The Affordable Care Act's Effects on Patients, Providers, and the Economy: What We've Learned So Far

Gruber, Jonathan; Sommers, Benjamin D.

doi:10.1002/pam.22158

Cited by 61 publications

(46 citation statements)

References 107 publications

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“…In addition to having direct consequences for the targeted population, Medicaid expansions have the potential to generate indirect effects known as “welcome mat” effects, which occur when persons previously eligible for Medicaid, but not enrolled, sign up following coverage expansions to other populations. As summarized by Gruber and Sommers (2019), prior studies suggest that the ACA's Medicaid expansions significantly increased Medicaid participation by both children and working‐age adults who were previously eligible (e.g., Frean, Gruber, & Sommers, 2017; Hudson & Moriya, 2017).…”

Section: Introductionmentioning

confidence: 99%

Welcome Mats and On‐Ramps for Older Adults: The Impact of the Affordable Care Act's Medicaid Expansions on Dual Enrollment in Medicare and Medicaid

McInerney¹,

Mellor²,

Sabik³

2020

J Policy Anal Manage

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For many low‐income Medicare beneficiaries, Medicaid provides important supplemental insurance that covers out‐of‐pocket costs and additional benefits. We examine whether Medicaid participation by low‐income adults age 65 and up increased as a result of Medicaid expansions to working‐age adults under the Affordable Care Act (ACA). Previous literature documents so‐called “welcome mat” effects in other populations but has not explicitly studied older persons dually eligible for Medicare and Medicaid. We extend this literature by estimating models of Medicaid participation among persons age 65 and up using American Community Survey data from 2010 to 2017 and state variation in ACA Medicaid expansions. We find that Medicaid expansions to working‐age adults increased Medicaid participation among low‐income older adults by 1.8 percentage points (4.4 percent). We also find evidence of an “on‐ramp” effect; that is, low‐income Medicare beneficiaries residing in expansion states who were young enough to gain coverage under the 2014 ACA Medicaid expansions before aging into Medicare were 4 percentage points (9.5 percent) more likely to have dual Medicaid coverage relative to similar individuals who either turned 65 before the 2014 expansions or resided in non‐expansion states. This on‐ramp effect is an important mechanism behind welcome mat effects among some older adults.

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Section: Introductionmentioning

confidence: 99%

Welcome Mats and On‐Ramps for Older Adults: The Impact of the Affordable Care Act's Medicaid Expansions on Dual Enrollment in Medicare and Medicaid

McInerney¹,

Mellor²,

Sabik³

2020

J Policy Anal Manage

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“…Literature reviews conclude that the expansion led to significant increases in coverage and access to care for low-income individuals in expansion states. 1,2 The evidence on the effects of the Medicaid expansion on health, however, is less clear. While some studies document improvements in self-reported health, [3][4][5][6][7][8] cardiac health, 9 and survival from end-stage renal disease, 10 others find no significant improvements.…”

Section: Introductionmentioning

confidence: 99%

ACA Medicaid Expansion Associated With Increased Medicaid Participation and Improved Health Among Near-Elderly: Evidence From the Health and Retirement Study

McInerney

Winecoff

Ayyagari

et al. 2020

INQUIRY

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The Affordable Care Act (ACA) dramatically expanded health insurance, but questions remain regarding its effects on health. We focus on older adults for whom health insurance has greater potential to improve health and well-being because of their greater health care needs relative to younger adults. We further focus on low-income adults who were the target of the Medicaid expansion. We believe our study provides the first evidence of the health-related effects of ACA Medicaid expansion using the Health and Retirement Study (HRS). Using geo-coded data from 2010 to 2016, we estimate difference-in-differences models, comparing changes in outcomes before and after the Medicaid expansion in treatment and control states among a sample of over 3,000 unique adults aged 50 to 64 with income below 100% of the federal poverty level. The HRS allows us to examine morbidity outcomes not available in administrative data, providing evidence of the mechanisms underlying emerging evidence of mortality reductions due to expanded insurance coverage among the near-elderly. We find that the Medicaid expansion was associated with a 15 percentage point increase in Medicaid coverage which was largely offset by declines in other types of insurance. We find improvements in several measures of health including a 12% reduction in metabolic syndrome; a 32% reduction in complications from metabolic syndrome; an 18% reduction in the likelihood of gross motor skills difficulties; and a 34% reduction in compromised activities of daily living (ADLs). Our results thus suggest that the Medicaid expansion led to improved physical health for low-income, older adults.

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“…Indeed, numerous studies have investigated the effects of ACA‐Medicaid expansion on these outcomes using quasi‐experimental differences‐in‐differences (DD) methods. Of particular relevance to our study, while there is a vast literature investigating effects of ACA‐Medicaid expansion on health care service utilization generally, 18,19 few studies have estimated the causal effects of this major policy on breast cancer service use, and available studies focus on screening and surgeries with inconclusive results. Several studies find no change in breast cancer screening in expansion states vs nonexpansion states 20‐24 .…”

Section: Introductionmentioning

confidence: 99%

The effect of Medicaid expansion on prescriptions for breast cancer hormonal therapy medications

Maclean

Halpern

Hill

2020

Health Services Research

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Objective To quantify the effects of the Affordable Care Act Medicaid expansion on prescriptions for effective breast cancer hormonal therapies (tamoxifen and aromatase inhibitors) among Medicaid enrollees. Data Source/Study Setting Medicaid State Drug Utilization Database (SDUD) 2011‐2018, comprising the universe of outpatient prescription medications covered under the Medicaid program. Study Design Differences‐in‐differences and event‐study linear models compare population rates of tamoxifen and aromatase inhibitor (anastrozole, exemestane, and letrozole) use in expansion and nonexpansion states, controlling for population characteristics, state, and time. Principal Findings Relative to nonexpansion states, Medicaid‐financed hormonal therapy prescriptions increased by 27.2 per 100 000 nonelderly women in a state. This implies a 28.8 percent increase from the pre‐expansion mean of 94.2 per 100 000 nonelderly women in expansion states. The event‐study model reveals no evidence of differential pretrends in expansion and nonexpansion states and suggests use grew to 40 or more prescriptions per 100 000 nonelderly women 3‐5 years postexpansion. Conclusions Medicaid expansion may have had a meaningful impact on the ability of lower‐income women to access effective hormonal therapies used to treat breast cancer.

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The Affordable Care Act's Effects on Patients, Providers, and the Economy: What We've Learned So Far

Cited by 61 publications

References 107 publications

Welcome Mats and On‐Ramps for Older Adults: The Impact of the Affordable Care Act's Medicaid Expansions on Dual Enrollment in Medicare and Medicaid

Welcome Mats and On‐Ramps for Older Adults: The Impact of the Affordable Care Act's Medicaid Expansions on Dual Enrollment in Medicare and Medicaid

ACA Medicaid Expansion Associated With Increased Medicaid Participation and Improved Health Among Near-Elderly: Evidence From the Health and Retirement Study

The effect of Medicaid expansion on prescriptions for breast cancer hormonal therapy medications

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