Staff Reports
The Great Equalizer: Medicare and the Geography of Consumer Financial Strain
Previous title: “Medicare and the Geography of Financial Health”
Number 911
January 2020 Revised September 2023

JEL classification: I13

Authors: Paul Goldsmith-Pinkham, Maxim L. Pinkovskiy, and Jacob Wallace

We use a five percent sample of Americans’ credit bureau data, combined with a regression discontinuity approach, to estimate the effect of universal health insurance at age 65—when most Americans become eligible for Medicare—at the national, state, and local level. We find a 30 percent reduction in debt collections—and a two-thirds reduction in the geographic variation in collections—with limited effects on other financial outcomes. The areas that experienced larger reductions in collections debt at age 65 were concentrated in the Southern United States, and had higher shares of black residents, people with disabilities, and for-profit hospitals.

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Author Disclosure Statement(s)
Paul Goldsmith-Pinkham
I declare that I have no relevant or material financial interests that relate to the research described in this paper.

Maxim Pinkovskiy
The author declares that he has no relevant or material financial interests that relate to the research described in this paper.

Jacob Wallace
The author declares that (s)he has no relevant or material financial interests that relate to the research described in this paper. Prior to circulation, this paper was reviewed in accordance with the Federal Reserve Bank of New York review policy, available at https://www.newyorkfed.org/research/staff_reports/index.html.
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