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.
Meyerman
My friend relies on several government programs to help keep his heat on, food on the table, medical insurance in place to cover him and his kids. He has to pay a lot of attention to maintain enrollment in these programs. It has always seemed to me that the programs are designed to shed enrollees by taking advantage of the fact that poor people are busy with work, childcare, and everything else that they have to do because they don’t have the money to hire people to do stuff for them. So they miss a deadline or miss a form and they get bounced. Why design a system like this? Mitigate fraud? Maybe. It would also seem that from the agencies perspective, this is a budget win – less money out the door. Just pretend that the people no longer receiving aid stopped needing it.
Ohio Mom
@Meyerman: Supposedly it’s to mitigate fraud but you do wonder how much fraud is prevented vs. how much money is spent constructing and holding up the hoops. But I agree, people falling off the rolls is a feature not a bug.
The saving grace for me as the mother of a disabled child (now an adult) has been my county board of developmental disabilities. When Son was a minor, every year he had to requalify for Medicaid, which meant resubmitting, among other documentation, copies of his birth certificate, social security card, and diagnosis letter (like there had been a change to his birth certificate).
The county DD board did us a great favor in collating the documentation and presenting it to the county agency that determined continued Medicaid eligibility (Jobs and Family Services). Sometimes there was a cranky reviewer st JFS and our DD rep would go back and forth with the JFS staff.
I would roll my eyes at my tax money going to pay for the two county workers arguing.
Another Scott
As you say, this is pretty intuitive. And, sadly, the system is working as designed.
One of Atrios’s hobbyhorses is that it is so much more efficient to make most benefits universal. You address the problem of the well-off “undeserving” getting benefits they don’t need (“It’s not fair for us to give Musk’s kids free college!!11ONE”) by increasing their taxes.
The GQPers, of course, are opposed to this approach. One of their cornerstones is that government doesn’t work and is inefficient, so when they’re in power they put up roadblocks and inefficiencies to make sure that is the case.
Thanks.
Cheers,
Scott.