Do some consumers really think they will handle medical catastrophes by getting as much care as possible, then filing for bankruptcy?
Neale Mahoney, a health policy researcher in Cambridge, Mass., has come up with evidence to support the idea that some consumers really do think of their ability to declare bankruptcy as a form of health insurance.
Mahoney has published the data in a paper on "Bankruptcy as Implicit Health Insurance," on the website of the National Bureau of Economic Research. The paper is behind a pay wall.
Mahoney found that households with more wealth to lose were more likely to have health insurance.
Similarly, Mahoney says, uninsured households with more assets that could be seized made bigger payments for medical care than uninsured households with fewer seizable assets.
"Health insurance is wealth insurance, to a certain degree, and is less valuable to those with fewer assets," Mahoney says. "Because households do not pay for bankruptcy insurance, too many households choose to be uninsured on the margin."
Mahoney analyzed federal government survey data and found that, if one household with more than$5,000 in annual medical bills had about $31,000 in seizable assets and a second household with more than $5,000 in annual medical bills had about $11,000 in seizable assets, the household with more seizable wealth would, after adjusting for other variables considered, make 34% more in out-of-pocket payments than the household with fewer assets to seize.
Wealth differences had no noticeable effect on out-of-pocket households with less than $5,000 per year in medical bills, Mahoney says.
Similarly, Mahoney found that the likelihood that the household with about $31,000 in seizable assets would have health insurance was about 2.5 percentage points to 3.6 percentage points higher than the probability that the household with $11,000 in seizable assets would have health insurance.
"The magnitude of the coverage effect is economically significant," Mahoney says. "The estimates indicate that if the bankruptcy laws of the least debtor-friendly state of Delaware were applied nationally, approximately 8% of the uninsured would take up coverage."