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Impacts of COVID-19 lockdowns and stimulus payments on low-income population's spending in the United States.

ABSTRACT: The COVID-19 pandemic has profoundly impacted the economy and human lives worldwide, particularly the vulnerable low-income population. We employ a large panel data of 5.6 million daily transactions from 2.6 million debit cards owned by the low-income population in the U.S. to quantify the joint impacts of the state lockdowns and stimulus payments on this population's spending along the inter-temporal, geo-spatial, and cross-categorical dimensions. Leveraging the difference-in-differences analyses at the per card and zip code levels, we uncover three key findings. (1) Inter-temporally, the state lockdowns diminished the daily average spending relative to the same period in 2019 by $3.9 per card and $2,214 per zip code, whereas the stimulus payments elevated the daily average spending by $15.7 per card and $3,307 per zip code. (2) Spatial heterogeneity prevailed: Democratic zip codes displayed much more volatile dynamics, with an initial decline three times that of Republican zip codes, followed by a higher rebound and a net gain after the stimulus payments; also, Southwest exhibited the highest initial decline whereas Southeast had the largest net gain after the stimulus payments. (3) Across 26 categories, the stimulus payments promoted spending in those categories that enhanced public health and charitable donations, reduced food insecurity and digital divide, while having also stimulated non-essential and even undesirable categories, such as liquor and cigar. In addition, spatial association analysis was employed to identify spatial dependency and local hot spots of spending changes at the county level. Overall, these analyses reveal the imperative need for more geo- and category-targeted stimulus programs, as well as more effective and strategic policy communications, to protect and promote the well-being of the low-income population during public health and economic crises.

SUBMITTER: Li K

PROVIDER: S-EPMC8425560 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description: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.

Project description:Importance:Health care spending on children in the United States continues to rise, yet little is known about how this spending varies by condition, age and sex group, and type of care, nor how these patterns have changed over time. Objective:To provide health care spending estimates for children and adolescents 19 years and younger in the United States from 1996 through 2013, disaggregated by condition, age and sex group, and type of care. Evidence Review:Health care spending estimates were extracted from the Institute for Health Metrics and Evaluation Disease Expenditure 2013 project database. This project, based on 183 sources of data and 2.9 billion patient records, disaggregated health care spending in the United States by condition, age and sex group, and type of care. Annual estimates were produced for each year from 1996 through 2013. Estimates were adjusted for the presence of comorbidities and are reported using inflation-adjusted 2015 US dollars. Findings:From 1996 to 2013, health care spending on children increased from $149.6 (uncertainty interval [UI], 144.1-155.5) billion to $233.5 (UI, 226.9-239.8) billion. In 2013, the largest health condition leading to health care spending for children was well-newborn care in the inpatient setting. Attention-deficit/hyperactivity disorder and well-dental care (including dental check-ups and orthodontia) were the second and third largest conditions, respectively. Spending per child was greatest for infants younger than 1 year, at $11?741 (UI, 10?799-12?765) in 2013. Across time, health care spending per child increased from $1915 (UI, 1845-1991) in 1996 to $2777 (UI, 2698-2851) in 2013. The greatest areas of growth in spending in absolute terms were ambulatory care among all types of care and inpatient well-newborn care, attention-deficit/hyperactivity disorder, and asthma among all conditions. Conclusions and Relevance:These findings provide health policy makers and health care professionals with evidence to help guide future spending. Some conditions, such as attention-deficit/hyperactivity disorder and inpatient well-newborn care, had larger health care spending growth rates than other conditions.

Project description:The COVID-19 pandemic caused widespread non-essential business closures in the U.S., which may have disproportionately impacted food consumption in lower-income communities, in part due to reduced access to healthy and affordable foods, as well as occupations that may have required working outside the home. The aims of this study were to examine restaurant dining behaviors (including drive-through, takeout, and delivery) at fast-food and non-fast-food (i.e., fast casual and full-service ['other']) restaurants and the impact on diet quality among racially/ethnically diverse low-income adults during the early months of the pandemic. Participants completed an online survey using CloudResearch regarding restaurant dining behaviors in the past week (during June 2020) and during a typical week prior to the pandemic. Diet quality was measured using the Prime Diet Quality Score (PDQS). Surveys from 1,756 low-income adults (incomes <250% of the Federal Poverty Level) were analyzed using chi-squared tests to examine differences in demographic characteristics among those dining at restaurants during the pandemic, as well as to examine differences in dining frequency compared with prior to COVID-19. Negative binomial regressions were used to examine the mean frequency of eating food from fast-food and other restaurants, adjusted for socio-demographic characteristics. This study found reductions in fast-food and other restaurant dining compared with prior to COVID-19, although overall restaurant consumption remained high with over half of participants reporting fast-food consumption in the week prior (average consumption of twice per week). Greater fast-food consumption was associated with poorer diet quality. In conclusion, while fast-food consumption was slightly lower during the pandemic, the overall high levels observed among socioeconomically disadvantaged adults remains concerning, highlighting the continued need for initiatives and policies to encourage greater access to and consumption of affordable and healthier foods.

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Impacts of COVID-19 lockdowns and stimulus payments on low-income population's spending in the United States.

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