New Evidence On The Affordable Care Act: Coverage Impacts Of Early Medicaid Expansions

Abstract

The Affordable Care Act expands Medicaid in 2014 to millions of low-income adults in states that choose to participate in the expansion. Since 2010 California, Connecticut, Minnesota, and Washington, D.C., have taken advantage of the law's option to expand coverage earlier to a portion of low-income childless adults. We present new data on these expansions. Using administrative records, we documented that the ramp-up of enrollment was gradual and linear over time in California, Connecticut, and D.C. Enrollment continued to increase steadily for nearly three years in the two states with the earliest expansions. Using survey data on the two earliest expansions, we found strong evidence of increased Medicaid coverage in Connecticut (4.9 percentage points; $$p ) and positive but weaker evidence of increased coverage in D.C. (3.7 percentage points; $$p=\mathbf{\boldsymbol{0.08}}$$). Medicaid enrollment rates were highest among people with health-related limitations. We found evidence of some crowd-out of private coverage in Connecticut (30-40 percent of the increase in Medicaid coverage), particularly for healthier and younger adults, and a positive spillover effect on Medicaid enrollment among previously eligible parents.

Changes in Utilization and Health Among Low-Income Adults After Medicaid Expansion or Expanded Private Insurance

“…For instance, previous research (Skopec, Musco, and Sommers, 2014) showed that the mean difference in the uninsured rate in the BRFSS and ACS was 3.3 percentage points, similar to the mean absolute differences of 2.8 to 6.2 percentage points for our measures in Appendix eTable 1. That study also found that the concordance for access-to-care measures across government surveys is lower than for coverage measures.…”

“…1,3,[11][12][13] Beyond coverage and access, research to date has demonstrated limited impact of the Medicaid expansion on utilization, preventive care, and health. However, coverage expansions can take several years to reach full enrollment, 14 so there is a critical need for longerterm studies.…”

Premium subsidies, the mandate, and Medicaid expansion: Coverage effects of the Affordable Care Act

“…Several states opted to expand Medicaid under the ACA prior to 2014, and studies indicate small marginal changes in coverage with variable crowd-out -little among those with health problems, but significant among younger adults (Sommers, Kenney, & Epstein, 2014). For the 2014 expansion, federal survey data (Cohen & Martinez, 2014;Smith & Medalia, 2015) and private data sources (Shartzer, Long, Karpman, Kenney, & Zuckerman, 2015;Sommers, Gunja, et al, 2015) all confirm a large drop in the uninsured rate, particularly among lower-income adults.…”

The Effect of the 2014 Medicaid Expansion on Insurance Coverage for Newly Eligible Childless Adults

“…Most of the literature on state-level Medicaid expansions prior to the ACA suggests that coverage expansions increase Medicaid enrollment even though take-up of Medicaid coverage among the newly eligible is often low (Long, Zuckerman, and Graves, 2006;Sommers, Baicker, and Epstein, 2012;Sommers, Kenney, and Epstein, 2014). The literature is more mixed regarding the degree to which expansions lead to offsetting decreases in private coverage, a phenomenon known as crowd-out.…”

“…We follow Sommers, Kenney, and Epstein (2014) in coding Minnesota's income limit as 75 percent of the FPL. 9 • New Jersey: TRIM3 reported 200 percent for parents versus 27 percent (61 percent MAGI) in the MAGI conversion reports.…”