Department of Health Management and Policy, University of Iowa, Iowa City, IA.
Department of Economics, University of Iowa, Iowa City, IA.
Health Serv Res. 2018 Apr;53(2):1248-1271. doi: 10.1111/1475-6773.12711. Epub 2017 May 18.
Examine the ACA Medicaid expansion effects on Medicaid take-up and private coverage through 2015 and coverage disparities by age, race/ethnicity, and gender.
2011-2015 American Community Survey for 3,137,989 low-educated adults aged 19-64 years.
Difference-in-differences regressions accounting for national coverage trends and state fixed effects.
Expansion effects doubled in 2015 among low-educated adults, with a nearly 8 percentage-point increase in Medicaid take-up and 6 percentage-point decline in uninsured rate. Significant coverage gains were observed across virtually all examined groups by age, gender, and race/ethnicity. Take-up and insurance declines were strongest among younger adults and were generally close by gender and race/ethnicity. Despite the increased take-up however, coverage disparities remained sizeable, especially for young adults and Hispanics who had declining but still high uninsured rates in 2015. There was some evidence of private coverage crowd-out in certain subgroups, particularly among young adults aged 19-26 years and women, including in both individually purchased and employer-sponsored coverage.
The ACA Medicaid expansions have continued to increase coverage in 2015 across the entire population of low-educated adults and have reduced age disparities in coverage. However, there is still a need for interventions that target eligible young and Hispanic adults.
研究 ACA 医疗补助扩大计划对 2015 年之前医疗补助参保率和私人保险覆盖范围的影响，以及按年龄、种族/族裔和性别划分的覆盖差距。
2011-2015 年美国社区调查，涉及 3137989 名低教育程度的 19-64 岁成年人。
采用双重差分回归方法，考虑全国覆盖趋势和州固定效应。
在 2015 年，低教育程度成年人的扩张效果增加了一倍，医疗补助参保率增加了近 8 个百分点，未参保率下降了 6 个百分点。在几乎所有年龄、性别和种族/族裔群体中，都观察到了显著的覆盖范围扩大。参保率和保险率下降在年轻成年人中最为明显，并且在性别和种族/族裔方面基本接近。尽管参保率有所增加，但覆盖差距仍然很大，尤其是在年轻人和西班牙裔中，他们的未参保率在 2015 年下降但仍很高。在某些亚组中，存在私人保险替代的证据，特别是在 19-26 岁的年轻成年人和女性中，包括个人购买和雇主赞助的保险。
ACA 医疗补助扩大计划在 2015 年继续增加了所有低教育程度成年人的覆盖范围，并减少了覆盖差距的年龄差异。然而，仍然需要针对符合条件的年轻和西班牙裔成年人的干预措施。
