Drexel University, Dornsife School of Public Health, Philadelphia, PA, United States of America.
University of Utah, Matheson Center for Health Care Studies, Salt Lake City, UT, United States of America.
PLoS One. 2019 Oct 23;14(10):e0223556. doi: 10.1371/journal.pone.0223556. eCollection 2019.
To determine the association of Medicaid expansion with health insurance coverage by marital status and sex.
A population-based, quasi-experimental policy analysis was undertaken of the implementation of the Patient Protection and Affordable Care Act's (ACA) Medicaid expansion provision on or after January 1, 2014. The 2010-16 American Community Survey provided data on 3,874,432 Medicaid-eligible adults aged 19-64 with incomes up to 138% of the federal poverty level. The outcome measures were no health insurance coverage and Medicaid coverage. The predictor variables were marital status and sex, with controls for family size, poverty status, race/ethnicity, education, employment status, immigration status, and metropolitan residence.
In 2016, the uninsured rate for married men and women in a Medicaid expansion state was 21.2% and 17.1%, respectively, compared to 37.4% for married men and 35.8% for married women in a non-expansion state. The Medicaid coverage rate grew between 14.8% to 19.3% in Medicaid expansion states, which contrasts with less than a 5% growth in non-expansion states. Triple differences analysis suggests that, for women of all age groups, Medicaid expansion resulted in a 1.6 percentage point lower uninsured rate for married women compared to unmarried women. For men, there was not a statistically significant difference in the uninsured rate for married compared to unmarried men. For women of all age groups, there was a 2.6 percentage point higher Medicaid coverage rate for married compared to unmarried women. For men, there was a 1.8 percentage point higher Medicaid coverage rate for married compared to unmarried men.
Medicaid expansion under the ACA differentially lowered uninsurance and improved Medicaid coverage for married persons, especially married women, more than unmarried persons.
确定医疗补助计划扩大覆盖范围与婚姻状况和性别的关联。
对 2014 年 1 月 1 日或之后实施《患者保护与平价医疗法案》（ACA）医疗补助扩大规定的情况进行了基于人群的准实验政策分析。2010-2016 年美国社区调查提供了 3874432 名符合医疗补助条件的 19-64 岁成年人的数据，这些成年人的收入在联邦贫困线的 138%以下。结果衡量标准为无医疗保险和医疗补助保险。预测变量为婚姻状况和性别，控制变量为家庭规模、贫困状况、种族/民族、教育、就业状况、移民状况和大都市区居住情况。
2016 年，在医疗补助计划扩大的州，已婚男性和女性的无保险率分别为 21.2%和 17.1%，而在非扩大的州，已婚男性和女性的无保险率分别为 37.4%和 35.8%。在医疗补助计划扩大的州，医疗补助保险的覆盖范围从 14.8%增长到 19.3%，而在非扩大的州，这一增长不到 5%。三重差分分析表明，对于所有年龄段的女性，与未婚女性相比，医疗补助计划扩大使已婚女性的无保险率降低了 1.6 个百分点。对于男性，已婚男性与未婚男性的无保险率没有统计学上的显著差异。对于所有年龄段的女性，已婚女性的医疗补助保险覆盖范围比未婚女性高 2.6 个百分点。对于男性，已婚男性的医疗补助保险覆盖范围比未婚男性高 1.8 个百分点。
ACA 下的医疗补助计划扩大对已婚人士，特别是已婚女性，降低了未保险率，提高了医疗补助保险的覆盖范围，而对未婚人士的影响则较小。
