Rajbhandari-Thapa Janani, Zhang Donglan, MacLeod Kara E, Thapa Kiran
Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia, USA.
Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA.
Obesity (Silver Spring). 2020 Jul;28(7):1219-1223. doi: 10.1002/oby.22793. Epub 2020 Apr 18.
This study examines insurance coverage rates among working-age adults with low income and with or without obesity before and after Medicaid expansion under the Affordable Care Act.
Individual-level data on noninstitutionalized and nonpregnant adult participants aged 18 to 64 years with household income below $15,000 from the Centers for Disease Control and Prevention 2006-2017 Behavioral Risk Factor Surveillance System were used. A difference-in-differences design with logistic regression was used to examine the likelihood of insurance coverage before and after Medicaid expansion.
Working-age adults (analytic sample N = 316,151) who were white, female, less educated, unemployed, and living in a Medicaid-expansion state were more likely to have insurance coverage. The insurance coverage rate in Medicaid-expanded states in years after expansion increased for both subgroups with and without obesity. However, the increase was slightly lower for the subpopulation with obesity (5.59%, 95% CI: 2.35%-8.83%) compared with the subpopulation without obesity (7.35%, 95% CI: 5.35%-9.34%).
Increased attention should be paid to reduce insurance coverage barriers for working-age adults with low income and obesity to address potential health disparities caused by lack of access to care. This is important, as access to care provides opportunities to increase prevention and treatment-oriented services to address obesity and associated health care costs.
本研究调查了《平价医疗法案》下医疗补助扩大前后，低收入且有或无肥胖问题的工作年龄成年人的保险覆盖率。
使用了美国疾病控制与预防中心2006 - 2017年行为风险因素监测系统中，家庭收入低于15,000美元、年龄在18至64岁之间的非机构化且未怀孕成年参与者的个体层面数据。采用逻辑回归的双重差分设计来研究医疗补助扩大前后的保险覆盖可能性。
白人、女性、受教育程度较低、失业且居住在医疗补助扩大州的工作年龄成年人（分析样本N = 316,151）更有可能获得保险覆盖。在医疗补助扩大后的几年里，扩大州中肥胖和非肥胖亚组的保险覆盖率均有所上升。然而，肥胖亚人群的增长率（5.59%，95%置信区间：2.35% - 8.83%）略低于非肥胖亚人群（7.35%，95%置信区间：5.35% - 9.34%）。
应更加关注减少低收入且肥胖的工作年龄成年人的保险覆盖障碍，以解决因无法获得医疗服务而导致的潜在健康差异问题。这很重要，因为获得医疗服务提供了增加以预防和治疗为导向的服务的机会，以解决肥胖及相关医疗费用问题。
