Medicaid and fiscal federalism during the COVID‐19 pandemic

Clemens, Jeffrey; Ippolito, Benedic; Veuger, Stan

doi:10.1111/pbaf.12287

Cited by 16 publications

(16 citation statements)

References 10 publications

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“…Results of this study are consistent with those of previous work showing that increased federal funds are not strongly correlated with changes in Medicaid enrollment nationally . The results are also consistent with findings that insurance coverage remained steady, unlike in previous recessions, with a larger increase in public coverage than decrease in employer-sponsored insurance and findings of weak correlation between Medicaid enrollment increases and unemployment rates .…”

Section: Discussionsupporting

confidence: 90%

Trends in Medicaid Enrollment and Disenrollment During the Early Phase of the COVID-19 Pandemic in Wisconsin

et al. 2022

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IMPORTANCEAfter the federal public health emergency was declared in March 2020, states could qualify for increased federal Medicaid funding if they agreed to maintenance of eligibility (MOE) provisions, including a continuous coverage provision. The implications of MOE provisions for total Medicaid enrollment are unknown. OBJECTIVE To examine observed increases in Medicaid enrollment and identify the underlying roots of that growth during the first 7 months of the COVID-19 public health emergency in Wisconsin. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study compared changes in Wisconsin Medicaid enrollment from March through September 2020 with predicted changes based on previous enrollment patterns (January 2015-September 2019) and early pandemic employment shocks. The participants included enrollees in full-benefit Medicaid programs for nonelderly, nondisabled beneficiaries in Wisconsin from March through September 2020. Individuals were followed up monthly as they enrolled in, continued in, and disenrolled from Medicaid. Participants were considered to be newly enrolled if they enrolled in the program after being not enrolled for at least 1 month, and they were considered disenrolled if they left and were not reenrolled within the next month. EXPOSURES Continuous coverage provision beginning in March 2020; economic disruption from pandemic between first and second quarters of 2020. MAIN OUTCOMES AND MEASURES Actual vs predicted Medicaid enrollment, new enrollment, disenrollment, and reenrollment. Three models were created (Medicaid enrollment with no pandemic, Medicaid enrollment with pandemic economic circumstances, and longer Medicaid enrollment with a pandemic-induced recession), and a 95% prediction interval was used to express uncertainty in enrollment predictions. RESULTS The study estimated ongoing Medicaid enrollment in March 2020 for 792 777 enrollees (mean [SD] age, 20.6 [16.5] years; 431 054 [54.4%] women; 213 904 [27.0%] experiencing an employment shock) and compared that estimate with actual enrollment totals. Compared with a model of enrollment based on past data and incorporating the role of recent employment shocks,most ongoing excess enrollment was associated with MOE provisions rather than enrollment of newly eligible beneficiaries owing to employment shocks. After 7 months, overall enrollment had increased to 894 619, 11.1% higher than predicted (predicted enrollment 805 130; 95% prediction interval 767 991-843 086). Decomposing higher-than-predicted retention, most enrollment was among beneficiaries who, before the pandemic, likely would have disenrolled within 6 months, although a substantial fraction (30.4%) was from reduced short-term disenrollment.

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Section: Discussionsupporting

confidence: 90%

Trends in Medicaid Enrollment and Disenrollment During the Early Phase of the COVID-19 Pandemic in Wisconsin

et al. 2022

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“…However, these prior works relied on an experimental survey with an approximate 7% response rate. Other studies found changes in unemployment were only weakly10 or negatively11 associated with Medicaid enrollment growth.…”

mentioning

confidence: 96%

Changes in Health Care Access by Race, Income, and Medicaid Expansion During the COVID-19 Pandemic

et al. 2022

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Background: The intersecting crises of the COVID-19 pandemic, job losses, and concomitant loss of employer-sponsored health insurance may have disproportionately affected health care access within minorized and lower-socioeconomic status communities. Objective: To describe changes in access to care during the COVID-19 pandemic, stratified by race/ethnicity, household income, and state Medicaid expansion status. Research Design: We used interrupted time series and difference-in-differences regression models, controlling for respondent characteristics and preexisting trends. Subjects: Data were extracted for all adults aged 18–64 surveyed in the 2015-2020 Behavioral Risk Factor Surveillance System (N=1,731,699) from all 50 states and the District of Columbia. Measures: Our outcomes included indicators for whether respondents had any health insurance coverage or avoided seeking care because of cost within the prior year. The primary exposure was the onset of the COVID-19 pandemic in the United States in March 2020. Results: The pandemic was associated with a 1.2 percentage point (pp) decline in uninsurance for Medicaid expansion states (95% CI, −1.8, −0.6); these reductions were concentrated among respondents who were Black, multiracial, or low income. The rates of uninsurance were generally stable in nonexpansion states. The rates of avoided care because of cost fell by 3.5 pp in Medicaid expansion states (95% CI, −3.9, −3.1), and by 3.6 pp (95% CI, 4.3–2.9) in nonexpansion states. These declines were concentrated among respondents who were Hispanic, Other Race, or low income. Conclusions: Our findings reinforce the value of Medicaid expansion as one tool to improve access to health insurance and care for marginalized and vulnerable populations.

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“…Infectious diseases are highly contagious and have serious consequences [ 83 ]. Previous studies have explored the economic, market, business, sports industry, and job impacts of the COVID-19 pandemic [ 8 , 9 , 43 , 84 , 85 , 86 , 87 ] but have neglected its effects on individual consumer psychology and behavior. This study filled this gap; we found that the COVID-19 pandemic exacerbated consumer impulse buying.…”

Section: Discussionmentioning

confidence: 99%

Effect of the COVID-19 Pandemic on Consumers’ Impulse Buying: The Moderating Role of Moderate Thinking

Wang

Liu

et al. 2021

IJERPH

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Based on event systems theory, this study examined the impact of the COVID-19 pandemic on consumers’ impulse buying, as well as the underlying mechanisms and boundary conditions from the perspective of individual consumers. Results of three experiments (N = 437) show that, first, the COVID-19 pandemic enhanced consumers’ impulse buying behavior. Second, two key elements, loss of control and anxiety, mediated the relationship between the COVID-19 pandemic and impulse buying; and third, moderate thinking (also known as Zhong-Yong thinking) moderated the relationship between the COVID-19 pandemic and impulse buying. The findings indicate that in consumers with low moderate thinking, the COVID-19 pandemic has had a stronger effect on impulse buying and has mediated more between the loss of control and anxiety. Conversely, in consumers with high moderate thinking, COVID-19 has had a weaker effect on impulse buying and has mediated less between loss of control and anxiety. This study extends the application of event systems theory and enriches the literature on how the COVID-19 pandemic affects consumer behavior. Furthermore, it provides strategic recommendations for government and consumer responses to COVID-19 pandemic shocks.

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Medicaid and fiscal federalism during the COVID‐19 pandemic

Cited by 16 publications

References 10 publications

Trends in Medicaid Enrollment and Disenrollment During the Early Phase of the COVID-19 Pandemic in Wisconsin

Trends in Medicaid Enrollment and Disenrollment During the Early Phase of the COVID-19 Pandemic in Wisconsin

Changes in Health Care Access by Race, Income, and Medicaid Expansion During the COVID-19 Pandemic

Effect of the COVID-19 Pandemic on Consumers’ Impulse Buying: The Moderating Role of Moderate Thinking

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