I saw two interesting things this morning that I’m connecting together as I drink my first cup of coffee. The first is a quick read of the just released Omnibus budget bill. Dr. McIntyre shares a lot of my research interests including thinking a lot on how administrative burden shapes the take-up of health insurance. She is following the COVID Medicaid maitenance of effort winddowns and pulled out an interesting point:
Redetermination of eligibility is a frequent cause of lost enrollment even when an individual is likely to have been eligible. In a paper led by Dr. Rushina Cholera, we showed that likely administrative error churn was common in North Carolina Medicaid for kids. Reducing the eligibility determination process to once a year will lead to more kids being covered. And these costs tend to be fairly low as the kids who are likely to fall through the cracks are likely to be relatively cheap as the grown-ups of kids with cancer will make sure that those kids have their Medicaid paperwork filled out one way or another. A national policy of once per year redetermination is a substantial reduction in administrative burden.
Another paper led by Bell in the Public Administration Review examined the incidence of burden by health status:
Across cases, attention disorders and pain are associated with more burdensome experiences and in the financial aid case, they are associated with reduced take-up as well. Individuals suffering from multiple health problems have the most negative experiences and lowest take-up.
This is, to me, pretty intuitive. Individuals have attention budgets. These attention budgets vary substantially between individuals. Administrative burden drains attention. Individuals with less attention reserves are more likely to run into administrative burden challenges. We’ve seen these types of stories play out with SES and seasonality of income timing, so applying the same logic to health is really novel and nifty.