Insurance instability and use of emergency and office-based care after gaining coverage: An observational cohort study

Abstract

Background The Affordable Care Act led to improvements in reporting a usual source of care, but it is unclear whether patients are changing their usual source of care in response to coverage gains. We assess whether prior insurance instability is associated with changes in use of emergency and office-based care after the Marketplace and Medicaid expansion were introduced. Methods Our study draws from the 2013-14 Medical Expenditure Panel Survey, identifying a cohort of non-elderly adults with full-year health insurance coverage in 2014. We use linear and multinomial logistic regression to assess the relationship between insurance instability prior to 2014 (uninsured for 1-11 months, �12 months) and person-level changes in use of health care after gaining coverage (change in ED and office visits from 2013 to 2014) with continuously insured individuals serving as a comparison group. Results Being uninsured for at least one year prior to gaining full-year coverage in 2014 was associated with a 33% increase in ED visits (0.06 visits, p<0.01) and a 47% increase in office visits (1.10 visits, p<0.01), driven by those gaining public coverage. We found no evidence of substitution across settings in the short term, often a stated goal of expansion.

Comparing health care use and costs among new Medicaid enrollees before and during the COVID-19 pandemic

“…When Medicaid expanded in Oregon in 2008 [ 5 ] and in other states via the Affordable Care Act (ACA) in 2014, questions arose about the health profile and use of new enrollees [ 6 , 7 ], and the implications for state budgets. In Oregon, gaining Medicaid coverage was associated with increased use of primary and preventive care, emergency department care, and hospitalization during the first year of coverage [ 8 ].…”

“…These prior studies compared the health care use and cost patterns of new enrollees to those who were uninsured or continuously enrolled [ 7 – 9 , 14 , 15 ]. We add to the extant literature by comparing the health care use and cost patterns of individuals who were newly enrolled just prior to versus newly enrolled during the first wave of the COVID-19 pandemic.…”