scholarly journals The Line Between Medicaid and Marketplace: Coverage Effects from Wisconsin’s Partial Expansion

2021 ◽  
Author(s):  
Laura Dague ◽  
Marguerite Burns ◽  
Donna Friedsam
Keyword(s):  
Health Insurance ◽  
Low Income ◽  
Medicaid Expansion ◽  
Poverty Level ◽  
Claims Database ◽  
Medicaid Coverage ◽  
Medicaid Enrollment ◽  
Medicaid Eligibility ◽  
Balanced Budget ◽  
Parents And Caregivers

Abstract Context: States have sought to experiment with the income eligibility threshold between Medicaid coverage and access to subsidized Marketplace plans in an effort to increase coverage for low-income adults while meeting other state priorities, particularly a balanced budget. In 2014, Wisconsin opted against adoption of an ACA Medicaid expansion, instead setting the Medicaid eligibility threshold at 100% of the poverty level—a state-funded partial expansion. Childless adults gained new eligibility, while parents and caregivers with incomes between 101–200% of poverty lost existing eligibility. Methods: We use Wisconsin’s all-payer claims database to assess health insurance gains, losses, and transitions among low-income adults affected by this partial expansion. Findings: We find that less than one third of adults who lost Medicaid eligibility definitely took up commercial coverage, and many returned to Medicaid. Among those newly Medicaid eligible, there was little evidence of crowd-out. Both groups experienced limited continuity of coverage. Overall, new Medicaid enrollment of childless adults was offset by coverage losses among parents and caregivers, rendering Wisconsin’s overall coverage gains similar to non-expansion states. Conclusions: Wisconsin’s experience demonstrates the difficulty in relying on the Marketplace to cover the near poor and suggests that full Medicaid expansion more effectively increases coverage.

scholarly journals ACA Medicaid Expansion Associated With Increased Medicaid Participation and Improved Health Among Near-Elderly: Evidence From the Health and Retirement Study

2020 ◽  
Vol 57 ◽  
pp. 004695802093522
Author(s):  
Melissa McInerney ◽  
Ruth Winecoff ◽  
Padmaja Ayyagari ◽  
Kosali Simon ◽  
M. Kate Bundorf
Keyword(s):  
Older Adults ◽  
Metabolic Syndrome ◽  
Health Insurance ◽  
Low Income ◽  
Well Being ◽  
Health And Retirement Study ◽  
Medicaid Expansion ◽  
Poverty Level ◽  
Care Needs ◽  
Retirement Study

The Affordable Care Act (ACA) dramatically expanded health insurance, but questions remain regarding its effects on health. We focus on older adults for whom health insurance has greater potential to improve health and well-being because of their greater health care needs relative to younger adults. We further focus on low-income adults who were the target of the Medicaid expansion. We believe our study provides the first evidence of the health-related effects of ACA Medicaid expansion using the Health and Retirement Study (HRS). Using geo-coded data from 2010 to 2016, we estimate difference-in-differences models, comparing changes in outcomes before and after the Medicaid expansion in treatment and control states among a sample of over 3,000 unique adults aged 50 to 64 with income below 100% of the federal poverty level. The HRS allows us to examine morbidity outcomes not available in administrative data, providing evidence of the mechanisms underlying emerging evidence of mortality reductions due to expanded insurance coverage among the near-elderly. We find that the Medicaid expansion was associated with a 15 percentage point increase in Medicaid coverage which was largely offset by declines in other types of insurance. We find improvements in several measures of health including a 12% reduction in metabolic syndrome; a 32% reduction in complications from metabolic syndrome; an 18% reduction in the likelihood of gross motor skills difficulties; and a 34% reduction in compromised activities of daily living (ADLs). Our results thus suggest that the Medicaid expansion led to improved physical health for low-income, older adults.

Improving Access to Health Services for Adolescents From Economically Disadvantaged Families

PEDIATRICS ◽  
1989 ◽  
Vol 84 (6) ◽  
pp. 1056-1063 ◽  
Author(s):  
Paul W. Newacheck
Keyword(s):  
Health Status ◽  
Low Income ◽  
Chronic Illnesses ◽  
Care Utilization ◽  
Access To Health Services ◽  
Physician Services ◽  
Poverty Level ◽  
Medicaid Coverage ◽  
Medicaid Eligibility ◽  
Utilization Patterns

An analysis of the health status and health care utilization patterns of poor and nonpoor adolescents was conducted using a sample of 22 792 adolescents 10 to 18 years of age from the 1983 and 1984 National Health Interview Surveys. The results indicate that adolescents from families with incomes below the poverty level were three times as likely to be reported in only fair or poor health status and were 47% more likely to suffer from disabling chronic illnesses than adolescents from families with incomes above the poverty level. Use of inpatient hospital services was similar for adolescents from poor and nonpoor families when health status was controlled. However, adolescents from poor families were 35% more likely than those from nonpoor families to have waited 2 or more years between physician contacts. In addition, poor adolescents made 13% fewer physician contacts on an annual basis when compared with nonpoor adolescents. Substantial differences in utilization rates were found when poor adolescents were disaggregated according to whether they were covered by Medicaid. Those with Medicaid coverage used physician services at rates similar to nonpoor adolescents, whereas those without Medicaid coverage lagged substantially behind. Based on the conclusion that Medicaid is effective in reducing barriers to needed services, strategies for expanding Medicaid eligibility to additional low-income adolescents are discussed.

scholarly journals Overturning the ACA’s Medicaid Expansion Would Likely Decrease Low-Income, Reproductive-Age Women’s Healthcare Spending and Utilization

2020 ◽  
Vol 57 ◽  
pp. 004695802098146
Author(s):  
Lucy Chen ◽  
Richard G. Frank ◽  
Haiden A. Huskamp
Keyword(s):  
Low Income ◽  
Medical Expenditure Panel Survey ◽  
Healthcare Spending ◽  
Reproductive Age ◽  
Medical Expenditure ◽  
Medicaid Expansion ◽  
Poverty Level ◽  
Difference In Differences ◽  
The Supreme Court ◽  
Household Incomes

In late 2020, the Supreme Court began hearing a case challenging the Affordable Care Act (ACA), which led to coverage gains for many low-income, reproductive-age women. To explore potential implications of a full ACA repeal for this population, we examined gains experienced after Medicaid expansion, assuming that such gains may be reversed. Using restricted 2013 to 2014 data from the Medical Expenditure Panel Survey for 1190 women ages 18 to 44 with household incomes below 138% of the federal poverty level, we compared the change in healthcare spending and utilization for women living in expansion states to the change in non-expansion states using a difference-in-differences design. We found that if Medicaid expansion were overturned, Medicaid coverage is likely to decrease, as well as Medicaid spending and prescription drug utilization.

scholarly journals Early-life Medicaid Coverage and Intergenerational Economic Mobility

2018 ◽  
Vol 59 (2) ◽  
pp. 300-315 ◽  
Author(s):  
Rourke L. O’Brien ◽  
Cassandra L. Robertson
Keyword(s):  
Low Income ◽  
Early Life ◽  
Instrumental Variable ◽  
Regression Models ◽  
Causal Effect ◽  
Economic Mobility ◽  
Medicaid Coverage ◽  
Instrumental Variable Regression ◽  
Normative Evaluation ◽  
Medicaid Eligibility

New data reveal significant variation in economic mobility outcomes across U.S. localities. This suggests that social structures, institutions, and public policies—particularly those that influence critical early-life environments—play an important role in shaping mobility processes. Using new county-level estimates of intergenerational economic mobility for children born between 1980 and 1986, we exploit the uneven expansions of Medicaid eligibility across states to isolate the causal effect of this specific policy change on mobility outcomes. Instrumental-variable regression models reveal that increasing the proportion of low-income pregnant women eligible for Medicaid improved the mobility outcomes of their children in adulthood. We find no evidence that Medicaid coverage in later childhood years influences mobility outcomes. This study has implications for the normative evaluation of this policy intervention as well as our understanding of mobility processes in an era of rising inequality.

State Fiscal Considerations and Research Opportunities Emerging from the Affordable Care Act's Medicaid Expansion

2014 ◽  
Vol 40 (2-3) ◽  
pp. 237-252
Author(s):  
Jean C. Sullivan ◽  
Rachel Gershon
Keyword(s):  
Low Income ◽  
Insurance Coverage ◽  
Supreme Court Decision ◽  
Health Insurance Coverage ◽  
The United States ◽  
Primary Objective ◽  
Medicaid Expansion ◽  
Poverty Level ◽  
Assistance Program ◽  
Social Security Act

As enacted, the Affordable Care Act (ACA) directed states to provide Medicaid coverage to most nonelderly adults with incomes up to 138% of the Federal Poverty Level (the “Medicaid expansion group”) beginning in 2014. The Medicaid expansion provision of the ACA is an integral component of fulfilling the ACA’s primary objective to achieve near-universal health insurance coverage rates across the United States.Title XIX of the Social Security Act (Title XIX) is Medicaid’s enabling statute. Medicaid is a medical assistance program for certain low-income individuals, jointly funded and administered by federal and state governments. Certain features of the Medicaid program provide a framework within which the ACA and subsequent Supreme Court decision National Federation of Independent Business (NFIB) v. Sebelius can be understood.

scholarly journals A National Survey of Trends in Health Insurance Coverage of Low-Income Adults Following Medicaid Expansion

2019 ◽  
Vol 35 (6) ◽  
pp. 1911-1913 ◽  
Author(s):  
Mark Olfson ◽  
Melanie M. Wall ◽  
Colleen L. Barry ◽  
Christine Mauro ◽  
Tianshu Feng ◽  
...  
Keyword(s):  
Health Insurance ◽  
National Survey ◽  
Low Income ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Medicaid Expansion

Medicaid Expansions and Participation in Supplemental Security Income by Noncitizens

2021 ◽  
pp. e1-e7
Author(s):  
Felix M. Muchomba ◽  
Neeraj Kaushal
Keyword(s):  
Low Income ◽  
Supplemental Security Income ◽  
Medicaid Expansion ◽  
Participation Rates ◽  
Social Security Administration ◽  
Eligibility Criteria ◽  
The Social ◽  
Before And After ◽  
Medicaid Eligibility ◽  
Using Data

Objectives. To estimate the effect of Medicaid expansion on noncitizens’ and citizens’ participation in the Supplemental Security Income (SSI) program. The Affordable Care Act (ACA) expanded Medicaid eligibility to cover low-income nonelderly adults without children, thus delinking their Medicaid participation from participation in the SSI program. Methods. Using data from the Social Security Administration for 2009 through 2018 (n = 1020 state-year observations) and the Current Population Survey for 2009 through 2019 (n = 78 776 respondents), we employed a difference-in-differences approach comparing SSI participation rates in US states that adopted Medicaid expansion with participation rates in nonexpansion states before and after ACA implementation. Results. Medicaid expansion reduced the SSI (disability) participation of nonelderly noncitizens by 12% and of nonelderly citizens by 2%. Estimates remained robust with administrative and survey data. Conclusions. Medicaid expansion caused a substantially larger decline in the SSI participation of noncitizens, who face more restrictive SSI eligibility criteria, than of citizens. Our estimates suggest an annual savings of $619 million in the federal SSI cost because of the decline in SSI participation among noncitizens and citizens. (Am J Public Health. Published online ahead of print April 15, 2021: e1–e7. https://doi.org/10.2105/AJPH.2021.306235 )

Abstract 13155: Differences in Cardiovascular Prescription Drug Utilization Among Medicaid Beneficiaries in Early Expander vs. Non-expander States From 2011 to 2018

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Andrew Sumarsono ◽  
Hussain Lalani ◽  
Matthew W Segar ◽  
Ambarish Pandey
Keyword(s):  
Drug Utilization ◽  
Prescription Drugs ◽  
Low Income ◽  
The United States ◽  
Medicaid Expansion ◽  
P2y12 Inhibitors ◽  
Healthcare It ◽  
Medicaid Eligibility ◽  
Receptor Blockers ◽  
Medicaid Beneficiaries

Introduction: Cardiovascular disease remains the leading cause of death in the United States. In 2014, the Affordable Care Act expanded Medicaid eligibility allowing low-income adults to access healthcare. It remains unclear how Medicaid expansion affected access to cardiovascular prescription drugs. Methods: We used the publicly available Medicaid State Drug Utilization dataset to evaluate the utilization of statins, P2Y12 receptor blockers (P2Y12-RB), and seven classes of oral antihypertensives. We used a difference-in-differences analysis to compare quarterly prescriptions per 1,000 Medicaid beneficiaries for each drug class among Medicaid expansion states versus non-expansion states during the three years before and five years after the 2014 Medicaid expansion. Results: Between 2011 and 2018, the number of annual prescriptions of statins, P2Y12-RB, and antihypertensives increased by 89.7% (11.0 to 20.8 million), 37% (1.7 to 2.3 million), and 76% (35.3 to 62.2 million). Medicaid expansion states had higher quarterly prescriptions per 1000 Medicaid beneficiaries compared to non-expansion states for statins (22.54 [CI 95%: 15.5 to 28.58], p<0.001), antiplatelets (1.68 [CI 95%: 1.15 to 2.21], p<0.001), and antihypertensives (63.21 [CI 95%: 47.31 to 79.11], p<0.001). Conclusion: National Medicaid use of statins, P2Y12-RB, and antihypertensives increased between 2011 to 2018. The Medicaid expansion was associated significant increases in per-capita utilization of all cardiovascular prescription drugs. These gains in utilization are likely providing long-term cardiovascular benefits to lower-income and previously underinsured populations. Figure 1: Trends in Quarterly Prescriptions/1000 Beneficiaries of statins, anti-platelets, and antihypertensives between 2011 to 2018 between expander and non-expander states. 1A: statins. 1B: P2Y12 inhibitors. 1C: Antihypertensives

Impact of late Medicaid expansion on prostate cancer screening.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 141-141 ◽  
Author(s):  
Daniel Pucheril ◽  
Dimitar V. Zlatev ◽  
Matthew Mossanen ◽  
Alexander P Cole ◽  
Matthew D. Ingham ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Health Insurance ◽  
Cancer Screening ◽  
Prostate Cancer Screening ◽  
Behavioral Risk ◽  
Medicaid Expansion ◽  
Poverty Level ◽  
Multivariable Logistic Regression Model ◽  
Significant Difference ◽  
Personal Physician

141 Background: A key provision of the Affordable Care Act (ACA) was the expansion of Medicaid to childless adults living < 138% of the federal poverty level (FPL). Aside from a few early expansion states, the majority of states adopting the provision expanded coverage in January 2014, and are categorized as late expansion states (LES). Non-expansion states (NES) opposed expansion and did not adopt these broader provisions. Our objective was to determine the effects of this policy change on prostate cancer screening (PSAS) trends in LES and NES. Methods: The 2014 and 2016 Behavioral Risk Factor Surveillance System surveys reflect 2013 and 2015 health behaviors, and were queried for men 40-64, without history of prostate cancer, with a household income < 138% FPL, and residing in NES or LES. Descriptive statistics, stratified by expansion status and year, were generated for covariates. The Chi-Square test was used to compare proportions between years within state categories. Difference-in-differences (DID) analyses were employed to compare trends in men with health insurance, a personal physician, and undergoing PSAS. Within a multivariable logistic regression model, the interaction term year*state expansion status was used to determine the significance of DID estimates. Results: A weighted 8.8 million (n = 14,979) men met inclusion criteria. PSAS significantly declined from 2014 to 2016 in both NES (22.6% to 16.4%, p = 0.0006) and LES (20.5% to 15.8%, p = 0.003). In LES, the proportion of men with health insurance significantly increased from 2014 to 2016 (75.5% to 82.7%, p = 0.0002), however the proportion of insured men in NES was constant. Additionally, the proportion of respondents with a personal physician was unchanged from 2014 to 2016 in both NES and LES. DID analysis determined a significant difference in health insurance trends between 2014 and 2016 for LES compared to NES (+6.9%, p = 0.008). DID estimates were not significant for comparisons of trends for PSAS or access to a personal physician. Conclusions: The ACA’s Medicaid expansion provision has led to significant gains in insurance coverage for eligible persons in LES compared to NES, however, these gains have not translated into significantly different rates of access to a personal physician or PSAS.

Effect of increasing Medicaid coverage in Medicaid expansion states on stage at presentation for urologic malignancies.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 400-400
Author(s):  
Xiaosong Meng ◽  
Hersh Trivedi ◽  
Alexander P. Kenigsberg ◽  
Rashed Ghandour ◽  
Vitaly Margulis ◽  
...  
Keyword(s):  
Low Income ◽  
Poverty Line ◽  
Testis Cancer ◽  
Medicaid Expansion ◽  
Uninsured Patients ◽  
Medicaid Coverage ◽  
Time Period ◽  
Before And After ◽  
Urologic Malignancies

400 Background: Medicaid Expansion (ME) was introduced by the Affordable Care Act to improve access to care for low income individuals by increasing the annual income limits to 138% of the poverty line. However, not all states have elected to participate in ME. Using the National Cancer Database (NCDB), we sought to assess the effects of participation in ME on the four most common urologic malignancies. Methods: The NCDB was queried for bladder, prostate, kidney and testis cancer from 2012-2016, to span the time period two years before and two years after the main ME which took place in 2014. Trends in insurance status at time of diagnosis and effects on stage at presentation before and after ME were analyzed. Results: The percentage of patients with Medicaid coverage at the time of diagnosis for all four urologic malignancies increased significantly after 2014, with a commiserate decrease in the percentage of uninsured patients (Table). By 2016, significantly more patients had Medicaid coverage at diagnosis in ME states compared to those in Non-ME states (bladder 5.0% vs 2.5%, prostate 5.9% vs 2.2%, kidney 9.7% vs 4.1%, 19.5% vs 7.2%, all p < 0.01). However, the stage at presentation for all four urologic malignancies did not significantly differ for patients in ME versus non-ME states. Conclusions: Despite an increase in the proportion of patients with Medicaid coverage after 2014, surprisingly, there was not an associated change in stage at presentation for urologic malignancies in ME states. Further long-term analysis is necessary to evaluate if expanded Medicaid coverage impacts overall survival in this patient population.[Table: see text]

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