Health insurance coverage and personal behavior
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Subsidies, taxes, premiums, and eligibility for health insurance can potentially cause "marriage lock," in which couples stay married for the sake of health insurance coverage, and marriage lock may change under the Affordable Care Act. In the first two chapters, marriage lock is examined in the context of two key health insurance decisions: divorce decisions upon qualification for Medicare at age 65, and marriage and divorce decisions associated with the introduction of the Massachusetts insurance mandate and health insurance exchange market reforms in 2006. In the first chapter, using the Health and Retirement Study data, I find evidence of a 7 percentage point increase in the number of divorces upon achieving Medicare eligibility at age 65 for people with spousal insurance coverage relative to those without it. In the second chapter, using the American Community Survey data, I find that the 2006 Massachusetts healthcare reform increased incentives for marriage in the health insurance exchange market relative to control states. Specifically, the Massachusetts reform appears to have reduced the divorce rate by 0.5 percentage point and increased marriage rate by 1.4 percentage points. In the third chapter, I use data from the China Household Finance Survey (CHFS) to explore three decisions potentially affected by the implementation of Medical Savings Accounts (MSAs). First, I find that individuals with MSAs incur 17 RMB more medical expenses per 1000 RMB increase in their MSAs balance, while I find no significant effect of after-tax income on medical expenses. Second, I study preference heterogeneity as revealed by three types of risky behaviors. I find undertaking risky investments is associated with 23% more medical expenditures, while always using a seatbelt and obeying traffic signals are associated with 16% and 22% higher medical expenditures, respectively. Finally, I find evidence suggesting that individuals become more risk adverse with MSAs than without, specifically by increasing their use of seatbelts and obeying traffic signals. These findings, using recent Chinese data, suggest that MSAs play an important role when consumers make health expenditure decisions, and that preferences involving risk and prevention also appear to be influenced by the MSA scheme.