Medicaid enrollment among previously uninsured Americans and associated outcomes by race/ethnicity—United States, 2008‐2014

Abstract

Objectives To examine the person‐level impact of Medicaid enrollment on costs, utilization, access, and health across previously uninsured racial/ethnic groups. Data Source Medical Expenditure Panel Survey, 2008‐2014. Study Design We pooled multiple 2‐year waves of data to examine the direct impact of Medicaid enrollment among uninsured Americans. We compared changes in outcomes among nonpregnant, uninsured individuals who gained Medicaid (N = 963) to those who remained uninsured (N = 9784) using a difference‐in‐differences analysis. Principal Findings Medicaid enrollment was associated with significant increases in total health care costs and total prescription drug costs and a significant decrease in out‐of‐pocket costs. Among those who gained Medicaid, prescription drug use increased significantly relative to those who remained uninsured. Medicaid enrollment was also associated with a significant increase in reporting a usual source of care, a decrease in foregone care, and significant improvements in severe psychological distress. Changes in total prescription drug costs and total prescription drug fills differed significantly across each racial/ethnic group. Conclusions Among a national sample of uninsured individuals, Medicaid enrollment was associated with substantial favorable changes in out‐of‐pocket costs, prescription drug use, and access to care. Our findings suggest Medicaid is an important tool to reduce insurance‐related disparities among Americans.

Examination of Changes in Health Status Among Michigan Medicaid Expansion Enrollees From 2016 to 2017

“…Our findings align with those of other work using national data and different study designs (eg, secondary analysis of national data between expansion and nonexpansion states) that have shown improvements in health among racial/ethnic groups and chronic disease and behavioral health subgroups who gained Medicaid coverage. 10,16,29 Our study is unique given the longitudinal panel nature of the design that allowed for assessment of the health status of actual Medicaid expansion enrollees to learn whether those who enrolled experienced improved health over time.…”

“…14 Most state and national studies examining the effect of Medicaid expansion on health have compared health outcomes for low-income persons in expansion and nonexpansion states. These studies have found mixed results, with some findings suggesting reductions in poor health days in expansion states [15][16][17] and other findings suggesting no changes in self-reported health status. 3,4 To our knowledge, no longitudinal studies of the health status of actual Medicaid expansion enrollees to learn whether those who enrolled experience improved health over time have been published to date.…”

Today’s Students, Tomorrow’s Physicians: Opinions on Enacted and Prospective Health Care Policies

“…Conservatives more frequently endorsed reforms likely to reduce access to health care, such as cutting funding to Medicaid and increasing the availability of high-deductible health plans (enrollment in Medicaid and high-deductible health plans have been associated with increased and decreased access to care, respectively). 23,24 Importantly, however, most conservative respondents opposed such measures: only 12.7% and 36.2% of conservative students supported cutting funding to Medicaid and increasing use of highdeductible plans, respectively.…”

Inpatient rehabilitation service utilization and outcomes under US ACA Medicaid expansion

“…Expansion states were defined as those states which implemented Medicaid expansion before January 1, 2016, while the states that did not expand their Medicaid programs until after January 1, 2016 were defined as non-expansion states. By incorporating the non-expansion states in the analysis for comparison, the difference-in-difference method controlled for the effects of time variant unobservable using the changes of outcome variables in the non-expansion states before and after the policy reform (i.e., Medicaid expansion) [ 4 , 5 , 8 ].…”

“…Follow other studies using the same methods on Medicaid expansion [ 4 , 5 , 8 , 28 , 29 ], all estimates were obtained from linear (or linear probability) models, which allowed for direct interpretation of estimated coefficient as percentage point changes relative to the average (or mean probability) of the outcome variable of interest. In order to capture the differentiated effects of Medicaid expansion for the subpopulations with and without comorbidities, the study estimated the models separately for the two patient groups.…”