Julie L. Hudson (
Asako S. Moriya (
Health Aff (Millwood). 2017 Sep 1;36(9):1643-1651. doi: 10.1377/hlthaff.2017.0347.
Before the implementation of the Affordable Care Act (ACA), most children in low-income families were already eligible for public insurance through Medicaid or the Children's Health Insurance Program. Increased coverage observed for these children since the ACA's implementation suggest that the legislation potentially had important spillover or "welcome mat" effects on the number of eligible children enrolled. This study used data from the 2013-15 American Community Survey to provide the first national-level (analytical) estimates of welcome-mat effects on children's coverage post ACA. We estimated that 710,000 low-income children gained coverage through these effects. The study was also the first to show a link between parents' eligibility for Medicaid and welcome-mat effects for their children under the ACA. Welcome-mat effects were largest among children whose parents gained Medicaid eligibility under the ACA expansion to adults. Public coverage for these children increased by 5.7 percentage points-more than double the 2.7-percentage-point increase observed among children whose parents were ineligible for Medicaid both pre and post ACA. Finally, we estimated that if all states had adopted the Medicaid expansion, an additional 200,000 low-income children would have gained coverage.
在《平价医疗法案》（ACA）实施之前，大多数低收入家庭的儿童已经通过医疗补助计划或儿童健康保险计划获得了公共保险。自 ACA 实施以来，这些儿童的覆盖范围增加表明，该立法可能对符合条件的入保儿童数量产生了重要的溢出或“欢迎垫”效应。本研究使用了 2013-15 年美国社区调查的数据，首次在全国范围内（分析）估计了 ACA 后欢迎垫效应对儿童保险的影响。我们估计，有 71 万名低收入儿童通过这些效应获得了保险。该研究还首次表明，父母有资格获得医疗补助与 ACA 下子女的欢迎垫效应之间存在联系。在 ACA 将成年人纳入医疗补助范围后，父母获得医疗补助资格的儿童的欢迎垫效应最大。这些儿童的公共保险覆盖率增加了 5.7 个百分点——是父母在 ACA 前后均不符合医疗补助资格的儿童 2.7 个百分点增长率的两倍多。最后，我们估计，如果所有州都采用了医疗补助扩展计划，将有另外 20 万名低收入儿童获得保险。
