TheAffordableCareAct(ACA)transitionedtheUnitedStatesawayfromavoluntaryhealthinsurancesystem toauniversalparticipationschemeprimarilythroughtheuseofanindividualmandate,whichrequiresall Americanstoobtainsomeformofhealthinsurancecoverageorfaceapenalty.Bymandatingamoreinclusive system,theindividualmandateisabletoraisesocialwelfarethroughloweringtheoverallcostofaccessing healthcareservices.Ontheotherhand,aninvoluntaryinsuranceschemecancompromisetheeconomic securityofhouseholds,asthelackofcomplementarypolicieswithintheACAforcessomehouseholdsto financeasignificantpartoftheirhealthinsurancepremiums.ThisnegativeincometransferfromtheACAcan constrainhouseholdbudgetstothepointwheretheycurtailutilizationofnecessities,whichcanleadtothe adoptionofadversehealthbehaviorsthatcancausenegativehealthoutcomes.Moreover,asminority householdsaremostlikelytobelivinginornearpoverty,theyaredisproportionallyaffectedmorethanother groups.Thisisaparticularlytroublingresult,astheACA?sindividualmandateraisessocialwelfareatthe expenseofindividualwelfarewithoutaclearmechanismtocompensateforthisloss. Onewaytoaddressthisissueisforhouseholdstoseektransferpaymentsfromthegovernmentthatwillhelp limittheirlossestohealthandmedicalrelateddebts.Governmentsareidealtoengagewith,astheyissueone- waytransfersthatarenotrequiredtopayback.Ingeneral,householdscansolicittransfersfromthe governmentusingthetaxsystem(i.e.,claimingmedicaldeductions)orbankruptcytorescheduleordischarge medicaldebts.Suchfinancialtoolshavethepotentialofnotonlymitigatingwelfarelossesfromnegative incometransfers,butalsoallowforreinvestmentintoahousehold?shealthandwellbeing.Theresearch containedwithinthisproposalinvestigatestwomainaims.Thefirstresearchaiminvestigatestheimpactof incometransfersgeneratedbytheACAonhouseholdfinancialdecision-making.Themainanalysisinthisaim utilizesdifference-in-differencemodelstoexaminetheimpactsofbothpositiveandnegativeincometransfers onahousehold?spropensitytoitemizedeductionsordeclarebankruptcy.
The secondaim examinesthe impactoffinancialdecision-makingonhealthoutcomes.Logisticregressionandmultinomialregressionare bothutilizedtoexaminehowthemorbidityofdiseaseandappropriatelevelsofutilizationareimpactedby itemizationandbankruptcydecisions.
The passage of the ACA raises social welfare through implementing a system that promotes universal health coverage by increasing the ease of access and lowering overall medical costs; however, the ACA provides a differential financial benefit to households, with some experiencing welfare loss. Our grant proposal measures the extent to which household financial decision-making is altered by negative income transfers generated by the ACA and the subsequent impact of these financial decisions on health disparities among minorities.
