My paper “Missouri’s Medicaid Contraction and Consumer Financial Outcomes” is now out at the American Journal of Health Economics. It is coauthored by Nate Blascak and Slava Mikhed, researchers at the Federal Reserve Bank of Philadelphia. They noticed that Missouri had done a cut in 2005 that removed about 100,000 people from Medicaid and reduced covered services for the remaining enrollees. Economists have mostly studied Medicaid expansions, which have been more common than cuts; those studying Medicaid cuts have focused on Tennessee’s 2005 dis-enrollments, so we were interested to see if things went differently in Missouri.

In short, we find that after Medicaid is cut, people do more out-of-pocket spending on health care, leading to increases in both credit card borrowing and debt in third-party collections. Our back-of-the-envelope calculations suggest that debt in collections increased by $494 per Medicaid-eligible Missourian, which is actually smaller than has been estimated for the Tennessee cut, and smaller than most estimates of the debt reduction following Medicaid expansions.

We bring some great data to bear on this; I used the restricted version of the Medical Expenditure Panel Survey to estimate what happened to health spending in Missouri compared to neighboring states, and my coauthors used Equifax data on credit outcomes that lets them compare even finer geographies:

The paper is a clear case of modern econometrics at work, in that it is almost painfully thorough. Counting the appendix, the version currently up at AJHE shows 130 pages with 29 tables and 11 figures (many of which are actually made up of 6 sub-figures each). We put a lot of thought into questioning the assumptions behind our difference-in-difference estimation, and into figuring out how best to bootstrap our standard errors given the small number of clusters. Sometimes this feels like overkill but hopefully it means the final results are really solid.

For those who want to read more and can’t access the journal version, an earlier ungated version is here.

Disclaimer: The results and conclusions in this paper are those of the authors and do not indicate concurrence by the Agency for Healthcare Research and Quality or the US Department of Health and Human Services. The views expressed in this paper are solely those of the authors and do not necessarily reflect the views of the Federal Reserve Bank of Philadelphia or the Federal Reserve System. Any errors or omissions are the responsibility of the authors.