Department of Economics, University of Nevada, Reno, Nevada, USA.
IZA, Bonn, Germany.
Health Serv Res. 2023 Aug;58(4):924-937. doi: 10.1111/1475-6773.14166. Epub 2023 May 11.
To evaluate the effects on racial disparities in health insurance coverage from the changes in the Premium Tax Credit (PTC) implemented in March 2021 as part of the American Rescue Plan Act (ARPA).
We use nationally representative individual-level data from the Household Pulse Survey (HPS), which provides demographic, economic, and health insurance information for United States residents during the period April 2020-August 2022.
While the PTC changes applied to all states, the 14 states that did not expand Medicaid received substantially more benefits than the expansion states since they had more uninsured individuals eligible for the PTC than the expansion states. In our analysis, the treatment (control) group includes all Medicaid nonexpansion (expansion) states. We use a difference-in-difference regression analysis to estimate the increase in the probability of insurance coverage after the expansion of the PTC. Furthermore, we conduct sensitivity and heterogeneity analyses.
DATA COLLECTION/EXTRACTION METHODS: We focus on survey respondents ages 18-64.
The expanded PTC increased the probability of an individual having coverage through the Health Insurance Exchange (HIX) in a nonexpansion state by 0.95 (95% CI: 0.6136, 1.2900), 1.75 (95% CI: 1.1795, 2.3291), and 1.75 (95% CI: 1.1815, 2.3269) percentage points among White, Black, and Hispanic respondents, respectively. It also increased overall health insurance coverage among all groups.
The expanded PTC boosted HIX and overall health insurance coverage and reduced racial disparities.
评估 2021 年 3 月作为《美国救援计划法案》（ARPA）一部分实施的保费税收抵免（PTC）变化对健康保险覆盖范围的种族差异的影响。
我们使用来自家庭脉搏调查（HPS）的全国代表性个人水平数据，该调查在 2020 年 4 月至 2022 年 8 月期间为美国居民提供人口统计、经济和健康保险信息。
虽然 PTC 的变化适用于所有州，但没有扩大医疗补助的 14 个州获得的收益要比扩大医疗补助的州多得多，因为它们有更多符合 PTC 条件的未参保人，而不是扩大医疗补助的州。在我们的分析中，治疗（对照）组包括所有没有扩大医疗补助的州（扩大医疗补助的州）。我们使用差分差异回归分析来估计 PTC 扩大后保险覆盖范围的增加。此外，我们还进行了敏感性和异质性分析。
数据收集/提取方法：我们关注年龄在 18-64 岁之间的调查受访者。
扩大 PTC 使非扩张州个人通过健康保险交易所（HIX）获得保险的可能性增加了 0.95（95%置信区间：0.6136，1.2900）、1.75（95%置信区间：1.1795，2.3291）和 1.75（95%置信区间：1.1815，2.3269），分别为白人、黑人、西班牙裔受访者。它还增加了所有群体的整体健康保险覆盖范围。
扩大 PTC 增加了 HIX 和整体健康保险覆盖范围，并减少了种族差异。
