We provide the first investigation into whether and how much genes explain having health insurance coverage or not and possible mechanisms for genetic variation. Using a twin-design that compares identical and non-identical twins from a national sample of US twins from the National Survey of Midlife Development in the United States, we find that genetic effects explain over 40% of the variation in whether a person has any health coverage versus not, and nearly 50% of the variation in whether individuals younger than 65 have private coverage versus whether they have no coverage at all. Nearly one third of the genetic variation in being uninsured versus having private coverage is explained by employment industry, self-employment status, and income, and together with education, they explain over 40% of the genetic influence. Marital status, number of children, and available measures of health status, risk preferences, and prevention effort do not appear to be important channels for genetic effects. That genes have meaningful effects on the insurance status suggests an important source of heterogeneity in insurance take up.
The Impacts of Stress on Economic Decisions by Zachary Hohman, Darren Hudson, Ryan Williams, Breanna Harris, Jessica Alquist, Donna Mitchell, Elizabeth Niedbala, Mindi Price :: SSRNOctober 18, 2018
The rational choice model presumes that individuals are rational and make optimizing decisions based on available information. Theory suggests that lack of information and risk (and risk perceptions) can alter decisions from the static perfect information case, but do not necessarily result in irrational decisions. Stress is another factor that may alter our perceptions and increase cognitive loading (increase the cost) of decision-making. Here, we use an experiment to induce stress and employ a simple ultimatum bargaining game to determine whether stress impacts economic decisions. Our results indicate that those exposed to stress (psychological, uncertainty or physiological, cold pressor task) significantly lower their gains (become less aggressive in bidding) than the control group. These results suggest that stress does, in fact, change behavior and leads to “hedging” behavior that lowers overall gains but increases the probability of success.
By 2013, the average Medicare beneficiary’s out-of-pocket spending on health care consumed 41 percent of the average Social Security check, according to Kaiser, which also estimated that the figure would rise.
Consumer Engagement in Health Care Among Millennials, Baby Boomers, and Generation X: Findings from the 2017 Consumer Engagement in Health Care SurveyMay 13, 2018
The EBRI/Greenwald & Associates Consumer Engagement in Health Care Survey (CEHCS) is an online survey that examines issues surrounding consumer-driven health care, including the cost of insurance, the cost of care, satisfaction with health care, satisfaction with health care plans, reasons for choosing a plan, and sources of health information. It is co-sponsored by the Employee Benefit Research Institute (EBRI) and Greenwald & Associates, with support from seven private organizations.
The 2017 survey was conducted online Aug. 10 to Sept. 1, 2017, using the Ipsos’ consumer panel. Over 3,560 adults ages 21−64 who had health insurance provided through an employer, purchased directly from a carrier, or purchased through a government exchange participated in the survey. However, most survey participants (82 percent) received coverage through an employer. The sample was weighted to reflect the actual proportions in the population ages 21–64 with private, health-insurance coverage.
This Issue Brief focuses on differences in consumer engagement in health care by generational cohorts – i.e., Millennials, Baby Boomers, and Gen Xers.
• Millennials are more satisfied than other generational cohorts with various aspects of their health coverage. More than other generational cohorts, Millennials are satisfied with their health coverage, out-pocket costs, and health plan choices.
• Millennials and Generation X engage with health care providers differently than Baby Boomers. Baby Boomers are more likely than Gen Xers and Millennials to have a primary care provider (PCP). Among those with a PCP, Baby Boomers are more likely than Generation X and Millennials to report that they make healthier lifestyle choices after seeing a PCP; that it is important that their PCP knows them and their medical history personally; that their PCP is aware of all of the other medical care that they receive; and that they are comfortable telling their PCP about their health issues. Both Millennials and Generation X are more likely than Baby Boomers to report that they have used a walk-in clinic.
• Millennials have the highest rates of wellness program participation. Millennials are nearly across the board more likely than Baby Boomers to participate in various aspects of wellness programs. They are more likely to report that they have visited an on-site clinic; made a tobacco-free pledge or participated in a smoking cessation program; participated in counseling or stress management training; participated in activity-based wellness challenges; received reimbursement for fitness club memberships; attended free seminars; and received financial wellness resources. Millennials are less likely than Baby Boomers to have completed a health risk assessment or biometric screenings.
Having children is like investing in a risky project. Postponing birth is like delaying an irreversible investment. It has an option value, which depends on its costs and benefits, and in particular on the additional risks motherhood brings. We develop a parsimonious theory of childbearing postponement along these lines. We derive its implications for asset accumulation, income, optimal age at first birth, and childlessness. The structural parameters are estimated by matching the predictions of the model to data from the National Longitudinal Survey of Youth NLSY79. The uncertainty surrounding income growth is shown to increase with childbearing, and this increase is stronger for more educated people. This effect alone can explain why the age at first birth and the childlessness rate both increase with education. We use the model to simulate two hypothetical policies. Providing free medically assisted reproduction technology does not affect the age at first birth much, but lowers the childlessness rate. Insuring mothers against income risk is powerful in lowering the age at first birth.
Health Savings Account Balances, Contributions, Distributions, and Other Vital Statistics, 2016: Statistics from the EBRI HSA DatabaseDecember 11, 2017
The Employee Benefit Research Institute (EBRI) developed the EBRI HSA Database to analyze the state of and individual behavior in health savings accounts (HSAs). The HSA database contained 5.5 million accounts with total assets of $11.3 billion as of Dec. 31, 2016.
This Issue Brief is the fourth annual report drawing on cross-sectional data from the EBRI HSA Database. It examines account balances, individual and employer contributions, distributions, invested assets and account-owner demographics in 2016.
Here are the key findings and insights:
HSAs are a significant part of employment-based health benefit programs.
Enrollment in high-deductible, HSA-eligible health plans was estimated to be between 20.2–22.6 million policyholders and their dependents, and covered nearly 3 in 10 employees in 2016. The HSA market did not exist until 2004. Similarly, there were an estimated 20 million HSAs as of the end of 2016. Most HSAs in the EBRI HSA Database are relatively new; more than 3 in 4 HSAs (77 percent) have been opened since 2013. HSA balances increased in 2016.
Two-thirds of account holders ended 2016 with positive net contributions, meaning annual contributions were higher than annual distributions. Over 90 percent of HSAs with individual or employer contributions in 2016 ended the year with funds to roll over for future expenses. As of the end of 2016, the average HSA balance among account holders with individual or employer contributions in 2016 was $2,532, up from $1,604 at the beginning of the year. Only 3 percent of HSAs had invested assets (beyond cash). Contributions and distributions drive account balances.
On average, individuals who made contributions in 2016 contributed $1,986 over the year and HSAs receiving employer contributions in 2016 received $935. But only 13 percent of account holders contributed the fully allowable annual amount. Three-fourths of HSAs with a 2016 contribution also had a distribution during 2016. Of the HSAs with distributions, the average amount distributed was $1,766, less than the average contribution, resulting in balance increases. The presence of individual or employer contributions were associated with an increase in account balances in 2016—even if account holders took a distribution. Investing does not maximize longer-term savings.
Investors (beyond cash) had much higher account balances than non-investors. While it might be expected that individuals who invested their account balance were using the account solely as a long-term savings vehicle, the opposite appears to have been true. Both investors and non-investors used the HSA to self-fund current uninsured medical expenses. Investors were more likely than non-investors to take a distribution (69 percent and 63 percent, respectively). In fact, when distributions were taken, investors took larger distributions ($2,451) than non-investors ($1,740) during 2016. However, the larger distributions may have been because they had larger account balances.
Notice from the chart that in 1997 some 67 percent of children had private health coverage. Roughly 21 percent had public coverage (Medicaid only, since CHIP was still in process), and about 13 percent were uninsured.
Over the next 20 years, boosted by CHIP, the percentage of children with public health coverage grew to 42.6 percent while those with private coverage dropped to 54 percent. The percentage of uninsured declined to 5 percent.