Teresa Molina, Tetine Sentell, and Timothy J. Halliday are with the University of Hawaii at Manoa, Honolulu. Randall Q. Akee is with University of California, Los Angeles. Alvin Onaka and Brian Horiuchi are with the Department of Health, State of Hawaii, Honolulu.
Am J Public Health. 2020 Aug;110(8):1205-1207. doi: 10.2105/AJPH.2020.305687. Epub 2020 Jun 18.
To study the impact on mortality in Hawaii from the revoked state Medicaid program coverage in March 2015 for most Compact of Free Association (COFA) migrants who were nonblind, nondisabled, and nonpregnant. We computed quarterly crude mortality rates for COFA migrants, Whites, and Japanese Americans from March 2012 to November 2018. We employed a difference-in-difference research design to estimate the impact of the Medicaid expiration on log mortality rates. We saw larger increases in COFA migrant mortality rates than White mortality rates after March 2015. By 2018, the increase was 43% larger for COFA migrants ( = .003). Mortality trends over this period were similar for Whites and Japanese Americans, who were not affected by the policy. Mortality rates of COFA migrants increased after Medicaid benefits expired despite the availability of state-funded premium coverage for private insurance and significant outreach efforts to reduce the impact of this coverage change.
研究表明，2015 年 3 月，夏威夷州取消了针对大多数《自由联系条约》（COFA）移民中未失明、无残疾和非孕妇的州医疗补助计划覆盖范围，这对死亡率产生了影响。我们计算了 2012 年 3 月至 2018 年 11 月期间 COFA 移民、白人和日裔美国人的季度粗死亡率。我们采用差异中的差异研究设计来估计医疗补助终止对对数死亡率的影响。我们发现，2015 年 3 月之后，COFA 移民的死亡率增长幅度大于白人的死亡率增长幅度。到 2018 年，COFA 移民的死亡率增长了 43%（ = .003）。在此期间，白人（未受该政策影响）和日裔美国人的死亡率趋势相似。尽管有州资助的私人保险保费覆盖，并且有大量外展工作来减轻这一覆盖变化的影响，但 COFA 移民的死亡率仍在医疗补助福利终止后上升。
