Comparison of Unemployment-Related Health Insurance Coverage Changes in Medicaid Expansion vs Nonexpansion States During the COVID-19 Pandemic

Benitez, Joseph

doi:10.1001/jamahealthforum.2022.1632

Cited by 10 publications

(5 citation statements)

References 22 publications

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“…The association between insurance coverage and a past-year Papanicolaou test underscores the importance of ensuring financial access. The number of persons without insurance increased slightly between the spring and winter of 2020, but losses of employer-sponsored insurance were offset by enrollment in Medicaid between 2019 and 2020 . Continued increases in insurance coverage, whether through Medicaid expansions or Affordable Care Act Health Insurance Marketplace enrollment assistance programs, could be a factor in the receipt of cervical cancer screenings.…”

Section: Discussionmentioning

confidence: 99%

Cervical Cancer Screening Rates Among Rural and Urban Females, From 2019 to 2022

Borders,

Thaxton Wiggins

2024

JAMA Netw Open

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ImportanceLittle nationally representative research has examined Papanicolaou testing rates from before the pandemic in 2019 through the COVID-19 pandemic in 2022. Papanicolaou testing rates among rural females are a concern as they have historically had lower screening rates than their urban counterparts.ObjectiveTo examine the receipt of a Papanicolaou test in the past year among US females overall and females residing in rural and urban areas in 2019, 2020, and 2022.Design, Setting, and ParticipantsThis repeated cross-sectional study used data from 3 years of the Health Information National Trends Survey (HINTS), a nationally representative survey that asks respondents about cancer screenings, sources of health information, and health and health care technologies. Study participants were females aged 21 to 65 years. Individuals who received a Papanicolaou test more than 1 to 3 years prior to a HINTS interview were excluded as they were likely not due for a Papanicolaou test.ExposuresSurvey year (2019, 2020, and 2022) and rural or urban residence were the main exposure variables.Main Outcomes and MeasuresSelf-reported receipt of a Papanicolaou test within the past year.ResultsAmong the 188 243 531 (weighted; 3706 unweighted) females included in the analysis, 12.5% lived in rural areas and 87.5% in urban areas. Participants had a mean (SE) age of 43.7 (0.27) years and were of Hispanic (18.8%), non-Hispanic Asian (5.2%), non-Hispanic Black (12.2%), non-Hispanic White (59.6%), or non-Hispanic other (4.1%) race and ethnicity. In 2022, unadjusted past-year Papanicolaou testing rates were significantly lower among rural vs urban residents (48.6% [95% CI, 39.2%-58.1%] vs 64.0% [95% CI, 60.0%-68.0%]; P &lt; .001). Adjusted odds of past-year Papanicolaou testing were lower in 2022 than 2019 (odds ratio, 0.70; 95% CI, 0.52-0.95; P = .02).Conclusions and RelevanceThis repeated cross-sectional study found that past-year Papanicolaou testing rates were lower in 2022 than 2019, pointing to a need to increase access to screenings to prevent an uptick in cervical cancer incidence. Rural-vs-urban differences in 2022 indicate a need to specifically target rural females.

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Section: Discussionmentioning

confidence: 99%

Cervical Cancer Screening Rates Among Rural and Urban Females, From 2019 to 2022

Borders,

Thaxton Wiggins

2024

JAMA Netw Open

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“…When states expanded Medicaid under the Affordable Care Act, the expanded guidelines allowed for more people to access the program during periods of joblessness (Benitez, Williams, et al, 2021a;Buchmueller et al, 2021). During the onset of the COVID-19 crisis, unemployment rose quickly from 3.5% to just under 15% between February and April 2020 (U.S. Bureau of Labor Statistics, 2021b) and Medicaid enrollments associated with job loss were more frequent in states that expanded Medicaid (Benitez, 2022;Benitez & Dubay, 2022;Jacobs & Moriya, 2023). In addition to eligibility guidelines, the fees that state Medicaid programs pay providers vary substantially across states, and how well Medicaid reimburses for provider services-or even whether Medicaid reimburses for selected services at all-could impact Medicaid's viability as a safety net program.…”

Section: Introductionmentioning

confidence: 99%

Joint effects of Medicaid eligibility and fees on recession‐linked declines in healthcare access and health status

Benitez,

Callison,

Adams

2024

Health Economics

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Whether Medicaid can function as a safety net to offset health risks created by health insurance coverage losses due to job loss is conditional on (1) the eligibility guidelines shaping the pathway for households to access the program for temporary relief, and (2) Medicaid reimbursement policies affecting the value of the program for both the newly and previously enrolled. We find states with more expansive eligibility guidelines lowered the healthcare access and health risk of coverage loss associated with rising unemployment during the 2007–2009 Great Recession. Rises in cost‐related barriers to care associated with unemployment were smallest in states with expansive eligibility guidelines and higher Medicaid‐to‐Medicare fee ratios. Similarly, states whose Medicaid programs had expansive eligibility guidelines and higher fees saw the smallest recession‐linked declines in self‐reported good health. Medicaid can work to stabilize access to health care during periods of joblessness. Our findings yield important insights into the alignment of at least two Medicaid policies (i.e., eligibility and payment) shaping Medicaid's viability as a safety net.

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“…Due to the COVID-19 pandemic, unemployment soared from 3.5% in February 2020 to 14.7% in April before falling to 6.7% in December . Research found that uninsurance rose among working-age adults due to falling employer-sponsored insurance (ESI) among newly unemployed workers that was only partially offset by Medicaid . We assessed racial and ethnic differences in uninsurance and coverage sources among working-age adults who worked in 2019 and 2020 (continuously employed) and who worked in 2019 but were unemployed in 2020 (newly unemployed).…”

Section: Introductionmentioning

confidence: 99%

Racial and Ethnic Differences in Insurance Outcomes After Job Loss During the First Year of the COVID-19 Pandemic

et al. 2023

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Comparison of Unemployment-Related Health Insurance Coverage Changes in Medicaid Expansion vs Nonexpansion States During the COVID-19 Pandemic

Abstract: This cohort study compares changes in health insurance coverage for previously employed US adults in states with and without Medicaid expansion during the COVID-19 pandemic.

Cited by 10 publications

References 22 publications

Cervical Cancer Screening Rates Among Rural and Urban Females, From 2019 to 2022

Cervical Cancer Screening Rates Among Rural and Urban Females, From 2019 to 2022

Joint effects of Medicaid eligibility and fees on recession‐linked declines in healthcare access and health status

Racial and Ethnic Differences in Insurance Outcomes After Job Loss During the First Year of the COVID-19 Pandemic

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