The effect of Affordable Care Act Medicaid expansions on foster care admissions

2021 ◽  
Vol 30 (11) ◽  
pp. 2943-2951
Author(s):  
Louis‐Philippe Beland ◽  
Jason Huh ◽  
Dongwoo Kim
Keyword(s):  
Foster Care ◽  
Affordable Care Act ◽  
Medicaid Expansions

scholarly journals All Medicaid Expansions Are Not Created Equal: The Geography and Targeting of the Affordable Care Act

2019 ◽  
Vol 2019 (2) ◽  
pp. 1-92
Author(s):  
Craig Garthwaite ◽  
John Graves ◽  
Tal Gross ◽  
Zeynal Karaca ◽  
Victoria Marone ◽  
...  
Keyword(s):  
Affordable Care Act ◽  
The Affordable Care Act ◽  
Medicaid Expansions

The Impact of the Affordable Care Act Medicaid Expansions on the Sources of Health Insurance Coverage of Undergraduate Students in the United States

2021 ◽  
pp. 107755872110158
Author(s):  
Priyanka Anand ◽  
Dora Gicheva
Keyword(s):  
United States ◽  
Health Insurance ◽  
Undergraduate Students ◽  
Affordable Care Act ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Percentage Points ◽  
The Affordable Care Act ◽  
Medicaid Expansions

This article examines how the Affordable Care Act Medicaid expansions affected the sources of health insurance coverage of undergraduate students in the United States. We show that the Affordable Care Act expansions increased the Medicaid coverage of undergraduate students by 5 to 7 percentage points more in expansion states than in nonexpansion states, resulting in 17% of undergraduate students in expansion states being covered by Medicaid postexpansion (up from 9% prior to the expansion). In contrast, the growth in employer and private direct coverage was 1 to 2 percentage points lower postexpansion for students in expansion states compared with nonexpansion states. Our findings demonstrate that policy efforts to expand Medicaid eligibility have been successful in increasing the Medicaid coverage rates for undergraduate students in the United States, but there is evidence of some crowd out after the expansions—that is, some students substituted their private and employer-sponsored coverage for Medicaid.

Change in facility-level share of Medicaid patients with cancer following implementation of the affordable care act.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18543-e18543
Author(s):  
Matthew Buck ◽  
Patrick C Demkowicz ◽  
James Nie ◽  
Victoria A. Marks ◽  
Michelle C. Salazar ◽  
...  
Keyword(s):  
Affordable Care Act ◽  
Insurance Coverage ◽  
Study Endpoint ◽  
Primary Study ◽  
Factors Associated ◽  
Percentage Points ◽  
The Affordable Care Act ◽  
Facility Level ◽  
Insured Patients ◽  
Medicaid Expansions

e18543 Background: Although Medicaid expansions associated with the Affordable Care Act (ACA) significantly increased insurance coverage for Americans with cancer, there is evidence that some facilities limit the number of Medicaid patients they treat due to lower reimbursement. We aimed to assess facility-level changes in the proportion of patients with Medicaid who were diagnosed with cancer in relation to Medicaid expansions associated with the ACA. Methods: We identified adult patients with the 19 most commonly diagnosed cancers using the National Cancer Database who were diagnosed with cancer from 2010 through 2017. We clustered Commission on Cancer (CoC) accredited institutions and included those diagnosing at least 10 patients in each year. The primary study endpoint was the change in the proportion of Medicaid-insured individuals relative to the implementation of the ACA (pre- and post-Jan 1, 2014). We used adjusted difference-in-differences (DID) estimation and multivariable logistic regression to examine patient and facility-level factors associated with changes in the proportion of Medicaid insured individuals. Results: We identified 1,064 eligible facilities in the study period. There were considerable changes in the share of Medicaid insured patients at the facility-level (range -20.0% to +44.7%, IQR -0.64% to +5.63%). There were significantly larger changes in facilities located in Medicaid expansion states (11.5 to 16.5% percentage points) versus non-expansion states (9.2 to 8.9% percentage points) with adjusted DID +5.79% (p < 0.001). Despite overall increases, 14.6% of facilities in expansion states experienced reductions in their share of Medicaid insured patients. Facility factors associated with decreasing share of Medicaid patients were non-expansion status (OR: 6.25, 95% CI 3.89 – 9.98, p < 0.001) and higher baseline Medicaid population (OR: 2.93, 95% CI 2.00 – 4.35, p < 0.001). There was also significant regional variation with larger decreases in the West South Central (OR: 5.86, 95% CI 2.30 – 15.74, p < 0.001) and West North Central (OR: 2.46, 95% CI 1.07 – 5.87, p = 0.037) regions. Conclusions: Although state expansions associated with the ACA led to increases in the share of Medicaid-insured patients diagnosed with cancer at CoC facilities, there was considerable variation in changes at the facility-level. These findings highlight that improved insurance coverage may not be sufficient to improve access to care, and facility-level policies may remain a source of access disparity.

scholarly journals Out-of-pocket spending and financial burden among low income adults after Medicaid expansions in the United States: quasi-experimental difference-in-difference study

BMJ ◽  
2020 ◽  
pp. m40 ◽  
Author(s):  
Hiroshi Gotanda ◽  
Ashish K Jha ◽  
Gerald F Kominski ◽  
Yusuke Tsugawa
Keyword(s):  
United States ◽  
Affordable Care Act ◽  
Low Income ◽  
Financial Burden ◽  
Healthcare Spending ◽  
Difference In Difference ◽  
Quasi Experimental ◽  
Premium Contributions ◽  
Medicaid Expansions ◽  
Experimental Difference

Abstract Objective To examine the association between expansion of the Medicaid program under the Affordable Care Act and changes in healthcare spending among low income adults during the first four years of the policy implementation (2014-17). Design Quasi-experimental difference-in-difference analysis to examine out-of-pocket spending and financial burden among low income adults after Medicaid expansions. Setting United States. Participants A nationally representative sample of individuals aged 19-64 years, with family incomes below 138% of the federal poverty level, from the 2010-17 Medical Expenditure Panel Survey. Main outcomes and measures Four annual healthcare spending outcomes: out-of-pocket spending; premium contributions; out-of-pocket plus premium spending; and catastrophic financial burden (defined as out-of-pocket plus premium spending exceeding 40% of post-subsistence income). P values were adjusted for multiple comparisons. Results 37 819 adults were included in the study. Healthcare spending did not change in the first two years, but Medicaid expansions were associated with lower out-of-pocket spending (adjusted percentage change −28.0% (95% confidence interval −38.4% to −15.8%); adjusted absolute change −$122 (£93; €110); adjusted P<0.001), lower out-of-pocket plus premium spending (−29.0% (−40.5% to −15.3%); −$442; adjusted P<0.001), and lower probability of experiencing a catastrophic financial burden (adjusted percentage point change −4.7 (−7.9 to −1.4); adjusted P=0.01) in years three to four. No evidence was found to indicate that premium contributions changed after the Medicaid expansions. Conclusion Medicaid expansions under the Affordable Care Act were associated with lower out-of-pocket spending and a lower likelihood of catastrophic financial burden for low income adults in the third and fourth years of the act’s implementation. These findings suggest that the act has been successful nationally in improving financial risk protection against medical bills among low income adults.

The Impact of Insurance Expansions on the Already Insured: The Affordable Care Act and Medicare

2020 ◽  
Vol 12 (4) ◽  
pp. 288-318
Author(s):  
Colleen M. Carey ◽  
Sarah Miller ◽  
Laura R. Wherry
Keyword(s):  
Access To Care ◽  
Affordable Care Act ◽  
Medicare Beneficiaries ◽  
Medicare Population ◽  
Large Panel ◽  
The Affordable Care Act ◽  
The Impact ◽  
Medicaid Expansions ◽  
Rule Out

Some states have not adopted the Affordable Care Act (ACA) Medicaid expansions due to concerns that the expansions may impair access to care and utilization for those who are already insured. We investigate such negative spillovers using a large panel of Medicare beneficiaries. Across many subgroups and outcomes, we find no evidence that the expansions reduced utilization among Medicare beneficiaries and can rule out all but very small changes in utilization or spending. These results indicate that the expansions in Medicaid did not impair access to care or utilization for the Medicare population. (JEL G22, H51, I13, I18, I38)

scholarly journals The Affordable Care Act Medicaid Expansions and Personal Finance

2017 ◽  
Vol 76 (5) ◽  
pp. 538-571 ◽  
Author(s):  
Kyle J. Caswell ◽  
Timothy A. Waidmann
Keyword(s):  
Affordable Care Act ◽  
Personal Finance ◽  
Data Set ◽  
Individual Outcomes ◽  
Triple Difference ◽  
Credit Scores ◽  
The Affordable Care Act ◽  
Early Effects ◽  
Medical Bills ◽  
Medicaid Expansions

Using a novel data set from a major credit bureau, we examine the early effects of the Affordable Care Act Medicaid expansions on personal finance. We analyze less common events such as personal bankruptcy, and more common occurrences such as medical collection balances, and change in credit scores. We estimate triple-difference models that compare individual outcomes across counties that expanded Medicaid versus counties that did not, and across expansion counties that had more uninsured residents versus those with fewer. Results demonstrate financial improvements in states that expanded their Medicaid programs as measured by improved credit scores, reduced balances past due as a percent of total debt, reduced probability of a medical collection balance of $1,000 or more, reduced probability of having one or more recent medical bills go to collections, reduction in the probability of experiencing a new derogatory balance of any type, reduced probability of incurring a new derogatory balance equal to $1,000 or more, and a reduction in the probability of a new bankruptcy filing.

Economic Freedom and the Affordable Care Act

2016 ◽  
Vol 46 (2) ◽  
pp. 301-324 ◽  
Author(s):  
Kevin Callison ◽  
Paul Sicilian
Keyword(s):  
Labor Market ◽  
Health Insurance ◽  
Affordable Care Act ◽  
Economic Freedom ◽  
White Women ◽  
Market Outcomes ◽  
Job Lock ◽  
Cast Doubt ◽  
The Affordable Care Act ◽  
Medicaid Expansions

A greater level of government involvement in the financing of health care is generally viewed unfavorably by organizations monitoring economic freedom. However, increased government provision of health insurance could be associated with improved economic freedom through enhanced labor market mobility. For example, job-lock alleviation accompanying a public insurance expansion could lead to increased innovation or a higher likelihood of self-employment. In this article, we use the Affordable Care Act (ACA)’s recent Medicaid expansions to examine the effect of an increase in public health insurance provision on labor market outcomes by gender and race/ethnicity. Our results lend support to the notion that state Medicaid expansions are associated with improved labor market autonomy for white men and white women; however, we find mixed results for black and Hispanic men and women. Notably, our findings cast doubt on earlier claims that the ACA would lead to large reductions in labor force participation and employment.

scholarly journals The Impact of Affordable Care Act Medicaid Expansions on Applications to Federal Disability Programs

2018 ◽  
Vol 21 (2) ◽  
Author(s):  
Priyanka Anand ◽  
Jody Schimmel Hyde ◽  
Maggie Colby ◽  
Paul O’Leary
Keyword(s):  
Regression Model ◽  
Affordable Care Act ◽  
Disability Insurance ◽  
Difference In Differences ◽  
Socioeconomic Characteristics ◽  
Patient Protection ◽  
Application Rates ◽  
Social Security Disability ◽  
The Impact ◽  
Medicaid Expansions

Abstract In this paper, we estimate the impact of Medicaid expansions via the Patient Protection and Affordable Care Act (ACA) on applications to federal disability programs in 14 states that expanded Medicaid in January 2014. We use a difference-in-differences regression model to compare disability application rates in geographic areas within states that expanded Medicaid to rates in areas of non-expansion states that were carefully selected using a matching approach that accounts for state Medicaid policies pre-ACA as well as demographic and socioeconomic characteristics that might influence disability application rates. We find a slower decrease in Supplemental Security Income (SSI) application rates after Medicaid expansions in expansion states relative to non-expansion states, with application rates declining in both state groups from 2014 through 2016. Our analysis of the impact of the Medicaid expansions on Social Security Disability Insurance (SSDI) application rates was inconclusive for reasons we discuss in the paper.

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