Jacobs Paul D, Hill Steven C, Abdus Salam
Paul D. Jacobs (
Steven C. Hill is a senior economist at AHRQ.
Health Aff (Millwood). 2017 Jan 1;36(1):32-39. doi: 10.1377/hlthaff.2016.1076.
Eligibility for and enrollment in Medicaid can vary with economic recessions, recoveries, and changes in personal income. Understanding how Medicaid responds to such forces is important to budget analysts and policy makers tasked with forecasting Medicaid enrollment. We simulated eligibility for Medicaid for the period 2005-14 in two scenarios: assuming that each state's eligibility rules in 2009, the year before passage of the Affordable Care Act (ACA), were in place during the entire study period; and assuming that the ACA's expanded eligibility rules were in place during the entire period for all states. Then we correlated the results with unemployment rates as a measure of the economy. Each percentage-point increase in the unemployment rate was associated with an increase in the share of people eligible for Medicaid of 0.32 percentage point under the 2009 eligibility rules and 0.77 percentage point under the ACA rules. Our simulations showed that the ACA expansion increased Medicaid's responsiveness to changes in unemployment. For states that have not expanded Medicaid eligibility, our analysis demonstrates that increased responsiveness to periods of high unemployment is one benefit of expansion.
医疗补助计划的资格认定和参保情况会随着经济衰退、复苏以及个人收入变化而有所不同。了解医疗补助计划如何应对这些因素，对于负责预测医疗补助计划参保人数的预算分析师和政策制定者而言至关重要。我们在两种情形下模拟了2005年至2014年期间医疗补助计划的资格认定情况：一种情形是假设每个州在2009年（即《平价医疗法案》（ACA）通过的前一年）的资格认定规则在整个研究期间保持不变；另一种情形是假设ACA扩大后的资格认定规则在整个期间适用于所有州。然后，我们将结果与作为经济指标的失业率进行关联分析。在2009年的资格认定规则下，失业率每上升一个百分点，符合医疗补助计划资格的人口比例就会增加0.32个百分点；而在ACA规则下，这一比例会增加0.77个百分点。我们的模拟结果表明，ACA的扩大增强了医疗补助计划对失业率变化的响应能力。对于尚未扩大医疗补助计划资格认定范围的州，我们的分析表明，增强对高失业时期的响应能力是扩大资格认定范围的一项益处。
