PhD Program in Health Policy, University of California, Berkeley, Berkeley, California.
Philip R. Lee Institute for Health Policy Studies and Adolescent and Young Adult Health National Resource Center, University of California, San Francisco, San Francisco, California.
J Adolesc Health. 2020 Sep;67(3):425-431. doi: 10.1016/j.jadohealth.2020.05.029. Epub 2020 Jul 3.
The purpose of the study was to evaluate the effects of early Medicaid expansions on young adults, who also benefitted from a private dependent coverage expansion.
We used the American Community Survey 2008-2013 to study three early expansion states-California, Connecticut, and Minnesota-using difference-in-differences. Control states are weighted combinations of other states and are similar to expansion states in the prepolicy periods. We analyze young adults and subgroups of women and men.
Early Medicaid reduced uninsurance and improved public coverage among low- and moderate-income young adults beyond the private dependent coverage expansion, but results differed across states. California, which targeted up to 200 percent of the federal poverty level (FPL), reduced uninsurance 1.3 percentage points (4.2% relative to mean) and increased public insurance by 1.4 percentage points (14.0%). Connecticut, which targeted up to 56 percent of FPL, had no change to uninsurance but a 5.4 percentage point (42.5%) increase in public coverage. Minnesota's programs (up to 75 and 250 percent of FPL) produced a 4.2 percentage point (21.9%) decline in uninsurance for their lowest income group, but no measurable changes for their moderate-income group. Young men benefitted more than women. Their uninsurance declined as much as 6.0 percentage points (25.0%, in Minnesota) and their public coverage increased up to 9.1 percentage points (61.5%, in Connecticut).
Medicaid expansion benefits young adults, even those with moderate incomes, and even following a private dependent expansion. Results were larger and concentrated among young men, who historically had little engagement with the program.
本研究旨在评估早期医疗补助计划（Medicaid）扩张对年轻人的影响，这些年轻人也受益于私人受抚养人保险覆盖范围的扩大。
我们使用 2008-2013 年美国社区调查数据，通过差分法研究了三个早期扩张州——加利福尼亚州、康涅狄格州和明尼苏达州。对照州是其他州的加权组合，与政策前时期的扩张州相似。我们分析了年轻人以及女性和男性的亚组。
早期医疗补助计划除了私人受抚养人保险覆盖范围的扩大外，还降低了低收入和中等收入年轻人的未保险率，并改善了公共保险覆盖范围，但其结果因州而异。加利福尼亚州的目标是覆盖联邦贫困线（FPL）的 200%，将未保险率降低了 1.3 个百分点（相对于平均值下降 4.2%），并将公共保险增加了 1.4 个百分点（增加 14.0%）。康涅狄格州的目标是覆盖 FPL 的 56%，未保险率没有变化，但公共保险覆盖率增加了 5.4 个百分点（增加 42.5%）。明尼苏达州的计划（覆盖 FPL 的 75%和 250%）使收入最低的群体的未保险率下降了 4.2 个百分点（下降 21.9%），但对中等收入群体没有可衡量的变化。年轻男性比女性受益更多。他们的未保险率下降了 6.0 个百分点（在明尼苏达州下降 25.0%），公共保险覆盖率增加了 9.1 个百分点（在康涅狄格州增加 61.5%）。
医疗补助计划的扩张使年轻人受益，即使是中等收入的年轻人，甚至在私人受抚养人保险覆盖范围扩大之后也是如此。结果在年轻男性中更为显著，他们在历史上与该计划的参与度较低。
