Department of Health Management & Policy, College of Public Health, University of Kentucky, Lexington.
JAMA Health Forum. 2022 Jun 17;3(6):e221632. doi: 10.1001/jamahealthforum.2022.1632. eCollection 2022 Jun.
The COVID-19 pandemic has been associated with increased unemployment rates and long periods when individuals were without health insurance. Little is known about how Medicaid expansion facilitates Medicaid enrollment as a buffer to coverage loss owing to unemployment.
To compare changes in health insurance coverage status associated with pandemic-related unemployment among previously employed adults in states that have vs have not expanded Medicaid eligibility.
This cohort study included US adults aged 27 to 64 years who were employed at baseline in the 2020 to 2021 Current Population Survey's Annual Social and Economic Supplement, which included calendar years 2019 to 2020 (32 462 person-years). Data analyses were conducted between November 2021 and April 2022.
Job loss (ie, new unemployment) experienced during 2020.
Primary outcomes were coverage status (ie, uninsured status) and source of coverage (ie, employer sponsored, marketplace, and Medicaid). Using 2-way person-by-year fixed-effects regression models, changes in coverage status associated with unemployment in states that expanded Medicaid were compared with states that did not expand Medicaid. Additional analyses were performed based on prepandemic coverage status.
The cohort included 16 231 adults (mean age, 46.8 [95% CI, 46.6-47.0] years; 51.6% women). New unemployment was associated with an increase of 2.9 (95% CI, 1.1-4.6) percentage points ( = .002) in the proportion of uninsured adults in Medicaid expansion states and an increase of 10.7 (95% CI, 2.4-18.9) percentage points ( = .01) in nonexpansion states. Workers were 5.4 (95% CI, 1.9-8.9) percentage points ( = .003) more likely to enroll in Medicaid after a job loss if they lived in a Medicaid expansion state compared with workers experiencing job loss in nonexpansion states.
In this cohort study of US adults, unemployment-related Medicaid enrollment was more frequent in Medicaid expansion states during the COVID-19 pandemic. Medicaid expansion led to a smaller increase in uninsured adults because those who lost private insurance coverage (eg, employer sponsored) appeared more able to transition to Medicaid after job loss.
COVID-19 大流行与失业率上升和个人长期没有医疗保险有关。对于医疗补助计划的扩大如何促进医疗补助计划的注册，作为失业导致的覆盖范围损失的缓冲，人们知之甚少。
比较在已经扩大医疗补助资格的州和尚未扩大医疗补助资格的州，与大流行相关的失业对以前就业的成年人的健康保险覆盖状况的变化。
设计、地点和参与者：本队列研究纳入了 2020 年至 2021 年期间参加过 2020 年至 2021 年美国人口普查年度社会经济补充调查的 27 岁至 64 岁的美国成年人，该调查包括日历年份 2019 年至 2020 年（32462 人年）。数据分析于 2021 年 11 月至 2022 年 4 月进行。
2020 年经历的失业（即新失业）。
主要结局是覆盖范围（即未参保状态）和覆盖范围来源（即雇主赞助、市场和医疗补助）。使用双向个人-年固定效应回归模型，比较了在扩大医疗补助的州和没有扩大医疗补助的州，与失业相关的覆盖范围变化。还根据大流行前的覆盖范围进行了额外的分析。
队列包括 16231 名成年人（平均年龄，46.8[95%置信区间，46.6-47.0]岁；51.6%为女性）。新的失业与医疗补助扩张州的未参保成年人比例增加了 2.9 个百分点（95%置信区间，1.1-4.6）（ = .002），非扩张州增加了 10.7 个百分点（95%置信区间，2.4-18.9）（ = .01）。与在非扩张州经历失业的工人相比，如果他们居住在医疗补助扩张州，工人在失业后更有可能通过医疗补助获得 5.4 个百分点（95%置信区间，1.9-8.9）（ = .003）的覆盖范围。
在这项针对美国成年人的队列研究中，在 COVID-19 大流行期间，与失业相关的医疗补助计划注册在医疗补助计划扩张州更为频繁。医疗补助计划的扩大导致未参保成年人的比例增加幅度较小，因为那些失去私人保险（如雇主赞助）的人在失业后似乎更容易过渡到医疗补助计划。
