How CBO handles imputing benefits about c-tam HOT 16 CLOSED

@feenberg said

But that is always true of insurance. Most of the ex post benefit goes to
a few. The ex ante benefit is spread evenly. We have chosen to model the
ex ante benefit for good reason.

I see. That makes sense to me. Then it seems we can just proceed with the average calculated as the total benefit expenditure divided by the total number of enrollee.

Is that sensible to you? @martinholmer

cc @andersonfrailey @MaxGhenis

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This assessment makes sense to me, but I could be missing something -- I'm interested to know what @feenberg and @Amy-Xu think. And Amy is probably in the best position to make the final call on the cost/benefit tradeoff, given her perspective on the maintenance burdens.

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@martinholmer Thanks very much for this detailed outline. I agree that we should assign the same actuarial value to everyone for the moment.

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An issue that @Amy-Xu pointed out with using just a simple average benefit amount, for Medicare at least, is that Medicare provides a lot of benefits for the institutionalized population that we don't have in our datasets. Should we worry at all about maybe trying to back out spending on that subset of the population? @Amy-Xu do you think it's a large enough issue to warrant the extra work?

cc @martinholmer @feenberg

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I imagine institutionalized population might have a different actuarial value, and this part of population has not been included in the CPS tax unit dataset yet. It would be the best using one universal value for everyone if this is a negligible point. But I want to hear more thoughts before we proceed with the universal value.

@martinholmer @feenberg @MattHJensen

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I'm confused by this discussion because I was under the impression that the CPS excludes the institutionalized population. Isn't this what this says?

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@martinholmer You're absolutely right. But is it a problem when CPS doesn't while Medicare, and potentially Medicaid, do?

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@Amy-Xu said:

You're absolutely right [that CPS does not include the institutionalized population].
But is it a problem when CPS doesn't while Medicare, and potentially Medicaid, do?

I thought what you said yesterday was that the "scaling factors" applied to the MEPS Medicare and Medicaid amounts were constructed to exclude program costs attributable to the institutionalized population.

@andersonfrailey

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@martinholmer

I interpreted your citation of CBO report

CBO assigns the average cost to the government per participant to all recipients.

as we need to calculate the actuarial value by dividing the total government cost by the total number of enrollee. Is that what you interpreted from the CBO report?

It seems in the current context that "total non-institutional benefit expenditure over total non-instituional enrollee' would be more accurate. What do you think?

Lastly, because the total benefit target is coming from the Medicare Trustee's Report, I assume this assignment of actuarial value has nothing to do with the MEPS imputation (for individual level benefit) anymore. Thus my understanding is that this issue is a separate one from C-TAM PR #70. Do you agree?

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@feenberg

Suppose 1% of the population is missed, and 50% of the expenditure is on that 1%. Then
dividing the total expenditure by number of enrollees give the correct
insurance value to each enrollee.

I see your argument, but somehow I feel your argument supports my conclusion rather than yours. Before I explain my logic, I think we need a clarification on the terms we use in this issue.

• Insurance value: It seems Martin, in his initial post of this issue, interprets as how much it worths to an enrollee. cc @martinholmer (Am I right?)

• Actuarial value: how much is paid.

I assume you're speaking about actuarial value. (Correct me if I'm wrong)

Then my logic is that non-institutional population shouldn't get assigned the actual whole population average because a huge amount of the expenditure is not on them.

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Sorry for letting this slip through the cracks. Has this discussion been settled? And if so are we just going with the changes made in TaxData PR #185?

@Amy-Xu @martinholmer @feenberg @MaxGhenis

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Since the corresponding TaxData Issue has been merged, I'm closing this issue. Thanks to everyone.

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