The Affordable Care Act and the COVID-19 Pandemic: A Regression Discontinuity Analysis

Chakrabarti, Rajashri; Meyerson, Lindsay; Nober, William; Pinkovskiy, Maxim L.

doi:10.2139/ssrn.3733129

Cited by 5 publications

(6 citation statements)

References 30 publications

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“…We anticipate that as an indicator of rising unemployment, the UI claim rate will be negatively associated with health care services spending. We expect this association to be stronger in nonexpansion states where access to Medicaid is more limited, consistent with existing research showing people in nonexpansion states were less likely to seek Covid‐related care than in expansion states 32 . We further expect FPUC to mitigate the negative association between the UI claims rate and health care spending, as those experiencing health problems allocate federal income support toward health care.…”

Section: Introductionsupporting

confidence: 75%

“…We expect this association to be stronger in nonexpansion states where access to Medicaid is more limited, consistent with existing research showing people in nonexpansion states were less likely to seek Covid‐related care than in expansion states. 32 We further expect FPUC to mitigate the negative association between the UI claims rate and health care spending, as those experiencing health problems allocate federal income support toward health care. This relationship should be stronger in nonexpansion states where low‐income adults are more likely to face higher out‐of‐pocket costs because they either lack health insurance or have less generous coverage.…”

Section: Introductionmentioning

confidence: 99%

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Emergency unemployment benefits and health care spending during Covid

Evangelist

Shaefer

2021

Health Services Research

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Objective To estimate the impact of the $600 per week Federal Pandemic Unemployment Compensation (FPUC) payments on health care services spending during the Covid pandemic and to investigate if this impact varied by state Medicaid expansion status. Data Sources This study leverages novel, publicly available data from Opportunity Insights capturing consumer credit and debit card spending on health care services for January 18–August 15, 2020 as well as information on unemployment insurance claims, Covid cases, and state policy changes. Study Design Using triple‐differences estimation, we leverage two sources of variation—within‐state change in the unemployment insurance claims rate and the introduction of FPUC payments—to estimate the moderating effect of FPUC on health care spending losses as unemployment rises. Results are stratified by state Medicaid expansion status. Extraction Methods Not applicable. Principal Findings For each percentage point increase in the unemployment insurance claims rate, health care spending declined by 1.0% (<0.05) in Medicaid expansion states and by 2.0% (<0.01) in nonexpansion states. However, FPUC partially mitigated this association, boosting spending by 0.8% (<0.001) and 1.3% (<0.05) in Medicaid expansion and nonexpansion states, respectively, for every percentage point increase in the unemployment insurance claims rate. Conclusions We find that FPUC bolstered health care spending during the Covid pandemic, but that both the negative consequences of unemployment and moderating effects of federal income supports were greatest in states that did not adopt Medicaid expansion. These results indicate that emergency federal spending helped to sustain health care spending during a period of rising unemployment. Yet, the effectiveness of this program also suggests possible unmet demand for health care services, particularly in states that did not adopt Medicaid expansion.

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Section: Introductionsupporting

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Emergency unemployment benefits and health care spending during Covid

Evangelist

Shaefer

2021

Health Services Research

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“…The indicators that are available in the COVIDcast API have been used in dashboards produced by COVID Act Now [32], COVID Exit Strategy [33], and others; to inform the Delphi, DeepCOVID [34], and the Institute for Health Metrics and Evaluation (IHME) [35] COVID forecasting models; in various federal and state government reports and analyses; and in a range of news stories. Aside from operational use in decision-making and forecasting, they have also facilitated numerous analyses studying the impacts of COVID-19 on the public, the effectiveness of policy interventions, and factors that influenced the spread of the pandemic [17,18,[36][37][38]. The API currently serves hundreds of thousands of requests to thousands of users every day.…”

Section: Resultsmentioning

confidence: 99%

An Open Repository of Real-Time COVID-19 Indicators

Reinhart

Brooks

Jahja

et al. 2021

Preprint

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The COVID-19 pandemic presented enormous data challenges in the United States. Policy makers, epidemiological modelers, and health researchers all require up-to-date data on the pandemic and relevant public behavior, ideally at fine spatial and temporal resolution. The COVIDcast API is our attempt to fill this need: operational since April 2020, it provides open access to both traditional public health surveillance signals (cases, deaths, and hospitalizations) and many auxiliary indicators of COVID- 19 activity, such as signals extracted from de-identified medical claims data, massive online surveys, cell phone mobility data, and internet search trends. These are available at a fine geographic resolution (mostly at the county level) and are updated daily. The COVIDcast API also tracks all revisions to historical data, allowing modelers to account for the frequent revisions and backfill that are common for many public health data sources. All of the data is available in a common format through the API and accompanying R and Python software packages. This paper describes the data sources and signals, and provides examples demonstrating that the auxiliary signals in the COVIDcast API present information relevant to tracking COVID activity, augmenting traditional public health reporting and empowering research and decision-making.

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“…Individuals with some form of health insurance can seek health care services early in the disease cycle, increasing their chances of positive outcomes and decreasing the number of people spreading the virus. 8 Some state officials in expansion states credited Medicare expansion for giving their states a fighting chance against the COVID-19 epidemic that would not have been possible had their states decided not to expand their Medicaid. 9 The pandemic's shifting spread pattern through 2020 seemed to support the hypothesis that Medicaid expansion positioned the expansion states for better aftermath.…”

Section: Introductionmentioning

confidence: 99%

The differential impact of the COVID-19 epidemic on Medicaid expansion and non-expansion states

Hussein

Morsi

Awad

et al. 2021

Preprint

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Medicaid expansion is a federally-funded program to expand health care access and coverage to economically challenged populations by increasing eligibility to Medicaid enrollment and investing in public health preventive services in the individual states. Yet, when the COVID-19 epidemic plagued the country, fourteen states were practicing their chosen decision not to enact the Medicaid expansion policy. We examined the consequences of this nationwide split in Medicaid design on the spread of the COVID-19 epidemic between the expansion and non-expansion states. Our study shows that, on average, the expansion states had 217.56 fewer confirmed COVID-19 cases per 100,000 residents than the non-expansion states [-210.41; 95%CI (-411.131) - (-2.05); P<0.05]. Also, the doubling time of COVID-19 cases in Medicaid expansion states was longer than that of non-expansion states by an average of 1.68 days [1.6826; 95%CI 0.4035-2.9617; P<0.05]. These findings suggest that proactive investment in public health preparedness was an effective protective policy measure in this crisis, unsurpassed by the benefits of COVID-19 emergency plans and funds. The study findings could be relevant to policymakers and healthcare strategists in non-expansion states considering their states' preparations for such public health crises.

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The Affordable Care Act and the COVID-19 Pandemic: A Regression Discontinuity Analysis

Cited by 5 publications

References 30 publications

Emergency unemployment benefits and health care spending during Covid

Emergency unemployment benefits and health care spending during Covid

An Open Repository of Real-Time COVID-19 Indicators

The differential impact of the COVID-19 epidemic on Medicaid expansion and non-expansion states

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