Effects of Medicaid Expansion on Poverty Disparities in Health Insurance Coverage

2021 ◽  
Author(s):  
Yilu Lin ◽  
Alisha Monnette ◽  
Lizheng Shi
Keyword(s):  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Community Survey ◽  
Medicaid Expansion ◽  
Market Exchange ◽  
Federal Poverty Level ◽  
Poverty Level ◽  
The Impact ◽  
Poverty Levels

Abstract Background: More than 30 States have either expanded Medicaid or considering expansion. The coverage gains from this policy is well documented, however, the impacts of its increasing coverage on poverty disparity are unclear at national level.Method: American Community Survey (2012-2018) was used to examine the effects of Medicaid expansion (ME) on poverty disparity in insurance coverage for nonelderly adults in the United States. Differences-in-differences-in-differences design was used to analyze the trends in uninsured rates (UR) by different poverty levels: <138%, 138–400% and >400% federal poverty level (FPL).Results: Compared with UR in 2012, UR in 2018 decreased by 10.75%, 6.42%, and 1.11% for <138%, 138-400%, and >400% FPL. From 2012-2018, >400% FPL group continuously had the lowest UR and <138% FPL group had the highest UR. Compared with ≥ 138% FPL groups, there was a 2.54% reduction in uninsured risk after ME among <138% FPL group in ME states versus control states. After eliminating the impact of the ACA market exchange premium subsidy, 3.18% decrease was estimated. Conclusion: Poverty disparity in UR improved with ME. However, <138% FPL population are still at a higher risk for being uninsured.

scholarly journals Effects of medicaid expansion on poverty disparities in health insurance coverage

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Yilu Lin ◽  
Alisha Monnette ◽  
Lizheng Shi
Keyword(s):  
Insurance Coverage ◽  
National Level ◽  
Health Insurance Coverage ◽  
The United States ◽  
Medicaid Expansion ◽  
Market Exchange ◽  
Federal Poverty Level ◽  
Poverty Level ◽  
The Impact ◽  
Poverty Levels

Abstract Background More than 30 states have either expanded Medicaid or are actively considering expansion. The coverage gains from this policy are well documented, however, the impacts of its increasing coverage on poverty disparity are unclear at the national level. Method American Community Survey (2012–2018) was used to examine the effects of Medicaid expansion on poverty disparity in insurance coverage for nonelderly adults in the United States. Differences-in-differences-in-differences design was used to analyze trends in uninsured rates by poverty levels: (1) < 138 %, (2) 138–400 % and (3) > 400 % federal poverty level (FPL). Results Compared with uninsured rates in 2012, uninsured rates in 2018 decreased by 10.75 %, 6.42 %, and 1.11 % for < 138 %, 138–400 %, and > 400 % FPL, respectively. From 2012 to 2018, > 400 % FPL group continuously had the lowest uninsured rate and < 138 % FPL group had the highest uninsured rate. Compared with ≥ 138 % FPL groups, there was a 2.54 % reduction in uninsured risk after Medicaid expansion among < 138 % FPL group in Medicaid expansion states versus control states. After eliminating the impact of the ACA market exchange premium subsidy, 3.18 % decrease was estimated. Conclusion Poverty disparity in uninsured rates improved with Medicaid expansion. However, < 138 % FPL population are still at a higher risk for being uninsured.

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.

Insurance coverage and care affordability in cancer survivors in 2016-2019.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 1520-1520
Author(s):  
Justin Michael Barnes ◽  
Eric Adjei Boakye ◽  
Mario Schootman ◽  
Evan Michael Graboyes ◽  
Nosayaba Osazuwa-Peters
Keyword(s):  
United States ◽  
Cancer Survivors ◽  
Low Socioeconomic Status ◽  
Private Insurance ◽  
Insurance Coverage ◽  
The United States ◽  
Mediating Effect ◽  
Medicaid Expansion ◽  
Poverty Level ◽  
Linear Probability

1520 Background: The Affordable Care Act (ACA) led to improvements in insurance coverage and care affordability in cancer patients. However, the uninsured rate for the general US reached its nadir in 2016 and has been increasing since. We aimed to quantify the changes in insurance coverage and rate of care unaffordability in cancer survivors from 2016 to 2019. Methods: We queried data from the Behavioral Risk Factor Surveillance System (2016-2019) for cancer survivors ages 18-64 years. Outcomes of interest were the percentage of cancer survivors reporting insurance coverage and the percentage reporting cost-driven lack of care in the previous 12 months. Survey-weighted linear probability models adjusted for covariates (age, sex, race/ethnicity, income, education, marital status, and state Medicaid expansion status) were utilized to estimate the average yearly change (AYC) in the outcomes across 2016-2019. Mediation analyses evaluated the mediating effect of insurance coverage changes on changes in cost-driven lack of care. Results: A total of 178,931 cancer survivors were identified among the survey respondents. The percentage of insured cancer survivors between 2016 and 2019 decreased from 92.4% to 90.4% (AYC: -0.54, 95% CI = -1.03 to -0.06, P =.026). This translates to an estimated 164,638 cancer survivors in the United States who lost insurance coverage in the study period. There were decreases in private insurance coverage (AYC: -1.66, 95% CI = -3.1 to -0.22, P =.024) but increases in Medicaid coverage (AYC: 1.14, 95% CI = 0.03 to 2.25, P =.043). The decreases in any coverage were largest in individuals with income < 138% federal poverty level (FPL) (AYC: -1.14, 95% CI = -2.32 to 0.04, P =.059; compared to > 250% FPL, Pinteraction=.03). Cost-driven lack of care in the preceding 12 months among cancer survivors increased from 17.9% in 2016 to 20% in 2019 (AYC: 0.67, 95% CI = 0.06 to 1.27, P =.03), which translates to an estimated 167,184 survivors in the US who skipped care due to costs. Changes in insurance coverage mediated 27.5% of the observed change in care unaffordability overall (p =.028) and 65.7% in individuals with income < 138% FPL relative to > 250% FPL (p =.045). Conclusions: Between 2016 and 2019, about 165,000 cancer survivors in the United States lost their insurance coverage and a similar number may have skipped needed care due to cost. Loss of insurance coverage was mostly among individuals with low socioeconomic status. Interventions to improve health insurance coverage among cancer survivors, such as the recent executive order to strengthen the ACA and further efforts promoting Medicaid expansion in additional states, may be important factors to mitigate these trends.

scholarly journals Poverty In The United States: A Continuing And Growing Problem

2011 ◽  
Vol 5 (12) ◽  
Author(s):  
Berch Haroian ◽  
Elizabeth C. Ekmekjian ◽  
Elias C. Grivoyannis
Keyword(s):  
Household Income ◽  
Insurance Coverage ◽  
Poverty Line ◽  
Health Insurance Coverage ◽  
The United States ◽  
Poverty Rate ◽  
Median Household Income ◽  
The Past ◽  
Area Of Interest ◽  
The Impact

<p class="Default" style="text-align: justify; margin: 0in 0.5in 0pt;"><span style="font-size: 10pt;"><span style="font-family: Times New Roman;">In recent years, the ability to deal with the problem of poverty in the US, in light of the new &ldquo;Federalism,&rdquo; is an area of interest to scholars. The poverty rate over the past 50 years has fluctuated from a high of 22.4% in 1959 to a low of 11.1% in 1973. Under George Bush&rsquo;s presidency, we again see an increase in the poverty rate to 12.7% in 2004. This paper provides an overview of poverty data for the 21<sup>st</sup> century, by region, race and age.<span style="mso-spacerun: yes;">&nbsp; </span>A discussion and comparison of median household income follows. Facts and figures are then provided/compared, tying in health care issues to income levels and citizenship/ethnicity. A brief introduction of the various attempts over the past years by the federal government to reduce the proportion of the American population that falls below the poverty line follows.<span style="mso-spacerun: yes;">&nbsp; </span>This section merely provides a listing of programs designed to satisfy social and equity considerations.<span style="mso-spacerun: yes;">&nbsp; </span>This paper does not provide the reader with the impact of these programs on the economy; a brief mention is provided to generate further thought and discussion.<span style="mso-spacerun: yes;">&nbsp; </span>The paper concludes with a summary of key elements of the above issues. The sole purpose is to provide an overview of historical data as concerns poverty, median household income and health insurance coverage. The ability to deal with the problem of poverty in the U S, is left for another paper.</span></span></p>

Same-Sex Marriage and Gains in Employer-Sponsored Insurance for US Adults, 2008–2017

2020 ◽  
Vol 110 (4) ◽  
pp. 537-539
Author(s):  
Janelle Downing ◽  
Paulette Cha
Keyword(s):  
Health Insurance ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Community Survey ◽  
Marriage Equality ◽  
Same Sex ◽  
Difference In Differences ◽  
Same Sex Marriage ◽  
Dependent Coverage

Objectives. To estimate the effects of same-sex marriage recognition on health insurance coverage. Methods. We used 2008–2017 data from the American Community Survey that represent 18 416 674 adult respondents in the United States. We estimated changes to health insurance outcomes using state–year variation in marriage equality recognition in a difference-in-differences framework. Results. Marriage equality led to a 0.61 percentage point (P = .03) increase in employer-sponsored health insurance coverage, with similar results for men and women. Conclusions. US adults gained employer-sponsored coverage as a result of marriage equality recognition over the study period, likely because of an increase in dependent coverage for newly recognized same-sex married partners.

scholarly journals A national study of the association between language use and health insurance coverage in the United States

2013 ◽  
Vol 2 (2) ◽  
pp. 115
Author(s):  
Garth Nigel Graham ◽  
Rashida Dorsey
Keyword(s):  
United States ◽  
Health Insurance ◽  
Ethnic Groups ◽  
Language Use ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
National Study ◽  
The Impact ◽  
The U.S

Background: A significant proportion of individuals seen in US hospitals speak a language other than English. A number of reports have shown that individuals who speak a language other than English have diminished access to care, but few have examined specifically language barriers and its relationship to health insurance coverage. Objectives: To estimate the impact of language use on prevalence of reported health insurance coverage across multiple racial and ethnic groups and among persons living in the U.S. for varying periods of time. Design and participants: Cross sectional study using data from the 2010 National Health Interview Survey. Main measures: The main outcome measure is health insurance status. Key results: Persons who spoke Spanish or a language other than English were less likely to have insurance. Among Hispanics who speak Spanish or a language other than English, only 50.6% report having health insurance coverage compared to 76.7% of Hispanics who speak only or mostly English. For non-Hispanic whites who speak Spanish or a language other than English, 71.7% report having health insurance coverage compared to 83.4% of non-Hispanic whites who speak only or mostly English, this same pattern was observed across all racial/ethnic groups. Among those speaking only or mostly English living in the U.S. <15 years had significantly lower adjusted odds of reporting health insurance coverage compared to those born in the United States. Conclusions: This was a large nationally representative study describing language differences in insurance access using a multi-ethnic population. This data suggest that individuals who speak a language other than English are less likely to have insurance across all racial and ethnic groups and nativity and years in the United States groups, underscoring the significant independent importance of language as a predictor for access to insurance.

Health Concerns for Mexican Migrants in Central Florida: Collaborations with the Sending State via Mobile Consulates and Hometown Associations

2014 ◽  
Vol 36 (3) ◽  
pp. 43-47
Author(s):  
Heide Castañeda ◽  
James Arango
Keyword(s):  
Health Care ◽  
Health Care Access ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Immigration Reform ◽  
Mexican Migrants ◽  
Hometown Associations ◽  
Care Giving ◽  
The Impact

Contemporary debates on health and immigration reform often display a lack of understanding of how limited health care access can aggravate problems and contribute to major disparities. The Affordable Care Act (ACA) of 2010, designed to ensure broader health insurance coverage for populations across the United States, is likely to actually reduce access to care for many immigrants by isolating them from the general, formerly uninsured, population (Arredondo et al. 2012; Bustamante et al. 2012; Zuckerman, Waidmann, and Lawton 2011). These changes will become increasingly relevant to practicing and applied anthropologists working in health care settings and seeking to ameliorate the impact of potentially reduced resources. Anthropologists must be attentive to these shifting processes of care-giving and seeking that impact vulnerable populations (Horton et al. 2014) and help to identify and propose solutions for the future.

The Patient Protection and Affordable Care Act, Public Health, and the Elusive Target of Human Rights

2011 ◽  
Vol 39 (3) ◽  
pp. 340-354 ◽  
Author(s):  
Lance Gable
Keyword(s):  
Public Health ◽  
United States ◽  
Health Care ◽  
Affordable Care Act ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Patient Protection ◽  
The Law ◽  
The Impact

The passage of the Patient Protection and Affordable Care Act (ACA) in March 2010 represents a significant turning point in the evolution of health care law and policy in the United States. By establishing a legal infrastructure that seeks to achieve universal health insurance coverage in the United States, the ACA targets some of the major impediments to accessing needed health care for millions of Americans and by extension attempts to strengthen the health system to support key determinants of health. Yet, like many newly passed legislative provisions, the ultimate effects and significance of the ACA remain uncertain. Those charged with implementing the ACA face formidable obstacles — indeed, some of the same obstacles that have been erected to impede other major pieces of social legislation in the past — including entrenched political opposition, constitutional challenges, and what will likely be a prolonged struggle over the content and direction of how the law is implemented. As these debates continue, it is nevertheless important to begin to assess the impact that the ACA has already had on health law in the United States and to consider the likely effects that the law will have on public health going forward.

Data Processing Improvements for Estimates of Health Insurance Coverage in the Current Population Survey Annual Social and Economic Supplement

2021 ◽  
pp. 107755872110008
Author(s):  
Edward R. Berchick ◽  
Heide Jackson
Keyword(s):  
Health Insurance ◽  
Data Processing ◽  
Current Population Survey ◽  
Population Survey ◽  
Insurance Coverage ◽  
Processing System ◽  
Health Insurance Coverage ◽  
The United States ◽  
Health Insurance Data ◽  
Current Population

Estimates of health insurance coverage in the United States rely on household-based surveys, and these surveys seek to improve data quality amid a changing health insurance landscape. We examine postcollection processing improvements to health insurance data in the Current Population Survey Annual Social and Economic Supplement (CPS ASEC), one of the leading sources of coverage estimates. The implementation of updated data extraction and imputation procedures in the CPS ASEC marks the second stage of a two-stage improvement and the beginning of a new time series for health insurance estimates. To evaluate these changes, we compared estimates from two files that introduce the updated processing system with two files that use the legacy system. We find that updates resulted in higher rates of health insurance coverage and lower rates of dual coverage, among other differences. These results indicate that the updated data processing improves coverage estimates and addresses previously noted limitations of the CPS ASEC.

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