title: Insurance expansions: do they hurt those they are designed to help?
abstract: Seeking to redress health disparities across income and race, many policy-makers mandate health insurance benefits, presuming that equalized benefits will help equalize use of beneficial health services. This paper tests that presumption by measuring health care use by a diverse population with comprehensive health insurance. Focusing on use of mental health care and pharmaceuticals, it finds that even when insurance benefits and access are constant, whites and those with high incomes consume more of these benefits than other people do. This suggests that privileged classes extract more health care services even when everyone pays equal premiums for equal insurance coverage.
authors.affiliation: Duke University School of Law, Durham, North Carolina, USA. barak.richman@duke.edu
authors.forename: Barak D
authors.initials: BD
authors.lastname: Richman
mesh_terms: D003191:Comprehensive Health Care / Q000191:economics / Q000706:statistics & numerical data*; D005249:Fees and Charges; D006264:Health Benefit Plans, Employee / Q000458:organization & administration*; D006297:Health Services Accessibility / Q000191:economics*; D006302:Health Services Research; D054625:Healthcare Disparities / Q000191:economics / Q000639:trends*; D006801:Humans; D009657:North Carolina; D016134:Organizational Policy; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011050:Policy Making; D015397:Program Evaluation; D014495:Universities / Q000458:organization & administration*; D035862:Vulnerable Populations