Edward Conard

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  • “…a very valuable contribution.” - Larry Summers, former Secretary of the Treasury and director of the National Economic Council, president emeritus, Harvard University
  • “…reminds us that inequality sends a signal of what society lacks most, in America’s case, entrepreneurship and risk taking.” - Lawrence Lindsey, CEO, The Lindsey Group, former Director of the National Economic Council
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Upside of Inequality Oxford Unintended Consequences

AI Summary. Tracking the same patients as they age from Medicaid into Medicare at 65, the authors find higher provider acceptance rates are associated with larger increases in primary care and specialist visits, especially new-patient specialist visits. They conclude Medicaid's smaller provider network plays a large role in limiting service provision.

Calvin Ackley, Abe Dunn, Eli Liebman and Adam Hale Shapiro Federal Reserve Bank of San Francisco
Date Posted:

When Medicaid patients qualify for Medicare at age 65, service provision increases by about 20%. 60-90% of the increase in office visits is with physicians who had not accepted a new Medicaid patient in the prior year. @ah_shapiro

How much do provider acceptance rates limit Medicaid patients' care?

Core argument: Tracking the same individuals as they age into Medicare from Medicaid at 65, a one percentage point increase in Medicare acceptance rates is correlated with a 0.008 larger increase in primary care visits.

We track the services provided to the same individual as they age into Medicare from Medicaid at age 65, becoming dual enrolled. On average, a one percentage point increase in Medicare acceptance rates is correlated with a 0.008 larger increase in primary care visits, consistent with patients having more access using more care. Bringing the Medicare acceptance rate down to the Medicaid acceptance rate (about 10 percentage points) would lead to about .08 fewer monthly primary care visits, which is about one-third of the pre-period mean and about 50% higher than the total increase we see in primary visits. A 10 percentage point increase in the state-level Medicaid acceptance rate would lead to a 0.028 smaller increase in specialist visits per month across the threshold, about 11% of the pre-period mean. Results are especially strong for new-patient visits with specialists. [Our] analysis indicates that Medicaid’s smaller provider network plays a large role in limiting service provision.

Takeaways by Macro Roundup® AI

  1. Tracking the same individuals as they age into Medicare from Medicaid at 65, a one percentage point increase in Medicare acceptance rates is correlated with a 0.008 larger increase in primary care visits.
  2. Lowering the Medicare acceptance rate to the Medicaid rate, about 10 percentage points, would mean roughly 0.08 fewer monthly primary care visits, about one-third of the pre-period mean and about 50% larger than the total observed increase.
  3. A 10 percentage point higher state-level Medicaid acceptance rate would lead to a 0.028 smaller increase in specialist visits per month across the age-65 threshold, about 11% of the pre-period mean, with results especially strong for new-patient specialist visits.

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