Department of Economics, Tufts University, Medford, Massachusetts.
National Bureau of Economic Research, Cambridge, Massachusetts.
JAMA Health Forum. 2022 Jun 3;3(6):e221373. doi: 10.1001/jamahealthforum.2022.1373. eCollection 2022 Jun.
Medicaid is an important source of supplemental coverage for older Medicare beneficiaries with low income. Research has shown that Medicaid expansion under the Patient Protection and Affordable Care Act (ACA) was associated with increased Medicaid coverage for previously eligible older adults with low income, but there has been little research on whether their health care use increased or whether such changes differed by beneficiaries' health status.
To assess whether the ACA Medicaid expansion to working-age adults was associated with increased Medicaid enrollment and health care use among older adults with low income with and without chronic condition limitations.
This cross-sectional study used data from the National Health Interview Survey from 2010 to 2017 for adults 65 years or older with low income (≤100% of the federal poverty level). Data were analyzed from November 2020 to March 2022.
Residence in a state with Medicaid expansion for working-age adults.
The main outcomes were Medicaid coverage and health care use, measured by physician office visits and inpatient hospital care. Survey weights were used in calculating descriptive statistics and regression estimates. In multivariate analysis, difference-in-differences models were used to compare changes in outcomes over time between respondents in Medicaid expansion states and respondents in nonexpansion states.
Of 21 859 adults included in the study, 7153 had chronic condition limitations (4983 [70.1%] female; mean [SD] age, 76.0 [0.1] years) and 14 706 did not have chronic condition limitations (9609 [66.3%] female; mean [SD] age, 74.85 [0.08] years). Of those with chronic condition limitations, 2707 (36.7%) were enrolled in Medicaid, 2816 (39.4%) had an office visit in the past 2 weeks, and 2152 (30.7%) used inpatient hospital care in the past year. Medicaid expansion was associated with differential increases in the likelihood of having Medicaid (4.92 percentage points; 95% CI, 0.25-9.60 percentage points; = .04) and having an office visit in the past 2 weeks (5.31 percentage points; 95% CI, 0.10-10.51 percentage points; = .046) compared with nonexpansion. There were no differential changes between expansion and nonexpansion states in receipt of inpatient hospital care (-0.62 percentage points; 95% CI, -5.39 to 4.14 percentage points; = .79). Among adults without chronic condition limitations, 3159 (19.8%) were enrolled in Medicaid, and no differential changes between expansion and nonexpansion states in Medicaid enrollment (-0.24 percentage points; 95% CI, -3.06 to 2.57 percentage points; = .86) or health care use were found.
In this cross-sectional study, ACA Medicaid expansion for working-age adults was associated with increased Medicaid enrollment and outpatient health care use among older adults with low income and chronic condition limitations who were dually eligible for Medicare and Medicaid.
医疗补助是为低收入的老年 Medicare 受益人的补充保险的重要来源。研究表明，《平价医疗法案》（ACA）下的医疗补助扩大计划与低收入、原本符合条件的老年成年人的医疗补助覆盖范围增加有关，但关于他们的医疗保健使用是否增加，以及这些变化是否因受益人的健康状况而异的研究甚少。
评估 ACA 对工作年龄成年人的医疗补助扩大计划是否与低收入老年人的医疗补助参保率和医疗保健使用率的增加有关，包括有和没有慢性病限制的老年人。
设计、地点和参与者：这项横断面研究使用了 2010 年至 2017 年全国健康访谈调查的数据，纳入了收入较低（≤联邦贫困水平的 100%）的 65 岁及以上成年人。数据分析于 2020 年 11 月至 2022 年 3 月进行。
居住在扩大工作年龄成年人医疗补助的州。
主要结局是医疗补助覆盖和医疗保健使用，通过医生门诊就诊和住院治疗来衡量。使用调查权重计算描述性统计和回归估计。在多变量分析中，采用差分法模型比较了在医疗补助扩大州和非扩大州的受访者在不同时间段内的结局变化。
在纳入的 21859 名成年人中，7153 人有慢性病限制（4983 [70.1%] 为女性；平均[SD]年龄为 76.0[0.1]岁），14706 人没有慢性病限制（9609 [66.3%] 为女性；平均[SD]年龄为 74.85[0.08]岁）。在有慢性病限制的人群中，2707 人（36.7%）参加了医疗补助，2816 人（39.4%）在过去 2 周内就诊过，2152 人（30.7%）在过去 1 年中使用过住院治疗。与非扩大州相比，医疗补助扩大计划与有医疗补助的可能性（4.92 个百分点；95%CI，0.25-9.60 个百分点； = .04）和过去 2 周内就诊的可能性（5.31 个百分点；95%CI，0.10-10.51 个百分点； = .046）的差异增加有关。在接受住院治疗方面，扩大和非扩大州之间没有差异变化（-0.62 个百分点；95%CI，-5.39 至 4.14 个百分点； = .79）。在没有慢性病限制的成年人中，3159 人（19.8%）参加了医疗补助，在医疗补助参保率（-0.24 个百分点；95%CI，-3.06 至 2.57 个百分点； = .86）或医疗保健使用方面，扩大和非扩大州之间没有差异。
在这项横断面研究中，ACA 对工作年龄成年人的医疗补助扩大计划与低收入、有慢性病限制且同时符合 Medicare 和 Medicaid 条件的老年人的医疗补助参保率和门诊医疗保健使用率的增加有关。
