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Published in: International Journal of Health Economics and Management 3-4/2019

01-12-2019 | Research article

Genetic variation in health insurance coverage

Authors: George L. Wehby, Dan Shane

Published in: International Journal of Health Economics and Management | Issue 3-4/2019

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Abstract

We provide the first investigation into whether and how much genes explain having health insurance coverage or not and possible mechanisms for genetic variation. Using a twin-design that compares identical and non-identical twins from a national sample of US twins from the National Survey of Midlife Development in the United States, we find that genetic effects explain over 40% of the variation in whether a person has any health coverage versus not, and nearly 50% of the variation in whether individuals younger than 65 have private coverage versus whether they have no coverage at all. Nearly one third of the genetic variation in being uninsured versus having private coverage is explained by employment industry, self-employment status, and income, and together with education, they explain over 40% of the genetic influence. Marital status, number of children, and available measures of health status, risk preferences, and prevention effort do not appear to be important channels for genetic effects. That genes have meaningful effects on the insurance status suggests an important source of heterogeneity in insurance take up.
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Literature
go back to reference Agarwal, A., Williams, G. H., & Fisher, N. D. (2005). Genetics of human hypertension. Trends in Endocrinology and Metabolism,16(3), 127–133.CrossRef Agarwal, A., Williams, G. H., & Fisher, N. D. (2005). Genetics of human hypertension. Trends in Endocrinology and Metabolism,16(3), 127–133.CrossRef
go back to reference Anokhin, A. P., Golosheykin, S., Grant, J. D., & Heath, A. C. (2011). Heritability of delay discounting in adolescence: A longitudinal twin study. Behavior Genetics,41(2), 175–183.CrossRef Anokhin, A. P., Golosheykin, S., Grant, J. D., & Heath, A. C. (2011). Heritability of delay discounting in adolescence: A longitudinal twin study. Behavior Genetics,41(2), 175–183.CrossRef
go back to reference Barnes, J. C., Wright, J. P., Boutwell, B. B., Schwartz, J. A., Connolly, E. J., Nedelec, J. L., et al. (2014). Demonstrating the validity of twin research in criminology. Criminology,52(4), 588–626.CrossRef Barnes, J. C., Wright, J. P., Boutwell, B. B., Schwartz, J. A., Connolly, E. J., Nedelec, J. L., et al. (2014). Demonstrating the validity of twin research in criminology. Criminology,52(4), 588–626.CrossRef
go back to reference Benjamin, D. J., Cesarini, D., Chabris, C. F., Glaeser, E. L., Laibson, D. I., Guðnason, V., et al. (2012). The promises and pitfalls of genoeconomics. Annual Review of Economics,4, 627.CrossRef Benjamin, D. J., Cesarini, D., Chabris, C. F., Glaeser, E. L., Laibson, D. I., Guðnason, V., et al. (2012). The promises and pitfalls of genoeconomics. Annual Review of Economics,4, 627.CrossRef
go back to reference Boardman, J. D., Blalock, C. L., & Pampel, F. C. (2010). Trends in the genetic influences on smoking. Journal of Health and Social Behavior,51(1), 108–123.CrossRef Boardman, J. D., Blalock, C. L., & Pampel, F. C. (2010). Trends in the genetic influences on smoking. Journal of Health and Social Behavior,51(1), 108–123.CrossRef
go back to reference Boardman, J. D., Domingue, B. W., & Daw, J. (2015). What can genes tell us about the relationship between education and health? Social Science and Medicine,127, 171–180.CrossRef Boardman, J. D., Domingue, B. W., & Daw, J. (2015). What can genes tell us about the relationship between education and health? Social Science and Medicine,127, 171–180.CrossRef
go back to reference Branigan, A. R., McCallum, K. J., & Freese, J. (2013). Variation in the heritability of educational attainment: An international meta-analysis. Social Forces,92(1), 109–140.CrossRef Branigan, A. R., McCallum, K. J., & Freese, J. (2013). Variation in the heritability of educational attainment: An international meta-analysis. Social Forces,92(1), 109–140.CrossRef
go back to reference Brim, O. G., Baltes, P. B., Lachman, M. E., Markus, H. R., Shweder, R. A., Marmot, M. G., et al. (2017). Midlife in the United States (MIDUS 1), 1995–1996. Ann Arbor, MI: Inter-University Consortium for Political and Social Research [distributor], 2017-11-16. https://doi.org/10.3886/icpsr02760.v12. Brim, O. G., Baltes, P. B., Lachman, M. E., Markus, H. R., Shweder, R. A., Marmot, M. G., et al. (2017). Midlife in the United States (MIDUS 1), 1995–1996. Ann Arbor, MI: Inter-University Consortium for Political and Social Research [distributor], 2017-11-16. https://​doi.​org/​10.​3886/​icpsr02760.​v12.
go back to reference Burt, C. H., & Simons, R. L. (2014). Pulling back the curtain on heritability studies: Biosocial criminology in the postgenomic era. Criminology,52(2), 223–262.CrossRef Burt, C. H., & Simons, R. L. (2014). Pulling back the curtain on heritability studies: Biosocial criminology in the postgenomic era. Criminology,52(2), 223–262.CrossRef
go back to reference Carlsson, S., Ahlbom, A., Lichtenstein, P., & Andersson, T. (2013). Shared genetic influence of BMI, physical activity and type 2 diabetes: A twin study. Diabetologia,56(5), 1031–1035.CrossRef Carlsson, S., Ahlbom, A., Lichtenstein, P., & Andersson, T. (2013). Shared genetic influence of BMI, physical activity and type 2 diabetes: A twin study. Diabetologia,56(5), 1031–1035.CrossRef
go back to reference Cesarini, D., Dawes, C. T., Johannesson, M., Lichtenstein, P., & Wallace, B. (2009). Genetic variation in preferences for giving and risk taking. Quarterly Journal of Economics,124, 809–842.CrossRef Cesarini, D., Dawes, C. T., Johannesson, M., Lichtenstein, P., & Wallace, B. (2009). Genetic variation in preferences for giving and risk taking. Quarterly Journal of Economics,124, 809–842.CrossRef
go back to reference Cesarini, D., Johannesson, M., Lichtenstein, P., Sandewall, Ö., & Wallace, B. (2010). Genetic variation in financial decision-making. The Journal of Finance,65(5), 1725–1754.CrossRef Cesarini, D., Johannesson, M., Lichtenstein, P., Sandewall, Ö., & Wallace, B. (2010). Genetic variation in financial decision-making. The Journal of Finance,65(5), 1725–1754.CrossRef
go back to reference Charney, E., & English, W. (2013). Genopolitics and the science of genetics. American Political Science Review,107(02), 382–395.CrossRef Charney, E., & English, W. (2013). Genopolitics and the science of genetics. American Political Science Review,107(02), 382–395.CrossRef
go back to reference Cronqvist, H., & Siegel, S. (2015). The origins of savings behavior. Journal of Political Economy,123(1), 123–169.CrossRef Cronqvist, H., & Siegel, S. (2015). The origins of savings behavior. Journal of Political Economy,123(1), 123–169.CrossRef
go back to reference Cutler, D., Finkelstein, A., & McGarry, K. (2008). Preference heterogeneity and insurance markets: Explaining a puzzle of insurance. American Economic Review: Papers and Proceedings,98(2), 157–162.CrossRef Cutler, D., Finkelstein, A., & McGarry, K. (2008). Preference heterogeneity and insurance markets: Explaining a puzzle of insurance. American Economic Review: Papers and Proceedings,98(2), 157–162.CrossRef
go back to reference Cutler, D. M., & Lleras-Muney, A. (2006). Education and health: Evaluating theories and evidence (No. w12352). National Bureau of Economic Research. Cutler, D. M., & Lleras-Muney, A. (2006). Education and health: Evaluating theories and evidence (No. w12352). National Bureau of Economic Research.
go back to reference Domingue, B. W., Fletcher, J., Conley, D., & Boardman, J. D. (2014). Genetic and educational assortative mating among US adults. Proceedings of the National Academy of Sciences,111(22), 7996–8000.CrossRef Domingue, B. W., Fletcher, J., Conley, D., & Boardman, J. D. (2014). Genetic and educational assortative mating among US adults. Proceedings of the National Academy of Sciences,111(22), 7996–8000.CrossRef
go back to reference Elks, C. E., Den Hoed, M., Zhao, J. H., Sharp, S. J., Wareham, N. J., Loos, R. J., et al. (2012). Variability in the heritability of body mass index: A systematic review and meta-regression. Frontiers in endocrinology,3, 29.CrossRef Elks, C. E., Den Hoed, M., Zhao, J. H., Sharp, S. J., Wareham, N. J., Loos, R. J., et al. (2012). Variability in the heritability of body mass index: A systematic review and meta-regression. Frontiers in endocrinology,3, 29.CrossRef
go back to reference Fang, H., Keane, P. M., & Silverman, D. (2008). Sources of advantageous selection: Evidence from the medigap insurance market. Journal of Political Economy,116(2), 303–350.CrossRef Fang, H., Keane, P. M., & Silverman, D. (2008). Sources of advantageous selection: Evidence from the medigap insurance market. Journal of Political Economy,116(2), 303–350.CrossRef
go back to reference Kendler, K. S., Gatz, M., Gardner, C. O., & Pedersen, N. L. (2006). A Swedish national twin study of lifetime major depression. American Journal of Psychiatry,163(1), 109–114.CrossRef Kendler, K. S., Gatz, M., Gardner, C. O., & Pedersen, N. L. (2006). A Swedish national twin study of lifetime major depression. American Journal of Psychiatry,163(1), 109–114.CrossRef
go back to reference Kosova, G., Abney, M., & Ober, C. (2010). Heritability of reproductive fitness traits in a human population. Proceedings of the National Academy of Sciences,107(suppl 1), 1772–1778.CrossRef Kosova, G., Abney, M., & Ober, C. (2010). Heritability of reproductive fitness traits in a human population. Proceedings of the National Academy of Sciences,107(suppl 1), 1772–1778.CrossRef
go back to reference Kuhnen, C. M., & Chiao, J. Y. (2009). Genetic determinants of financial risk taking. PLoS ONE,4(2), e4362.CrossRef Kuhnen, C. M., & Chiao, J. Y. (2009). Genetic determinants of financial risk taking. PLoS ONE,4(2), e4362.CrossRef
go back to reference Maes, H. H., Sullivan, P. F., Bulik, C. M., Neale, M. C., Prescott, C. A., Eaves, L. J., et al. (2004). A twin study of genetic and environmental influences on tobacco initiation, regular tobacco use and nicotine dependence. Psychological Medicine,34(07), 1251–1261.CrossRef Maes, H. H., Sullivan, P. F., Bulik, C. M., Neale, M. C., Prescott, C. A., Eaves, L. J., et al. (2004). A twin study of genetic and environmental influences on tobacco initiation, regular tobacco use and nicotine dependence. Psychological Medicine,34(07), 1251–1261.CrossRef
go back to reference McGue, M., Zhang, Y., Miller, M. B., Basu, S., Vrieze, S., Hicks, B., et al. (2013). A genome-wide association study of behavioral disinhibition. Behavior Genetics,43(5), 363–373.CrossRef McGue, M., Zhang, Y., Miller, M. B., Basu, S., Vrieze, S., Hicks, B., et al. (2013). A genome-wide association study of behavioral disinhibition. Behavior Genetics,43(5), 363–373.CrossRef
go back to reference Moor, M. M., Willemsen, G., Rebollo-Mesa, I., Stubbe, J., Geus, E. C., & Boomsma, D. (2011). Exercise participation in adolescents and their parents: Evidence for genetic and generation specific environmental effects. Behavior Genetics,41, 211–222.CrossRef Moor, M. M., Willemsen, G., Rebollo-Mesa, I., Stubbe, J., Geus, E. C., & Boomsma, D. (2011). Exercise participation in adolescents and their parents: Evidence for genetic and generation specific environmental effects. Behavior Genetics,41, 211–222.CrossRef
go back to reference Oster, E., Shoulson, I., Quaid, K., & Dorsey, E. A. (2010). Genetic adverse selection: Evidence from long-term care insurance and Huntington disease. Journal of Public Economics,94, 1041–1050.CrossRef Oster, E., Shoulson, I., Quaid, K., & Dorsey, E. A. (2010). Genetic adverse selection: Evidence from long-term care insurance and Huntington disease. Journal of Public Economics,94, 1041–1050.CrossRef
go back to reference Rabe-Hesketh, S., Skrondal, A., & Gjessing, H. K. (2008). Biometrical modeling of twin and family data using standard mixed model software. Biometrics,64, 280–288.CrossRef Rabe-Hesketh, S., Skrondal, A., & Gjessing, H. K. (2008). Biometrical modeling of twin and family data using standard mixed model software. Biometrics,64, 280–288.CrossRef
go back to reference Romeis, J. C., Heath, A. C., Xian, H., Eisen, S. A., Scherrer, J. F., Pedersen, N. L., et al. (2005). Heritability of SF-36 among middle-age, middle-class, male-male twins. Medical Care,43(11), 1147–1154.CrossRef Romeis, J. C., Heath, A. C., Xian, H., Eisen, S. A., Scherrer, J. F., Pedersen, N. L., et al. (2005). Heritability of SF-36 among middle-age, middle-class, male-male twins. Medical Care,43(11), 1147–1154.CrossRef
go back to reference Romeis, J., Scherrer, J., Xian, H., Eisen, S., Bucholz, K., Health, A., et al. (2000). Heritability of self-reported health status. Health Services Research,35(5 Part 1), 995–1010.PubMedPubMedCentral Romeis, J., Scherrer, J., Xian, H., Eisen, S., Bucholz, K., Health, A., et al. (2000). Heritability of self-reported health status. Health Services Research,35(5 Part 1), 995–1010.PubMedPubMedCentral
go back to reference Stacey, D., Clarke, T. K., & Schumann, G. (2009). The genetics of alcoholism. Current Psychiatry Reports,11(5), 364–369.CrossRef Stacey, D., Clarke, T. K., & Schumann, G. (2009). The genetics of alcoholism. Current Psychiatry Reports,11(5), 364–369.CrossRef
go back to reference Stubbe, J. H., Boomsma, D. I., Vink, J. M., Cornes, B. K., Martin, N. G., Skytthe, A., et al. (2006). Genetic influences on exercise participation in 37,051 twin pairs from seven countries. PLoS ONE,1(1), e22.CrossRef Stubbe, J. H., Boomsma, D. I., Vink, J. M., Cornes, B. K., Martin, N. G., Skytthe, A., et al. (2006). Genetic influences on exercise participation in 37,051 twin pairs from seven countries. PLoS ONE,1(1), e22.CrossRef
go back to reference Thomsen, S. F., Van Der Sluis, S., Kyvik, K. O., Skytthe, A., & Backer, V. (2010). Estimates of asthma heritability in a large twin sample. Clinical and Experimental Allergy,40(7), 1054–1061.CrossRef Thomsen, S. F., Van Der Sluis, S., Kyvik, K. O., Skytthe, A., & Backer, V. (2010). Estimates of asthma heritability in a large twin sample. Clinical and Experimental Allergy,40(7), 1054–1061.CrossRef
go back to reference Treloar, S. A., McDonald, C. A., & Martin, N. G. (1999). Genetics of early cancer detection behaviours in Australian female twins. Twin Research,2(01), 33–42.CrossRef Treloar, S. A., McDonald, C. A., & Martin, N. G. (1999). Genetics of early cancer detection behaviours in Australian female twins. Twin Research,2(01), 33–42.CrossRef
go back to reference True, W. R., Romeis, J. C., Heath, A. C., Flick, L. H., Shaw, L., Eisen, S. A., et al. (1997). Genetic and environmental contributions to healthcare need and utilization: A twin analysis. Health Services Research,32, 37–53.PubMedPubMedCentral True, W. R., Romeis, J. C., Heath, A. C., Flick, L. H., Shaw, L., Eisen, S. A., et al. (1997). Genetic and environmental contributions to healthcare need and utilization: A twin analysis. Health Services Research,32, 37–53.PubMedPubMedCentral
go back to reference Trumbetta, S. L., Markowitz, E. M., & Gottesman, I. I. (2007). Marriage and genetic variation across the lifespan: Not a steady relationship? Behavior Genetics,37(2), 362–375.CrossRef Trumbetta, S. L., Markowitz, E. M., & Gottesman, I. I. (2007). Marriage and genetic variation across the lifespan: Not a steady relationship? Behavior Genetics,37(2), 362–375.CrossRef
go back to reference Verhulst, B. (2013). Gene-environment interplay in twin models. Political Analysis,21(3), 368–389.CrossRef Verhulst, B. (2013). Gene-environment interplay in twin models. Political Analysis,21(3), 368–389.CrossRef
go back to reference Wehby, G. L., Domingue, B. W., & Boardman, J. D. (2015). Prevention, use of health services, and genes: Implications of genetics for policy formation. Journal of Policy Analysis and Management,34(3), 519–536.CrossRef Wehby, G. L., Domingue, B. W., & Boardman, J. D. (2015). Prevention, use of health services, and genes: Implications of genetics for policy formation. Journal of Policy Analysis and Management,34(3), 519–536.CrossRef
go back to reference Wehby, G. L., Domingue, B. W., Ullrich, F., & Wolinsky, F. D. (2017). Genetic predisposition to obesity and medicare expenditures. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences,73(1), 66–72.CrossRef Wehby, G. L., Domingue, B. W., Ullrich, F., & Wolinsky, F. D. (2017). Genetic predisposition to obesity and medicare expenditures. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences,73(1), 66–72.CrossRef
go back to reference Wehby, G. L., Domingue, B. W., & Wolinsky, F. D. (2018). Genetic risks for chronic conditions: Implications for long-term wellbeing. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences,73(4), 477–483.CrossRef Wehby, G. L., Domingue, B. W., & Wolinsky, F. D. (2018). Genetic risks for chronic conditions: Implications for long-term wellbeing. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences,73(4), 477–483.CrossRef
go back to reference Wolinsky, F. D., Jones, M. P., Ullrich, F., Lou, Y., & Wehby, G. L. (2014). The concordance of survey reports and medicare claims in a nationally representative longitudinal cohort of older adults. Medical Care,52(5), 462–468.CrossRef Wolinsky, F. D., Jones, M. P., Ullrich, F., Lou, Y., & Wehby, G. L. (2014). The concordance of survey reports and medicare claims in a nationally representative longitudinal cohort of older adults. Medical Care,52(5), 462–468.CrossRef
Metadata
Title
Genetic variation in health insurance coverage
Authors
George L. Wehby
Dan Shane
Publication date
01-12-2019
Publisher
Springer US
Published in
International Journal of Health Economics and Management / Issue 3-4/2019
Print ISSN: 2199-9023
Electronic ISSN: 2199-9031
DOI
https://doi.org/10.1007/s10754-018-9255-y

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