Health insurance coverage during the COVID-19 pandemic: The role of Medicaid expansion.
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ABSTRACT:
SUBMITTER: Mandal B
PROVIDER: S-EPMC9877596 | biostudies-literature | 2022 Dec
REPOSITORIES: biostudies-literature
Publications
Health insurance coverage during the COVID-19 pandemic: The role of Medicaid expansion.
Mandal Bidisha B Porto Nilton N Kiss D Elizabeth DE Cho Soo Hyun SH Head Lorna Saboe-Wounded LS
The Journal of consumer affairs 20221210
Using data from the US Census Bureau's Household Pulse Survey, we analyzed the likelihood of loss of health insurance and enrollment into new health coverage during the early months of the COVID-19 pandemic. Loss of employment was associated with a significant increase in the likelihood of loss of health insurance and, specifically, an increase in the likelihood of employer-sponsored health insurance. However, individuals in Medicaid expansion states experienced a lower likelihood of loss of hea ...[more]
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Project description:ImportanceThe COVID-19 pandemic has been associated with increased unemployment rates and long periods when individuals were without health insurance. Little is known about how Medicaid expansion facilitates Medicaid enrollment as a buffer to coverage loss owing to unemployment.ObjectiveTo compare changes in health insurance coverage status associated with pandemic-related unemployment among previously employed adults in states that have vs have not expanded Medicaid eligibility.Design setting and participantsThis cohort study included US adults aged 27 to 64 years who were employed at baseline in the 2020 to 2021 Current Population Survey's Annual Social and Economic Supplement, which included calendar years 2019 to 2020 (32 462 person-years). Data analyses were conducted between November 2021 and April 2022.ExposuresJob loss (ie, new unemployment) experienced during 2020.Main outcomes and measuresPrimary outcomes were coverage status (ie, uninsured status) and source of coverage (ie, employer sponsored, marketplace, and Medicaid). Using 2-way person-by-year fixed-effects regression models, changes in coverage status associated with unemployment in states that expanded Medicaid were compared with states that did not expand Medicaid. Additional analyses were performed based on prepandemic coverage status.ResultsThe cohort included 16 231 adults (mean age, 46.8 [95% CI, 46.6-47.0] years; 51.6% women). New unemployment was associated with an increase of 2.9 (95% CI, 1.1-4.6) percentage points (P = .002) in the proportion of uninsured adults in Medicaid expansion states and an increase of 10.7 (95% CI, 2.4-18.9) percentage points (P = .01) in nonexpansion states. Workers were 5.4 (95% CI, 1.9-8.9) percentage points (P = .003) more likely to enroll in Medicaid after a job loss if they lived in a Medicaid expansion state compared with workers experiencing job loss in nonexpansion states.Conclusions and relevanceIn this cohort study of US adults, unemployment-related Medicaid enrollment was more frequent in Medicaid expansion states during the COVID-19 pandemic. Medicaid expansion led to a smaller increase in uninsured adults because those who lost private insurance coverage (eg, employer sponsored) appeared more able to transition to Medicaid after job loss.
| S-EPMC9206185 | biostudies-literature
Project description:ImportanceWhile most working-age adults in the US obtain health insurance through an employer, little is known about the implications of the massive pandemic-related job loss in March 2020 and subsequent rebound for rates of employer-sponsored coverage and uninsurance.ObjectiveTo determine how health insurance coverage changed during the COVID-19 pandemic.Design setting and participantsAnalysis of trends in insurance coverage based on repeated cross sections of the US Census Bureau's Household Pulse Survey data, using linear regression to adjust for respondent's demographic and socioeconomic characteristics and state of residence. More than 1.2 million US adults aged 18 to 64 years were surveyed from April 23 through December 21, 2020.ExposuresThe COVID-19 pandemic, separated into spring and summer and fall and winter time periods during 2020, as well as state Medicaid expansion status.Main outcomes and measuresRegression-based estimates of the weekly percentage-point change in respondents' health insurance status, including having any health insurance, any employer-sponsored health insurance, or only nonemployer sponsored coverage. Nonemployer-sponsored coverage is categorized into private, Medicaid, and other public in some analyses.ResultsThe study population included 1 212 816 US adults (51% female; mean [SD] age, 42 [13] years) across all 50 US states and Washington DC. Among these respondents, rates of employer-sponsored coverage declined by 0.2 percentage points each week during the COVID-19 pandemic. Other types of coverage, particularly from public sources, increased by 0.1 and 0.2 percentage points in the spring and summer and fall and winter periods, respectively. Overall, health insurance coverage of any type declined, particularly during the spring and summer period, during which uninsurance increased by 1.4 percentage points, representing more than 2.7 million newly uninsured people, over a 12-week period.Conclusions and relevanceIn this cross-sectional study of data from the US Census Bureau's Household Pulse Survey, results showed that while public programs played an important role in protecting US adults from pandemic-driven declines in employment-sponsored coverage, many people became uninsured during 2020.
| S-EPMC8796896 | biostudies-literature
Project description:ObjectiveTo assess post-COVID-19 changes in insurance coverage, health behaviors, and self-assessed health among low-income, non-elderly adults by state Medicaid expansion status.Data sourcesWe used nationally representative survey data from the 2016 through 2020 Behavioral Risk Factor Surveillance System (BRFSS). The sample was restricted to adults aged 19-64 with household income below 138 percent of the federal poverty level (N = 179,135).Study designWe examined a broad set of outcomes related to coverage, health behaviors, and self-assessed health available in the BRFSS. We used a difference-in-differences model to compare changes in outcomes for individuals living in the 35 states and DC that expanded Medicaid under the Affordable Care Act to those in the 15 non-expansion states before and after the COVID-19 pandemic commenced in March 2020.Data collection/extraction methodsN/A.Principal findingsWe found that the expansions provided some protection for low-income people during the pandemic. In 2020, relative to earlier years, people in expansion states were more likely to report very good or excellent health (4.9 percentage points, 95%CI = 0.022, 0.076; p < 0.01) and physical health (-0.393 days of poor physical health in the past month, 95%CI = -0.714, -0.072; p < 0.05), lower rates of smoking (-1.9 percentage points, 95%CI = -0.041, 0.004; p < 0.10) and heavy drinking (-1.4 percentage points, 95%CI = -0.025, -0.004; p < 0.01), and higher flu vaccination rates (2.8 percentage points, 95%CI = 0.005, 0.051; p < 0.05) than those in non-expansion states. These benefits were particularly salient for Black and Hispanic individuals. We found no significant differences in insurance coverage, exercise, obesity, and self-assessed mental health between expansion and non-expansion states for the overall low-income sample. However, the expansion was associated with greater insurance coverage for Hispanic adults during the pandemic.ConclusionsInvestments in public health through expanding Medicaid may shield low-income populations from some of the health ramifications of public health emergencies.
| S-EPMC9538092 | biostudies-literature
Project description:OBJECTIVE:To determine the association of Medicaid expansion with health insurance coverage by marital status and sex. METHODS:A population-based, quasi-experimental policy analysis was undertaken of the implementation of the Patient Protection and Affordable Care Act's (ACA) Medicaid expansion provision on or after January 1, 2014. The 2010-16 American Community Survey provided data on 3,874,432 Medicaid-eligible adults aged 19-64 with incomes up to 138% of the federal poverty level. The outcome measures were no health insurance coverage and Medicaid coverage. The predictor variables were marital status and sex, with controls for family size, poverty status, race/ethnicity, education, employment status, immigration status, and metropolitan residence. RESULTS:In 2016, the uninsured rate for married men and women in a Medicaid expansion state was 21.2% and 17.1%, respectively, compared to 37.4% for married men and 35.8% for married women in a non-expansion state. The Medicaid coverage rate grew between 14.8% to 19.3% in Medicaid expansion states, which contrasts with less than a 5% growth in non-expansion states. Triple differences analysis suggests that, for women of all age groups, Medicaid expansion resulted in a 1.6 percentage point lower uninsured rate for married women compared to unmarried women. For men, there was not a statistically significant difference in the uninsured rate for married compared to unmarried men. For women of all age groups, there was a 2.6 percentage point higher Medicaid coverage rate for married compared to unmarried women. For men, there was a 1.8 percentage point higher Medicaid coverage rate for married compared to unmarried men. CONCLUSION:Medicaid expansion under the ACA differentially lowered uninsurance and improved Medicaid coverage for married persons, especially married women, more than unmarried persons.
| S-EPMC6808332 | biostudies-literature
Project description:ImportanceAlthough nearly 1 in 5 persons in the United States has a physical or mental disability, little is known about the association of the Patient Protection and Affordable Care Act (ACA) with health insurance coverage among persons with a disability.ObjectiveTo determine the association of Medicaid expansion with health insurance coverage among persons with a disability.Design, setting, and participantsCross-sectional analysis of adults eligible for Medicaid expansion (aged 26-64 years with incomes up to 138% of the federal poverty level), using a triple-differences (difference-in-difference-in-difference) approach to compare the pre-ACA with post-ACA trend in health insurance rates by disability status between expansion and nonexpansion states using nationally representative, repeated cross-sectional sample data obtained from the American Community Survey in the United States from January 1, 2010, to December 31, 2016. Time was defined as either pre-ACA (January 1, 2010, to December 31, 2013) or post-ACA (January 1, 2014, to December 31, 2016). Treatment status was defined as whether a state implemented Medicaid expansion after January 1, 2014. States that expanded Medicaid between January 1, 2014, to December 31, 2016, were classified as the treatment group, and states that did not expand Medicaid during the study period were classified as the control group. Data were analyzed from December 12, 2018, to May 21, 2019.Main outcomes and measuresSelf-reported health insurance coverage (uninsured, Medicaid, private) and self-reported disability status (≥1 condition limiting activity, including cognitive, ambulatory, self-care, independent living, and sensory difficulties).ResultsOf 2 549 376 Medicaid-eligible adults, 1 348 620 (52.9%) were female; 1 218 602 (47.8%) were non-Hispanic white, 497 128 (19.5%) were non-Hispanic black, 211 598 (8.3%) were Hispanic, and 206 499 (8.1%) were of other race/ethnicity; and 619 498 (24.3%) reported at least 1 disability. The percentage of persons without health insurance was greatest for persons without a disability who lived in a nonexpansion state before the ACA's Medicaid expansion provision went into effect (236 645 of 426 387 [55.5%]), and the smallest proportion of persons without health insurance was reported for persons with a disability living in an expansion state after the ACA went into effect (19 552 of 176 145 [11.1%]). Triple-differences analysis suggested that Medicaid expansion was associated with a decrease in the uninsured rate for both persons with a disability (7.1% - 16.2% = -9.1%) and without a disability (21.2% - 34.9% = -13.7%) and that Medicaid expansion was associated with a 4.6% decrease in the uninsurance rate for persons without a disability and a 2.6% decrease in persons with a disability (P < .001). Although Medicaid expansion was associated with an increase in Medicaid coverage for both persons with a disability (49.3% pre-ACA to 62.3% post-ACA; change, 13.0%) and persons without a disability (21.6% pre-ACA to 40.3% post-ACA; change, 17.7%), the triple difference-estimated Medicaid coverage was -4.7% for persons with a disability and 0.4% for persons without a disability, a difference of 5.1% (P < .001). Medicaid expansion was associated with a 3% higher private insurance rate for persons with a disability than for persons without a disability.Conclusions and relevanceMedicaid expansion appeared to be associated with lower uninsurance rates and higher Medicaid and private insurance coverage for persons with a disability. This study's findings suggest that the reduction in the uninsured rate and gains in Medicaid coverage were greater for persons without a disability than for persons with a disability.
| S-EPMC6647921 | biostudies-literature
Project description:The extent to which the COVID-19 pandemic has affected early changes in health coverage and access to dental care services in states that expanded Medicaid versus those that did not is currently not well known. Using data from the National Health Interview Survey, we found that, during the first year of the COVID-19 pandemic, states that had previously expanded their Medicaid programs under the Affordable Care Act had lower uninsurance rates for White low-income adults (-8.8 percentage points; 95% CI: -16.6, -1.0) and lower dental uninsurance rates for all low-income adults (-5.4 percentage points; 95% CI: -10.4, -0.5). Our findings also suggest that the combination of Medicaid expansion with coverage of adult dental benefits in Medicaid was associated with improved dental coverage and access to dental care during the pandemic. With the expiration of the public health emergency declaration, states are considering strategies to prevent disruptions in Medicaid coverage. Our study adds to the evidence of the importance of Medicaid expansion in stabilizing health coverage during a public health crisis.
| S-EPMC10948102 | biostudies-literature
Project description:Virginia expanded Medicaid under the Affordable Care Act beginning in January 2019, which substantially increased income eligibility up to 138% of the federal poverty level (FPL) for both childless adults and parents. In this study, we examined the effects of Virginia's Medicaid expansion in 2019 on health insurance coverage, access to care, and health status by employing a difference-in-differences and a synthetic control design. The study included data on health insurance from the 2016-2020 American Community Survey (ACS) and data on access to care and health status come from the 2016-2020 Behavioral Risk Factors Surveillance System (BRFSS). The samples from ACS and BRFSS were limited to non-elderly adults with income below 138% of the FPL. Separate models were estimated for individuals below 100% of FPL, and those within 100-138% of FPL. The Virginia Medicaid expansion was associated with a 9-11 percentage-point increase in Medicaid coverage rate and a 7-8 percentage-point increase in the insured rate among individuals below 100% FPL, in the first two years of expansion. There was a larger increase in Medicaid coverage among individuals within 100-138% of FPL which also led to a larger increase in the insured rate in 2020. Both income groups showed no changes in private coverage after the expansion in Virginia. We also found a decline in delaying necessary medical visits due to cost for individuals below 100% FPL in 2019 and for individuals within 100-138% FPL in 2020. There was overall no discernable change in health status outcomes. Virginia's 2019 Medicaid expansion substantially increased insurance coverage among poor adults with suggestive early evidence for improved access. The findings highlight the missed opportunity for other states that have not yet decided to expand their Medicaid programs to improve coverage and access among their low-income individuals.
| S-EPMC9134455 | biostudies-literature
Project description:This cross-sectional study examines changes in postpartum insurance churn during the COVID-19 pandemic.
| S-EPMC9034403 | biostudies-literature
Project description: Not available
| S-BSST1055 | biostudies-other
Project description:ObjectiveMultiple studies have detailed the relationship between Medicaid expansion under the Affordable Care Act and various health and financial outcomes. However, fewer studies have examined Medicaid expansion's effects on individuals with psychiatric diagnoses. This study sought to determine the relationship between Medicaid expansion and various health and financial outcomes among low-income adults with depression.MethodsThis quasi-experimental study used a random-digit-dial survey of U.S. citizens ages 19-64 with incomes below 138% of the federal poverty level. Surveys were conducted in three southern states (two expansion states, Arkansas and Kentucky, and one nonexpansion state, Texas) between 2013 and 2016. The study sample consisted of those with a positive screen for depression-score of ≥2 on the two-item Patient Health Questionnaire (N=4,853). Survey-weighted difference-in-differences regressions were conducted with insurance status, health care access and utilization, and affordability of care as outcomes of interest. Subgroup analyses stratified the sample on the basis of the respondent's residence in a health professional shortage area (HPSA) in mental health and severity of depression.ResultsMedicaid expansion was associated with a significant reduction in the proportion of adults with depression who lacked health insurance (-23 percentage points, 95% confidence interval=-32 to -14, p<.001). Medicaid expansion was also associated with significant reductions in delaying care and medications because of cost. These changes were similar regardless of residence in a mental health HPSA and severity of depression.ConclusionsMedicaid expansion was associated with improved access to care and medication among persons with depression, even in areas with relative shortages of mental health professionals.
| S-EPMC6395562 | biostudies-literature