Association between state Medicaid expansion status and health outcomes during the COVID‐19 pandemic

Abstract

Objective To 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 Sources We 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 Design We 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 Methods N/A. Principal Findings We 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. Conclusions Investments in public health through expanding Medicaid may shield low‐income populations from some of the health ramifications of public health emergencies.

Characteristics of COVID-19 in children and potential risk factors for requiring mechanical ventilation; an analysis of 22,490 cases from the United States

“…A recent report by Rakus et al described the importance of Medicaid in covering various low-income populations that may have contributed to lowering the impact of the pandemic. (26) However, further analysis should be encouraged to understand the impact on children, as seen in our study. Another significant socioeconomic disparity that we found consisted of the higher odds of mechanical ventilation among those who are from the lower quartile of median household income compared to those from the top quartile.…”

Effects of the Affordable Care Act Medicaid Expansions on Mental Health During the COVID-19 Pandemic in 2020-2021

“…25,42 Another study reported no statistically significant difference in changes in days not in good mental health in the past 30 days during 2020 between expansion and non-expansion states overall, although the study found a statistically significant decline in this outcome for non-Hispanic Black individuals. 47 That study, however, included individuals up to 138% of the FPL and did not examine the effect separately for individuals below 100% of the FPL. In non-expansion states, individuals within 100-138% of the FPL are eligible for insurance marketplace subsidies, so including them in the sample may attenuate the effect of the Medicaid expansion.…”