Division of Health Systems Management and Policy, University of Memphis, Memphis, TN, USA.
Department of Health Management and Policy, University of Iowa, Iowa City, IA, USA.
Inquiry. 2022 Jan-Dec;59:469580221092856. doi: 10.1177/00469580221092856.
Virginia expanded Medicaid under the Affordable Care Act beginning in January 2019, which substantially increased income eligibility up to 138% of the federal poverty level (FPL) for both childless adults and parents. In this study, we examined the effects of Virginia's Medicaid expansion in 2019 on health insurance coverage, access to care, and health status by employing a difference-in-differences and a synthetic control design. The study included data on health insurance from the 2016-2020 American Community Survey (ACS) and data on access to care and health status come from the 2016-2020 Behavioral Risk Factors Surveillance System (BRFSS). The samples from ACS and BRFSS were limited to non-elderly adults with income below 138% of the FPL. Separate models were estimated for individuals below 100% of FPL, and those within 100-138% of FPL. The Virginia Medicaid expansion was associated with a 9-11 percentage-point increase in Medicaid coverage rate and a 7-8 percentage-point increase in the insured rate among individuals below 100% FPL, in the first two years of expansion. There was a larger increase in Medicaid coverage among individuals within 100-138% of FPL which also led to a larger increase in the insured rate in 2020. Both income groups showed no changes in private coverage after the expansion in Virginia. We also found a decline in delaying necessary medical visits due to cost for individuals below 100% FPL in 2019 and for individuals within 100-138% FPL in 2020. There was overall no discernable change in health status outcomes. Virginia's 2019 Medicaid expansion substantially increased insurance coverage among poor adults with suggestive early evidence for improved access. The findings highlight the missed opportunity for other states that have not yet decided to expand their Medicaid programs to improve coverage and access among their low-income individuals.
弗吉尼亚州在 2019 年开始实施《平价医疗法案》下的医疗补助扩展计划，这将无子女成年人和父母的收入资格大大提高到联邦贫困线（FPL）的 138%。在这项研究中，我们采用差异分析和综合控制设计，研究了弗吉尼亚州 2019 年医疗补助计划扩大对保险覆盖范围、获得医疗服务和健康状况的影响。研究数据来自 2016-2020 年美国社区调查（ACS）的医疗保险数据，以及 2016-2020 年行为风险因素监测系统（BRFSS）的获得医疗服务和健康状况的数据。ACS 和 BRFSS 的样本仅限于收入低于 FPL 的 138%的非老年人。分别为收入低于 100%FPL 的个体和收入在 100-138%FPL 的个体建立模型。在扩张的头两年，弗吉尼亚州医疗补助计划的扩张与 Medicaid 覆盖率增加了 9-11 个百分点，以及收入低于 100%FPL 的参保率增加了 7-8 个百分点有关。收入在 100-138%FPL 之间的个体的 Medicaid 覆盖范围增加更多，这也导致 2020 年参保率增加更多。在弗吉尼亚州扩张后，这两个收入群体的私人保险覆盖范围都没有变化。我们还发现，收入低于 100%FPL 的个体在 2019 年和收入在 100-138%FPL 的个体在 2020 年，因费用而推迟必要医疗就诊的人数有所减少。总体而言，健康状况结果没有明显变化。弗吉尼亚州 2019 年的医疗补助扩张计划大大增加了贫困成年人的保险覆盖范围，并初步表明改善了获得医疗服务的机会。这些发现强调了其他尚未决定扩大医疗补助计划以提高其低收入人群覆盖范围和获得医疗服务的州所错失的机会。
