RAND Corporation, Arlington, Virginia, USA.
Health Aff (Millwood). 2013 Jun;32(6):1030-6. doi: 10.1377/hlthaff.2012.1019.
The US Supreme Court's ruling on the Affordable Care Act in 2012 allowed states to opt out of the health reform law's Medicaid expansion. Since that ruling, fourteen governors have announced that their states will not expand their Medicaid programs. We used the RAND COMPARE microsimulation to analyze how opting out of Medicaid expansion would affect coverage and spending, and whether alternative policy options-such as partial expansion of Medicaid-could cover as many people at lower costs to states. With fourteen states opting out, we estimate that 3.6 million fewer people would be insured, federal transfer payments to those states could fall by $8.4 billion, and state spending on uncompensated care could increase by $1 billion in 2016, compared to what would be expected if all states participated in the expansion. These effects were only partially mitigated by alternative options we considered. We conclude that in terms of coverage, cost, and federal payments, states would do best to expand Medicaid.
2012 年，美国最高法院对《平价医疗法案》的裁决允许各州选择退出医改法的医疗补助扩大计划。自该裁决以来，已有 14 位州长宣布他们的州将不会扩大其医疗补助计划。我们使用 RAND COMPARE 微观模拟来分析退出医疗补助扩大计划将如何影响覆盖范围和支出，以及替代政策选择（如部分扩大医疗补助）是否可以以更低的成本覆盖更多的人。如果 14 个州选择退出，我们估计，到 2016 年，将有 360 万人失去保险，这些州的联邦转移支付可能减少 84 亿美元，各州用于无补偿医疗的支出可能增加 10 亿美元，与所有州都参与扩大计划相比。我们所考虑的替代方案仅部分缓解了这些影响。我们的结论是，就覆盖范围、成本和联邦支付而言，各州最好扩大医疗补助。
