The Effects of Expanding Public Insurance to Rural Low‐Income Childless Adults

Abstract

Objective This study measures the change in health care use after enrollment into a new public insurance program for low-income childless adults. Data Sources/Study Setting The data sources include claims from a large integrated health system in rural Wisconsin and Medicaid enrollment files, January 2007–September 2012. Study Design We employ a regression discontinuity design to measure the causal effect of public insurance enrollment on counts of outpatient, emergency department, and inpatient events for two years following enrollment for a sample of previously uninsured low-income adults in rural Wisconsin. Principal Findings Public insurance enrollment led to substantial increases in outpatient visits including preventive visits but not mental health visits. Public insurance enrollment also led to increases in inpatient stays, but the study is inconclusive on whether it led to an increase in ED visits. Conclusions Public insurance expansions to childless adults have the potential to impact the use of health care. The large increase in Medicaid coverage and reduction in rates of uninsurance anticipated to result from the Affordable Care Act should increase the use of inpatient and outpatient services but will have an uncertain impact on the use of ED among rural populations.

The Effect of Public Insurance Coverage for Childless Adults on Labor Supply

“…We use the same regression discontinuity design from this study to look at how public insurance affects usage of health care and compare health care usage in the pre-period among the waitlisted and enrolled applicants (Burns et al 2014). We find no differences among those who applied just before and just after the waitlist implementation for two years of prior emergency department use, inpatient hospitalizations, outpatient visits, mental health visits, or preventive care visits.…”

Impacts of the ACA Medicaid expansion on health behaviors: Evidence from household panel data

“…A growing number of papers identifies these relationships using arguably exogenous variation in health insurance from government health insurance expansions (e.g., the introduction of Medicaid and Medicare), insurance market reforms (e.g., the 2006 Massachusetts insurance reform and the ACA), and health insurance experiments (e.g., the RAND Health Insurance Experiment and the Oregon Health Insurance Experiment). A great deal of interest focuses on the effectiveness of policy changes in accomplishing their stated objectives of increasing insurance coverage and health care utilization and investigating policies' impacts on health care costs or select types of care (Barbaresco, Courtemanche, & Qi, 2015;Brook et al, 1983;Burns et al, 2014;Chua & Sommers, 2014;Cogan, Hubbard, & Kessler, 2010;Courtemanche & Zapata, 2014;Currie & Gruber, 1996;Dafny & Gruber, 2005;DeLeire, Lopoo, & Simon, 2011;Finkelstein et al, 2012;Long & Masi, 2009;Long & Stockley, 2011;Miller, 2012;Sommers, Baicker, & Epstein, 2012;Sommers, Buchmueller, Decker, Carey, & Kronick, 2013;Sommers & Kronick, 2012). Other studies focus on the labor market effects of program participation (Baicker, Finkelstein, Song, & Taubman, 2014;Dave, Decker, Kaestner, & Simon, 2015;Kolstad & Kowalski, 2016).…”

Changes in Hospital Inpatient Utilization Following Health Care Reform

“…), while another study examining the same program found that inpatient hospitalizations increased in a population of rural enrollees (Burns et al. ). Nikpay, Buchmueller, and Levy () analyzed Medicare cost report data for Connecticut hospitals before and after the state's early expansion in 2010, finding an increase in Medicaid admissions and revenues.…”

“…In the case of Massachusetts health care reform, studies found decreases in uninsured admissions and length of stay (Kolstad and Kowalski 2012), and increases in inpatient surgeries (Ellimoottil et al 2014;Hanchate et al 2012). Following introduction of a new public insurance program for chronically ill, childless adults in Wisconsin, one study found a decrease in preventable hospitalizations (DeLeire et al 2013), while another study examining the same program found that inpatient hospitalizations increased in a population of rural enrollees (Burns et al 2014). Nikpay, Buchmueller, and Levy (2015) analyzed Medicare cost report data for Connecticut hospitals before and after the state's early expansion in 2010, finding an increase in Medicaid admissions and revenues.…”