Medicaid Expansion Spillover Effects on Health Care Consumption and Coverage: Evidence from Medicare Administrative Data

Barkowski, Scott; Jun, Dajung; Zhang, Yuting

doi:10.2139/ssrn.4047511

Cited by 4 publications

(6 citation statements)

References 24 publications

(37 reference statements)

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“…Previously uninsured 50–64-year-old individuals surviving up to age 65 may have increases in physician office visits, total health expenditures, and hospitalizations after becoming eligible for Medicare coverage (McWilliams et al, 2007). In contrast, coverage before Medicare is associated with lower Medicare costs and improved health status after gaining Medicare (Barkowski et al, 2022; Hadley & Waidmann, 2006).…”

Section: Introductionmentioning

confidence: 99%

Effects of the Affordable Care Act Insurance Expansions on Health Care Coverage, Access, and Health Status of 50–64-Year-Old Adults: Evidence From the First Six Years

Baten

Wehby

2023

J Appl Gerontol

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Individuals aged 50–64 face a higher burden of chronic conditions and an increased probability of insurance coverage loss, making them particularly vulnerable to limited access than younger adults. This study examines the effects of the Affordable Care Act (ACA) insurance expansions, including both Medicaid eligibility and other expansions, on health care coverage, access, and health status of adults aged 50–64 years over 6 years since the initial expansions in 2014. Using a triple difference-in-difference-in-differences model and nationally representative data, we find that the ACA increased private insurance and Medicaid coverage. There is evidence of improved access based on having a personal provider, completing a routine checkup, and reducing forgoing medical care due to cost. There is little evidence for the effects on self-reported health outcomes. Findings suggest that coverage expansions have improved access to care but have thus far not had discernible and consistent effects on self-reported health for 50–64-year-olds.

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Section: Introductionmentioning

confidence: 99%

Effects of the Affordable Care Act Insurance Expansions on Health Care Coverage, Access, and Health Status of 50–64-Year-Old Adults: Evidence From the First Six Years

Baten

Wehby

2023

J Appl Gerontol

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“…In addition, ACA Medicaid may be an "on-ramp" to dual eligibility by raising Medicaid coverage among the near elderly. 5,[9][10][11] For example, 64-year-olds in 2014 may benefit from Medicaid coverage as a direct result of the ACA expansion and remain enrolled upon aging into Medicare at age 65 in 2015.…”

Section: Introductionmentioning

confidence: 99%

“…Medicaid expansion may be a “welcome mat” for previously‐eligible groups, by increasing program awareness or enrollment assistance from states, providers, and others, or reducing stigma associated with participation. In addition, ACA Medicaid may be an “on‐ramp” to dual eligibility by raising Medicaid coverage among the near elderly 5,9–11 . For example, 64‐year‐olds in 2014 may benefit from Medicaid coverage as a direct result of the ACA expansion and remain enrolled upon aging into Medicare at age 65 in 2015.…”

Section: Introductionmentioning

confidence: 99%

“…First, we use administrative measures of Medicaid coverage and health care spending and utilization, unlike prior analyses that rely on self‐reports 6 . Second, we use respondent‐level information on income, as opposed to ZIP code level income, to identify beneficiaries likely to be affected by spillover effects of Medicaid expansion 10,11,19 . Finally, we provide new evidence on the association between ACA Medicaid expansion and Medicare Part A and B enrollment, which may serve as mechanisms for increased spending.…”

Section: Introductionmentioning

confidence: 99%

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The impact of Medicaid expansion on spending and utilization by older low‐income Medicare beneficiaries

Mellor

McInerney

Garrow

et al. 2023

Health Services Research

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ObjectiveTo examine indirect spillover effects of Affordable Care Act (ACA) Medicaid expansions to working‐age adults on health care coverage, spending, and utilization by older low‐income Medicare beneficiaries.Data Sources2010–2018 Health and Retirement Study survey data linked to annual Medicare beneficiary summary files.Study DesignWe estimated individual‐level difference‐in‐differences models of total spending for inpatient, institutional outpatient, physician/professional provider services; inpatient stays, outpatient visits, physician visits; and Medicaid and Part A and B Medicare coverage. We compared changes in outcomes before and after Medicaid expansion in expansion versus nonexpansion states.Data Collection/Extraction MethodsThe sample included low‐income respondents aged 69 and older with linked Medicare data, enrolled in full‐year traditional Medicare, and residing in the community.Principal FindingsACA Medicaid expansion was associated with a 9.8 percentage point increase in Medicaid coverage (95% CI: 0.020–0.176), a 4.4 percentage point increase in having any institutional outpatient spending (95% CI: 0.005–0.083), and a positive but statistically insignificant 2.4 percentage point change in Part B enrollment (95% CI: −0.003 to 0.050, p = 0.079).ConclusionsACA Medicaid expansion was associated with more institutional outpatient spending among older low‐income Medicare beneficiaries. Increased care costs should be weighed against potential benefits from increased realized access to care.

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“…However, other studies have found that Medicaid expansion has had little to no impact on private insurance coverage (Atherly et al., 2016; Lindner, Levy, and Horner‐Johnson, 2021; Yazici and Kaestner, 2000). Moreover, some studies have suggested that Medicaid expansion could have positive spillover effects into other health insurance markets (Barkowski, Jun, and Zhang, 2022; Peng, 2017).…”

mentioning

confidence: 99%

Medicaid expansions and private insurance “crowd‐out” (1999–2019)

Semprini

2023

Social Science Quarterly

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BackgroundRecent Medicaid expansions have rekindled the debate around private insurance “crowd‐out.” Prior research is limited by short‐time horizons and state‐specific analyses. Our study overcomes these limitations by evaluating 20 years of Medicaid expansions across the entire United States.MethodsWe obtain data from the U.S. Census Bureau for all U.S. states and District of Columbia for private insurance coverage rates of adults 18–64 for years 1999–2019. After estimating a naïve, staggered Two‐way fixed effects difference‐in‐differences regression model, we implement four novel econometric methods to diagnose and overcome threats of bias from staggered designs. We also test for pre‐treatment differential trends and heterogenous effects over time.ResultsOur findings suggest that Medicaid expansion was associated with a 1.5 percent‐point decline in private insurance rates (p < 0.001). We also observe significant heterogeneity over time, with estimates peaking 4 years after expansion.ConclusionsMedicaid expansions reduced private insurance rates. Future research should assess whether or how this crowd‐out may have affected consumer welfare or government budgets. Recognizing the crowd‐out should enable policymakers to make informed decisions regarding healthcare policy. The importance of a 1‐2 percent‐point crowd‐out, we leave for future research and debate.

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Medicaid Expansion Spillover Effects on Health Care Consumption and Coverage: Evidence from Medicare Administrative Data

Cited by 4 publications

References 24 publications

Effects of the Affordable Care Act Insurance Expansions on Health Care Coverage, Access, and Health Status of 50–64-Year-Old Adults: Evidence From the First Six Years

Effects of the Affordable Care Act Insurance Expansions on Health Care Coverage, Access, and Health Status of 50–64-Year-Old Adults: Evidence From the First Six Years

The impact of Medicaid expansion on spending and utilization by older low‐income Medicare beneficiaries

Medicaid expansions and private insurance “crowd‐out” (1999–2019)

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