Medicaid dental benefit generosity for pregnant people and the child having a dental visit in the past year. Children in states with emergency-only dental coverage for pregnant people were 2.5 times as likely to have had a dental visit than children in states with extensive coverage (OR 2.48, 95% CI 1.35-4.53). In supplemental analyses excluding children living in Texas, there was no longer an association between dental coverage for pregnant people and dental utilization among young children (OR 1.52, 95% CI 0.82-2.83). Young children in states that provided emergency-only dental benefits for pregnant people in Medicaid had significantly higher odds of dental utilization than young children in states with more generous dental benefits for pregnant people. This relationship disappeared after excluding the state Texas, which had the highest rate of child dental utilization in the country and provided emergency-only dental benefits for pregnant people in Medicaid.

National Health Expenditure Projections, 2023-32: Payer Trends Diverge As Pandemic-Related Policies Fade.

Health care spending growth is expected to outpace that of the gross domestic product (GDP) during the coming decade, resulting in a health share of GDP that reaches 19.7percent by 2032 (up from 17.3percent in 2022). National health expenditures are projected to have grown 7.5percent in 2023, when the COVID-19 public health emergency ended. This reflects broad increases in the use of health care, which is associated with an estimated 93.1percent of the population being insured that year. In 2024, Medicaid enrollment is projected to decline significantly as states continue their eligibility redeterminations. Simultaneously, private health insurance enrollment is projected to increase because of the extension of enhanced subsidies for direct-purchase health insurance under the Inflation Reduction Act (IRA) of 2022, as well as a temporary special enrollment period for qualified people losing Medicaid coverage (after eligibility redeterminations). Over the course of 2024-26, the IRA expands Medicare's drug benefit generosity and implements drug price negotiations for beneficiaries; concurrently, the extended enhanced subsidies for direct-purchase health insurance expire in 2026. During 2027-32, personal health care price inflation and growth in the use of health care services and goods contribute to projected health spending that grows at a faster rate than the rest of the economy.

The Impact of Family Tax Benefits on Children’s Health and Educational Outcomes

We leverage recent income support reforms for families with children in Canada to investigate the impact of child benefits on child health and educational outcomes. Using administrative school data from British Columbia linked to parents' tax files, we find evidence that increased family benefit generosity improved children's mental health, but little evidence of any change in test scores from standardized exams. Our results suggest that most of the mental health effect is concentrated among girls and that relative improvements in mental health were larger among children in higher-income families.

Unemployment Insurance (UI) Benefit Generosity and Labor Supply from 2002 to 2020: Evidence from California UI Records

Unemployment Insurance (UI) Benefit Generosity and Labor Supply from 2002 to 2020: Evidence from California UI Records

Quantity over quality? How economic factors and welfare state interventions affected job insecurity and job quality before, during and after the economic crises

AbstractThis article uses multilevel analysis of 24 European countries to examine the effects of macroeconomic variables (GDP and unemployment) and welfare state interventions (active and passive labour market policies) on job insecurity and job quality in Europe from the mid‐1990s until the last 2021 COVID crisis. The paper makes a distinction between the crisis of the welfare state and the reaction of welfare states to crises and connects the job quality literature with that on the transformation of the welfare state. The article introduces several innovations to the literature by looking at the impact of welfare state interventions on multidimensional job quality, distinguishing between different types of active labour market policy spending and considering the generosity of benefits. The findings show that active labour market policies (ALMPs) and passive labour market policies (PLMPs) have a positive effect in reducing job insecurity across skill groups. ALMPs and PLMPs also improved several dimensions of job quality, but mostly among manual/low‐skilled workers, while they have a negative effect on work pressure which mostly affects medium‐ and high‐skilled workers. The article concludes by discussing how, due to the reach of ALMP and PLMP interventions, the positive effects of the welfare state on job quality are concentrated among lower‐skilled workers, thereby limiting the ambition of contemporary welfare states to generate positive spillover effects on the quality of work for all workers.

Unemployment Insurance and the Family: Heterogeneous Effects of Benefit Generosity on Reemployment and Economic Precarity

Unemployment Insurance and the Family: Heterogeneous Effects of Benefit Generosity on Reemployment and Economic Precarity

UI Benefit Generosity and Labor Supply from 2002-2020

UI Benefit Generosity and Labor Supply from 2002-2020

Did pandemic unemployment benefits increase unemployment? Evidence from early state‐level expirations

AbstractDuring the 2021 pandemic year, the generosity of Unemployment Insurance benefits was expanded (Federal Pandemic Unemployment Compensation [FPUC]) and eligibility for benefits was broadened (Pandemic Unemployment Assistance [PUA]). These two programs were set to expire in September 2021. In June 2021, 18 states exited both FPUC and PUA and three states exited FPUC (but not PUA). Using Current Population Survey data and a wide range of estimation methods, we find that the flow of unemployed workers into employment increased by around two‐thirds following early exit among prime‐age workers. We also find evidence of reductions in state‐level unemployment rates, increases in employment‐populations ratios, and reductions in the share of households that had no difficulty meeting expenses.

Two faces of benefit generosity: comparing justice preferences in the access to and level of welfare benefits

Abstract Welfare generosity is a multidimensional concept that refers to both the access to benefits and the levels of benefits (in terms of the amounts paid to recipients). However, in analyses of public support for welfare, this distinction has been largely disregarded. To gain a fuller picture of attitudes towards welfare redistribution, the current study explicitly compares the two elements and examines which distributive justice principles—that is, equality, equity, and need—are preferred to govern, on the one hand, the access to benefits and, on the other hand, their levels. The article evaluates this distinction in two different distributive contexts (pensions and unemployment benefits) and contrasts social-structural as well as ideological dividing lines. For this purpose, data from the Belgian National Elections Study 2019 are analysed. The results indicate that the access to and levels of benefits are clearly distinct dimensions in public opinion, as different justice principles are preferred for the two policy dimensions. In addition, structural equation models illustrate that the access dimension is more ideologically structured, whereas preferences regarding the levels of benefits are more strongly stratified along social-structural lines. Overall, the results imply that social justice preferences are clearly different when considering the access to benefits or their level. This distinction should be taken into account in welfare attitude research.

Who Cares, Too? Degenderization of Childcare Policies in Europe: A Dynamic Fuzzy-Set Analysis

This article traces the evolution of childcare policies in Denmark, Estonia, Germany, Ireland, Italy, Poland, Slovenia, Sweden, and the United Kingdom during the period 2005–15 in order to observe changes possibly related to economic crisis. Applying the concept of degenderization and the method of fuzzy-set Qualitative Comparative Analysis (fs/QCA), the study examines: (1) equality of parental leave entitlements, (2) generosity of parental leave-related benefits, (3) accessibility of childcare services, and (4) length of all available leave schemes, at six points in time. The argument is that changes within this period did not lead to a radical transformation in childcare policy, while those shifts that took place could be more often characterized as degenderizing, contrary to expectations. Finally, the study identified policy clusters: four types of genderization (strong genderization, with care payment, with care parity, and with activation), strong and weak versions of degenderization, as well as a mixed case. HIGHLIGHTS This study traces the evolution of childcare policies across nine EU countries during the period of recession between 2005 and 2015. It uses the concept of “degenderization” to develop a typology of childcare policies. A dynamic analysis reveals that despite austerity measures, policies usually remained stable over time. Moreover, despite the crisis, policies tended to promote gender equality in care. Small steps toward degenderization in care policies over time signal that the gender revolution is not “stalled.”

Welfare Benefit Generosity and Refugee Integration

This study examines how welfare benefit generosity impacts refugees’ integration into their new country. The effects of welfare benefit generosity are identified from a policy reform that reduced welfare benefits, first for newly arrived refugees, and second for those who had been in the country for at least 10 months. The results suggest that refugees respond quickly to the benefit reduction, but men and women react on different margins. Male refugees enter employment faster when they experience a benefit reduction, whereas no effect on the labor market is found for female refugees. Even though some men succeed in finding a job, both men and women experience a drop in disposable income of 20 percent. This seems to adversely affect women as they seek more health care, are more often hospitalized, and are more often charged with property crimes. No such unintended effects are found for men.

Examining the effect of Medicaid expansion on early detection of head and neck cancer of the oral cavity and pharynx by HPV-type and generosity of dental benefits.

Over a decade of evidence supports the claim that increased access to insurance through Medicaid expansions improves early detection of cancer. Yet, evidence linking Medicaid expansions to early detection of head and neck cancers (HNC) of the oral cavity and pharynx, specifically, may be limited by the lack of attention to Human Papillomavirus (HPV) etiology, generosity of dental coverage, and valid inference analyzing state cancer registry data. This studyreexamined the effect of Medicaid expansion on early detection of HPV+/- HNC in states offering extensive dental benefits. Specialized data from the Surveillance, Epidemiology, and End Results (SEER) program was analyzed to account for, previously unmeasurable, differential detection patterns of HNCs associated with HPV. Then, to identify the effect of increasing Medicaid eligibility on staging patterns in states offering extensive benefits amidst potentially non-common trends between states, a "Triple Differences" design identifies the differential effect of Medicaid Expansion (with dental coverage) on HPV-negative HNCs relative to the change in HPV-positive HNCs. For valid inference analyzing a small number of state clusters (12) in cancer registry data, each regression model applies a Wild Cluster Bootstrap. Expanding Medicaid eligibility was found to be associated with a decrease in the proportion of distant-stage diagnoses of HPV(-) HNCs, but only among states which increased Medicaid dental generosity at the time of Medicaid expansion. These results suggest that adding extensive Medicaid dental benefits was the primary mechanism impacting HNC detection. This study highlights the potential positive spillover effects of policies which increase access to public dental coverage for low-income adults, while also showing the limitation of access to dental services for improving early detection of HPV+ HNCs.

The Impact of State 529 Plan Tax Incentives on Take-Up and Savings

This paper examines the impact of the 529 plan tax benefits on plan participation and savings. Using state-level data on tax benefits for plan contributions and on the number of open accounts and the amount of assets under management, we estimate fixed effects regression of the use of 529 accounts as a function of measures of tax benefit generosity. Our results imply that offering a tax benefit per se does not significantly increase the percentage of children with an account or the average balances in accounts. In addition, while regression analysis suggests that offering a larger tax benefit for a moderate contribution leads to a small increase in the growth of the percentage of children with 529 savings plans and a larger tax benefit for the maximum contribution is associated with larger balances in savings plans, neither finding is sustained within multiple permutation tests and both are likely spurious.

Plan Selection, Enrollee Risk, and Health Spending on the Patient Protection and Affordable Care Act Individual Marketplaces, 2019

The Patient Protection and Affordable Care Act (ACA) individual marketplaces are a source of insurance for millions of residents in the US. However, the association between enrollee risk, health spending, and metal tier selection remains unclear. To describe individual marketplace enrollees' metal tier selections by risk score and assess enrollees' health spending by metal tier, risk score, and spending type. This retrospective, cross-sectional study analyzed claims data from the Wakely Consulting Group ACA database, a deidentified claims database built on data voluntarily submitted by insurers. Enrollees with continuous, full-year enrollment in on-exchange or off-exchange ACA-qualified health plans during the 2019 contract year were included. Data analysis was conducted from March 2021 to January 2023. Enrollment totals, total spending, and out-of-pocket cost were calculated, stratified by metal tier and the Department of Health and Human Services (HHS) Hierarchical Condition Category (HCC) risk score for 2019. Enrollment and claims data were obtained for 1 317 707 enrollees (53.5% female; mean [SD] age, 46.35 [13.43] years) across all census areas, age groups, and sexes. Of these, 34.6% were on plans with cost-sharing reductions (CSRs), 75.5% did not have an assigned HCC, and 84.0% submitted at least 1 claim. Compared with enrollees in bronze plans (17.2%), enrollees were more likely to be classified in the top HHS-HCC risk quartile if they selected platinum (42.0%), gold (34.4%), or silver (29.7%) plans. The highest share of enrollees with $0 total spending was noted with the catastrophic (26.4%) and bronze (22.7%) plans, while gold plans had the lowest share (8.1%). Median total spending was lower among bronze plan enrollees ($593; IQR, $28-$2100) vs platinum ($4111; IQR, $992-$15 821) or gold ($2675; IQR, $728-$9070). Within the top risk score decile, CSR enrollees had less average total spending than any other metal tier by more than 10%. In this cross-sectional study of the ACA individual marketplace, enrollees who selected plans with higher actuarial value also had greater mean HHS-HCC risk scores and health spending. The findings suggest these differences may be associated with variation in benefit generosity by metal tier, enrollee's perceptions of future health needs, or other barriers to care access.

A safety net for all? – Vignette-based assessments of Swedish social assistance over three decades

Abstract Swedish welfare is often characterized as comprehensive and generous. Social assistance constitutes the final safety net in the Swedish model. Unlike most other benefits, eligibility and subsidy levels are here subject to extensive means-testing, with eligibility determined by individual caseworkers. In this article, we explore the extent to which eligibility determination and generosity of benefits have changed in social assistance assessments over three decades, relating these to changes in regulations over the same period. The article presents data from three independent vignette studies conducted in the mid-1990s, mid-2000s and in 2018 respectively. The data consist of assessments of a total of six vignettes, made by individual caseworkers (n=1 337). The results indicate that overall generosity in social assistance has decreased considerably over the last 25 years and that, despite both national and local initiatives to reduce individual variation in assessments, disparities have instead increased.