Insurance Expansions: Do They Hurt Those They are Designed to Help?

Document Type



The most up-to-date version of this piece can be found in the Duke Law Scholarship


Seeking to redress health disparities across income and race, many policymakers 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.

Date of Authorship for this Version

September 2007