Myerson Rebecca, Li Honglin
University of Wisconsin-Madison.
Am J Health Econ. 2022 Fall;8(4):477-505. doi: 10.1086/721569. Epub 2022 Sep 22.
We studied the impact of Affordable Care Act navigator programs on health insurance coverage, using the 80 percent cut in program funding under the Trump administration as a natural experiment. Our study design exploited county-level differences in the program prior to funding cuts. We did not find that cuts to the program significantly decreased rates of marketplace coverage or any health insurance coverage by 2019; however, our estimates could not rule out marketplace coverage declines of up to 2.7 percent (point estimate -1.3 percent, 95 percent CI: 2.7 percent to 0.1 percent), or total coverage declines of up to 1.8 percentage points (point estimate -0.8 percentage points or -1.2 percent, 95 percent CI: -1.8 to 0.2). Cuts to the navigator program significantly decreased marketplace coverage and total coverage among lower-income adults, and significantly decreased total coverage among adults under age 45, Hispanic adults, and adults who speak a language other than English at home. We found no significant impact of the cuts on Medicaid enrollment (95 percent CI: -1.9 percentage points to 0.5 percentage points); most uninsured people in the states we studied lived in locations that had not implemented Medicaid eligibility expansions. These findings suggest that before the funding cuts, navigators were helping underserved consumers obtain coverage.
我们利用特朗普政府时期该项目资金削减80%这一自然实验，研究了《平价医疗法案》导航项目对医疗保险覆盖范围的影响。我们的研究设计利用了资金削减前该项目在县级层面的差异。我们发现，到2019年，该项目的削减并没有显著降低市场覆盖率或任何医疗保险覆盖率；然而，我们的估计不能排除市场覆盖率下降高达2.7%（点估计为-1.3%，95%置信区间：2.7%至0.1%），或总覆盖率下降高达1.8个百分点（点估计为-0.8个百分点或-1.2%，95%置信区间：-1.8至0.2）。导航项目的削减显著降低了低收入成年人的市场覆盖率和总覆盖率，也显著降低了45岁以下成年人、西班牙裔成年人以及在家说英语以外语言的成年人的总覆盖率。我们发现削减对医疗补助登记没有显著影响（95%置信区间：-1.9个百分点至0.5个百分点）；在我们研究的州，大多数未参保人员居住在尚未实施医疗补助资格扩大政策的地区。这些发现表明，在资金削减之前，导航员正在帮助服务不足的消费者获得保险。
