Premium Subsidies Research Articles

Effects of medicaid expansion on poverty disparities in health insurance coverage

BackgroundMore than 30 states have either expanded Medicaid or are actively considering expansion. The coverage gains from this policy are well documented, however, the impacts of its increasing coverage on poverty disparity are unclear at the national level.MethodAmerican Community Survey (2012–2018) was used to examine the effects of Medicaid expansion on poverty disparity in insurance coverage for nonelderly adults in the United States. Differences-in-differences-in-differences design was used to analyze trends in uninsured rates by poverty levels: (1) < 138 %, (2) 138–400 % and (3) > 400 % federal poverty level (FPL).ResultsCompared with uninsured rates in 2012, uninsured rates in 2018 decreased by 10.75 %, 6.42 %, and 1.11 % for < 138 %, 138–400 %, and > 400 % FPL, respectively. From 2012 to 2018, > 400 % FPL group continuously had the lowest uninsured rate and < 138 % FPL group had the highest uninsured rate. Compared with ≥ 138 % FPL groups, there was a 2.54 % reduction in uninsured risk after Medicaid expansion among < 138 % FPL group in Medicaid expansion states versus control states. After eliminating the impact of the ACA market exchange premium subsidy, 3.18 % decrease was estimated.ConclusionPoverty disparity in uninsured rates improved with Medicaid expansion. However, < 138 % FPL population are still at a higher risk for being uninsured.

Estimated Plan Enrollment Outcomes After Changes to US Health Insurance Marketplace Automatic Renewal Rules

The American Rescue Plan increases premium subsidies for health insurance marketplace enrollees, potentially leading to situations in which enrollees could switch to other health care plans with lower premiums and less cost sharing (ie, deductibles and copayments). Current policy defaults enrollees to their current health care plan if they automatically renew their coverage, which may cause them to stay in health care plans that, because of the American Rescue Plan, are now dominated in that they have higher premiums and cost sharing than other options. To estimate the extent to which a smart default policy could reduce US health insurance marketplace enrollees' cost sharing and premiums. Using 2018 individual enrollment data and 2021 premium data from California's marketplace and the American Rescue Plan premium tax credit subsidy schedule, this economic analysis estimated the characteristics of enrollees' default health care plans if they defaulted into 2021 health care plans under current and smart default policies. The analysis was conducted from March 20 to April 8, 2021. Characteristics of enrollees' default health care plans under current and smart default policies, including net premiums, plan levels, and cost sharing. The analytic sample consisted of 748 087 Covered California enrollees from 2018 (mean [SD] age, 44.80 [13.72] years; 408 410 [54.6%] women). Under current policy with the enhanced subsidies implemented under the American Rescue Plan, 5.8% of sample enrollees would default into dominated health plans. Of these enrollees, 98.0% would have incomes below 250% of the federal poverty level. A smart default policy would lead to a mean $102.47 decrease in monthly premiums (95% CI, $103.84-$101.10), a mean $1960 reduction in individual annual medical deductibles (95% CI, $1991-$1928), and a $49.56 reduction in specialty prescription copays (95% CI, $49.77-$49.34). The findings of this economic analysis suggest that a smart default policy could avoid defaulting lower-income marketplace enrollees to objectively inferior health care insurance plans and may lead to large reductions in lower-income enrollees' deductibles, copayments, and maximum out-of-pocket amounts. Implementation of a smart default policy could enable marketplace administrators to reduce the prevalence of underinsurance among lower-income marketplace enrollees.

Comparison study of agricultural insurance government subsidy and farmers' self-subsistent premium in Indonesia

Agricultural Insurance as an embodiment of farmer protection and empowerment is carried out with The Rice Farming Business Insurance (AUTP) facility with an insurance premium scheme by the Government of 80% and 20% by farmers. This study aims to simulate the AUTP premium based on government's subsidy and farmers' self-subsistent premium. The simulation test used panel data estimates in Indonesia Province during 2016-2019. The AUTP premium simulation was identified through the Moderating Regression Analysis (MRA) approach, with the moderate variables being government subsidies and farmers' self-subsistent premium. The Government's premium subsidy policy became a pure moderator that significantly increased the AUTP land area by 0.057%. Meanwhile, the coefficient of the farmers' self-subsistent premium variable has a negative and significant effect on the realization of AUTP in Indonesia. The results of the policy simulation emphasize the importance of the government's role in encouraging the increase in the realization of AUTP through subsidizing premium assistance to farmers. The implication of this simulation of the MRA model is that the response and participation rate of the farmers' premium payments independently is not followed by an increase in the realization of AUTP in Indonesia. The policy implications in the simulation of the two equation models conclude the importance of managing subsidized farmer premium payments and self-subsistent schemes based on insured land and farmer insurance policy. Agricultural insurance policy needs to adopt risk management tools, diversify agricultural insurance programs, and calculate the willingness to pay agricultural insurance premiums appropriately.

Employment Rank and the Choice of Health Insurance Benefit Scheme among Bangladeshi Civil Servants

Abstract This study surveys 622 Bangladeshi civil servants of all administrative jurisdictions and elicits their preference for health insurance schemes. The latter vary in the amount of sum assured as well as in terms of premium sharing rules with the government. The paper also explores the financial burden that the premium subsidy may impose on the exchequer and the state’s fiscal capacity to shoulder it. We discover a very high willingness to join the scheme. Though all three premium-sharing options posit flat rates common for all employment ranks, respondents appear to prefer premiums proportional to their basic salary.

The role of premium subsidies in crop insurance

This study develops a novel framework of heterogeneous producer attitudes towards risk to analyze different, stated and revealed, roles of crop insurance premium subsidies and underlying policy objectives of the government. The analysis reveals a strong connection and a complementarity between the roles of premium subsidies in increasing producer participation in crop insurance, inducing a desired separating equilibrium in the presence of asymmetric information, and transferring income to agricultural producers participating in the program. Developing an alternative design of premium subsidies that can achieve the stated government objective of increased producer participation and induce any desired separating equilibrium at significantly reduced costs, our study rejects the idea that the income redistribution taking place under the current policy design is necessary for increasing producer participation in crop insurance. Indeed, the current policy design reveals that premium subsidies are either a means of income redistribution or a policy failure.

The impact of premium subsidies on health plan choices in Switzerland: Who responds to the incentives set by in-kind as opposed to cash transfers?

Mandatory health insurance in Switzerland operates on a community-based premium scheme. This can lead to a high financial burden on lower income individuals. Until 2014, premium subsidies were paid as cash transfer or in-kind transfer, providing different incentives to individuals for choosing their health plans. Using a difference-in-differences strategy, the impact of in-kind subsidy transfers on deductible choice and the choice of a cost-saving health plan was evaluated to understand effect heterogeneity based on individual background characteristics. The results indicate that eligible individuals from in-kind transfer cantons in general are incentivized to choose a low deductible plan compared to eligible individuals from cash transfer cantons. This effect is found strongest among female, middle-aged and healthy individuals who have most flexibility in adjusting their health plan choices in response to the financial incentives. Additionally, eligible individuals are less likely to choose a cost-saving health plan compared to a cash transfer canton.

EFFECT OF THE GOVERNMENT INTERVENTION PROGRAM TO THE CROP INSURANCE PARTICIPATION LEVEL

In addition to premium subsidies, Indonesia's government implements other intervention programs as a stimulus to boost farmers’ participation in Rice Farmers Business Insurance (AUTP). Therefore, this study aimed to investigate the effect of the government intervention program in 2019 that requires participation in AUTP as a prerequisite for redeeming subsidized fertilizer. This study also aimed to ascertain the socioeconomic factors that influence farmers to participate. Meanwhile, primary data were obtained through questionnaires distributed from March 23 to April 6, 2020, and completed by 103 farmers in 14 villages in Sliyeg, Indramayu. The data were analyzed with McNemar Test to determine the effect of farmers’ participation in AUTP when the government intervention program was implemented and terminated. Furthermore, Logistic Regression Analysis is used to ascertain the socioeconomic factors that influence farmers to participate. The result showed that the program affects their participation in AUTP. This level is higher when the program is enforced and decreased when terminated. The socio-economics variables that influenced farmers to participate in AUTP when implemented in the government program are land ownership status and land size, while only land size influenced them when terminated. Keywords: agriculture risk, consumer behavior, government stimulus, participation rate, premium subsidy

Optimal strategies for a capital constrained contract-farming supply chain with yield insurance

We consider a capital-constrained contract-farming supply chain with a risk-averse farmer and a risk-neutral agro-dealer, where the farmer faces some yield uncertainty that can be covered by insurance. Using the Stackelberg model, we derive the optimal strategies on the insured level, production and wholesale price. The result shows that farmers with low risk aversion tend not to be insured, while those with high risk aversion tend to insure. Further analysis indicates that, as the degree of the farmer’s risk aversion increases, the farm size decreases, but the yield per unit area and the wholesale price of the agricultural product increases. In addition, yield insurance and premium subsidies can lead to a decrease of the yield per unit area. However, the expansion of the farm size can compensate for the inhibitory effect of the decrease of yield per unit area on the total yield, and thus the total yield increases. We also find that when the premium subsidy rate is low, the yield insurance’s value to farmers is negative. Moreover, the yield insurance’s value to farmers increases with respect to the bank’s interest rate.

Understanding Irrigated Cotton Producer’s Crop Insurance Coverage Level Choices Under the 2014 Farm Bill

The Agricultural Act of 2014 (2014 Farm Bill) significantly changed the Title I commodity programs, and shallow loss insurance programs were added to the federal crop insurance program (Title XI). Stacked Income Protection Plan and Supplemental Coverage Option were new insurance programs enacted in the 2014 Farm Bill. Participation in these programs is influenced by premium subsidies and the type of coverage provided. Relationships between insurance agents and producers also have the potential to influence program participation. These changes could impact the producer’s insurance choice decision. The overall objective of this research is to understand the impact of the new insurance options on Texas cotton producers’ risk management decisions and participation and understand the change in coverage level of primary crop insurance due to availably of other protection. A mail survey was conducted among cotton producers in Texas to collect insurance choices data for 2014 and anticipated choices for 2015. Responses from 42% of Texas counties were received. In 2015, the USDA Risk Management Agency reported 155 counties in Texas produced cotton. Regression analysis conducted on anticipated change in coverage level of crop insurance indicated Common Crop Insurance Policy coverage level choice for larger farm size and higher non-farm income had an increase in coverage level effect; whereas enterprise unit, revenue protection, price, yield, and insurance agents had a decrease in coverage level effect. Results suggest that greater insurance agent involvement in program design and implementation of an insurance program could contribute to program success.

The Innovation and development of Rural Revitalization: Agricultural Supply Chain Finance

Agricultural supply chain finance provides a feasible supply channel for the fund demand in rural economic development, alleviates the financing difficulties of small and micro enterprises and farmers in rural areas. However, there are also problems such as low standardization of agricultural products, imperfect credit risk system and incomplete information system, which seriously hinder the implementation of Rural Revitalization strategy. Financial product innovation is put forward in this paper, giving play to the role of government-led, perfect the premium subsidy, guarantees subsidy policy, actively into more involved in the main body, using the emerging technology industrialization construction, building ecological system resource sharing, expand the scope of services, to better precision power financial poverty alleviation, finally realizes the Rural Revitalization strategy.

Epidemic and Pandemic Risk Transfer Solutions and Options for Public Sector Support

The current COVID-19 pandemic caused a significant shock to the world economy which led to large-scale government support measures and thus proved the non-resilience of the current financial ecosystem, with devastating effects on the human global population. As research indicates, pandemic disease outbreaks will increase in frequency and impact in the future. This paper addresses the question how to possibly create a prudent and resilient financial ecosystem resistant to future disease outbreaks and minimalizing the individual financial and economic impact. While insurance risk transfer solutions have been available for epidemic risk, fundamental hurdles of insurability prevent the supply of sufficient capacity to address the magnitude of potential economic losses. A risk transformation market platform is described which enables a wider participation of capacity providers. While initially focusing on a specialty market segment, it is analysed how governments can contribute, alongside private sector investors, to an accelerated industrialization of this market segment. It is shown how the challenge of affordability for insureds can be addressed without requiring premium subsidies, thus maintaining risk-adequate incentives which are relevant for preparedness.

Understanding family-based health insurance enrolment among informal sector workers in a rural district of Vietnam: Adverse selection and key determinants

ABSTRACT Background: Challenges remain in the implementation of family-based health insurance (FHI) – the key strategy for achieving universal health coverage in Vietnam. Objectives: To explore the experiences of and factors influencing enrolment in FHI among informal sector workers (ISW) in a rural district in Vietnam. Methods: A cross-sectional study was conducted from January to June 2016 in Tien Du, a rural district in Bac Ninh province. Secondary data were extracted from provincial social insurance databases to identify the rate of FHI among ISW in the district. Qualitative data were collected from 55 participants: 20 semi-structured in-depth interviews (IDI) and 6 focus group discussions (FGD). Data were transcribed verbatim. Thematic analysis was conducted. Results: Only 25.1% of ISW had FHI. Those individuals with FHI tended to be older or already experiencing health problems or have ‘risky’ jobs. The key determinants of adverse selection from different levels included: individual, family and health system. Conclusions: Low health insurance uptake remains an issue for ISW. Policy makers should consider raising awareness of FHI and improve the quality of primary health services, simplify the procedures of enrolment and claim for ISW. Additional government premium subsidy is required to increase FHI enrolment among ISW.

Preferences for private long-term care insurance products in a super-ageing society: A discrete choice experiment in Hong Kong.

There is a stark contrast between rising long-term care (LTC) demands and limited financing capacity in many ageing societies. Despite the theoretical potential of private insurance in LTC financing reforms, the reality is that the market remains remarkably underdeveloped. This study adopts a novel two-phase approach to quantitatively examine the market demand for private long-term care insurance (LTCI) in Hong Kong, one of the world's super-ageing societies. In order to examine people's preferences regarding private LTCI in Hong Kong, which has been exploring alternative LTC financing mechanisms to relieve the overburdened public system, we conducted a discrete choice experiment (DCE) in 2019 to elicit the preferences of a representative sample of 410 middle-aged adults. At first, we used data from the US National Longterm Care Survey to perform an actuarial projection for Hong Kong. In the first phase, we computed the indicative premiums based on various attributes of hypothetical private LTCI products. Undertaken in the second phase and using two econometric techniques, the DCE suggested that the most preferred hypothetical LTCI product in Hong Kong was associated with the following features: 1) a monthly benefit level of HK$20,000 or HK$25,000, 2) 3% inflation protection, and 3) 15 years of contribution. These attributes led to a monthly premium of HK$1237 (US$160)/HK$1546 (US$200) for men and HK$2150 (US$278)/HK$2687 (US$348) for women. Furthermore, we also found that the preference for LTCI products varied across people with different socioeconomic and health characteristics. These insights could inform initial market segmentation, LTCI product design, and targeted marketing in the future. This paper concludes with cautious optimism regarding the market demand for private LTCI in Hong Kong, and recommends concrete policy instruments to nurture the LTCI market, including information campaign, premium subsidies, and tax benefits.

Does agricultural insurance promote primary industry production? Evidence from a quasi-experiment in China

Whether agricultural insurance promotes primary industry production has been debated for decades. Our paper studies this question based on the agricultural insurance premium subsidy policy in China. We use this quasi-experiment to conduct difference-in-differences and event study estimations. We find that the development of agricultural insurance, induced by premium subsidies, significantly promotes primary industry production; per person, it increases by CNY 1430 in subsidised provinces compared to unsubsidised provinces. We use county-level data to address the aggregation problem in our province-level analysis and obtain the same conclusion. We also find that agricultural insurance primarily affects agriculture and husbandry among the four subindustries of the primary industry.

Demand for Health Insurance in the Time of COVID-19: Evidence from the Special Enrollment Period in the Washington State ACA Marketplace

I study the demand for health insurance during the COVID-19 pandemic using Special Enrollment Period (SEP) individual-level enrollment data from the Washington State Affordable Care Act Marketplace. I document that most individuals enrolling in plans during the pandemic are those who lost minimum essential coverage, followed by uninsured individuals making use of Washington’s limited-time SEP for uninsured individuals. I estimate a demand model and find that low-income individuals and young individuals are more premium sensitive. I find that 20.4 percent of the individuals in my analysis sample did not pay their initial premium. Individuals losing minimum essential coverage are less likely to pay their initial premium than individuals using the SEP for other qualifying events. Lower income individuals are less likely to pay the initial premium than higher income individuals. My results suggest three reasons for considering more generous premium subsidies during the remainder of the pandemic: (1) individuals losing minimum essential coverage are already using the exchange to replace lost coverage, (2) consumers are premium sensitive, and (3) there are meaningful differences across demographic groups in the probability of paying the first premium, which is necessary for coverage to take effect.

Uptake of insurance-embedded credit in presence of credit rationing: evidence from a randomized controlled trial in Kenya

PurposeDrought-related climate risk and access to credit are among the major risks to agricultural productivity for smallholder farmers in Kenya. Farmers are usually credit-constrained due to either involuntary quantity rationing or voluntary risk rationing. By exploiting randomized distribution of weather risk-contingent credit (RCC) and traditional credit, the authors estimate the causal effect of bundling weather index insurance to credit on uptake of agricultural credits among rural smallholders in Eastern Kenya. Further, the authors assess farmers' credit rationing, its determinants and effects on credit uptake.Design/methodology/approachThe study design was a randomized controlled trial (RCT) conducted in Machakos County, Kenya. 1,170 sample households were randomly assigned to one of three research groups, namely control, RCC and traditional credit. This paper is based on baseline household survey data and the first phase of loan implementation data.FindingsThe authors find that 48% of the households were price-rationed, 41% were risk-rationed and 11% were quantity-rationed. The average credit uptake rate was 33% with the uptake of bundled credit being significantly higher than that of traditional credit. Risk rationing seems to influence the credit uptake negatively, whereas premium subsidies do not have any significant association with credit uptake. Among the socio-economic variables, training attendance, crop production being the main household head occupation, expenditure on food, maize labour requirement, hired labour, livestock revenue and access to credit are found to influence the credit uptake positively, whereas the expenditure on non-food items is negatively related with credit uptake.Research limitations/implicationsThe study findings provide important insights on the factors of credit demand. Empirical results suggest that risk rationing is pervasive and discourages farmers to take up credit. The study results also imply that credit demand is inelastic although relatively small sample size for RCC premium subsidy groups may be a limiting factor to the authors’ estimation.Originality/valueBy implementing a multi-arm RCT, the authors estimate the factors affecting the uptake of insurance bundled agricultural credits along with eliciting credit rationing among rural smallholders in Eastern Kenya. This paper provides key empirical findings on the uptake of RCC and the effect of credit rationing on uptake of agricultural credits, a field which has been majorly theoretical.

Incentivizing catastrophe risk sharing

Government plays a vital role in improving community resilience against natural disasters. Due to the limited relief capacity of a government, it is desirable to develop a risk-sharing mechanism involving both private sector providers (e.g., insurers, for-profit disaster agencies, and firms that provide resources for risk mitigation and recovery) and the public. In this article, we take catastrophe insurance as an example to examine ways of providing incentives for multilateral risk sharing, especially when it involves socially connected communities. We consider a sequential game with three sets of players, the government, a private insurer, and a community of households. The government determines an optimal subsidy portfolio (including ex ante insurance premium subsidy and ex post relief subsidy) for a community with particular levels of social network influence and risk perception. We characterize the equilibrium purchase rate within the community by positive and negative herding behaviors and identify the government’s optimal subsidy strategy dependent on the available budget and the emphasis on ex post social responsibility. We also extend the game to account for multi-community coverage and multi-year insurance contracts to demonstrate the benefits of spatial and inter-temporal risk pooling.

Behavioral weather insurance: Applying cumulative prospect theory to agricultural insurance design under narrow framing.

Experience across many countries shows that, without large premium subsidies, crop insurance uptake rates are generally low. In this article, we propose to use the cumulative prospect theory to design weather insurance products for situations in which farmers frame insurance narrowly as a stand-alone investment. To this end, we introduce what we call “behavioral weather insurance” whereby insurance contract parameters are adjusted to correspond more closely with farmers’ preferences. Depending on farmers’ preferences, we find that a stochastic multiyear premium increases the prospect value of weather insurance, while a zero deductible design does not. We suggest that insurance contracts should be tailored precisely to serve farmers’ needs. This offers potential benefits for both the insurer and the insured.

Impact of the Affordable Care Act Insurance Marketplaces on Out-of-Pocket Spending Among Surgical Patients.

To evaluate the association between the introduction of the Affordable Care Act (ACA) Health Insurance Marketplaces ("Marketplaces") and financial protection for patients undergoing surgery. The ACA established Marketplaces through which individuals could purchase subsidized insurance coverage. However, the effect of these Marketplaces on surgical patients' healthcare spending remains largely unknown. We analyzed a nationally representative sample of adults aged 19-64 who underwent surgery in 2010-2017, using the Medical Expenditure Panel Survey. Low-income patients eligible for cost-sharing and premium subsidies in the Marketplaces [income 139%-250% federal poverty level (FPL)] and middle-income patients eligible only for premium subsidies (251%-400% FPL) were compared to high-income controls ineligible for subsidies (>400% FPL) using a quasi-experimental difference-in-differences approach. We evaluated 3 main outcomes: (1) out-of-pocket spending, (2) premium contributions, and (3) likelihood of experiencing catastrophic expenditures, defined as out-of-pocket plus premium spending exceeding 19.5% of family income. Our sample included 5450 patients undergoing surgery, representing approximately 69 million US adults. Among low-income patients, Marketplace implementation was associated with $601 lower [95% confidence interval (CI): -$1169 to -$33; P = 0.04) out-of-pocket spending; $968 lower (95% CI: -$1652 to -$285; P = 0.006) premium spending; and 34.6% lower probability (absolute change: -8.3 percentage points; 95% CI: -14.9 to -1.7; P = 0.01) of catastrophic expenditures. We found no evidence that health expenditures changed for middle-income surgical patients. The ACA's insurance Marketplaces were associated with improved financial protection among low-income surgical patients eligible for both cost-sharing and premium subsidies, but not in middle-income patients eligible for only premium subsidies.

Influence of farm size and insured type on crop insurance returns

AbstractIn this article, we empirically examine the impact of farm size and insured type on returns from crop insurance participation in four regions using unit‐level crop insurance contract data. Our quasi‐panel empirical model provides guidance on whether larger producers are riskier than smaller producers and whether cash producers are riskier than landlords. In our sample, we did not find evidence that large producers obtain higher returns from insurance participation than their smaller counterparts. In fact, we found evidence of the opposite that larger producers in Iowa and Nebraska receive less than their smaller counterparts. Our farm size results suggest that any legislation limiting crop insurance participation from large producers would negatively influence the insurance pool, driving up premiums and consequently administrative and operational subsidies and per‐acre premium subsidy dollars. We did find evidence that cash insured types get more back in insurance than landlords in both Montana and Oklahoma, suggesting the possibility of moral hazard in input usage. Our results also highlight spatial differences in crop insurance outcomes.