Effects of losing public health insurance on preventative care, health, and emergency department use: Evidence from the TennCare disenrollment

Abstract

This paper studies the effect of losing public health insurance eligibility on preventative care, self‐reported health, and emergency department use. I exploit the 2005 TennCare disenrollment in which 190,000 residents–mainly non‐elderly childless adults–lost public health insurance eligibility due to budget cuts. I use two surveys, the Behavioral Factor Surveillance System and the National Health Interview Survey, in a difference‐in‐difference methodology to study the effects of the reform. I find that the reform lead to a 4%–5% reduction in reporting having mammograms and breast exams. An increase of 20% in number of days with health incapacitation and no strong evidence of changes of emergency department visits (nor number of visits). I document margins of heterogeneity of the effects across demographic characteristics. Finally, I explore the margins of symmetry between gaining and losing public insurance by comparing estimates to those from the Affordable Care Act Medicaid Expansions.