Department of Health Management & Policy, College of Public Health, Martin School of Public Policy and Administration, University of Kentucky, Lexington, Kentucky, USA.
Department of Health Policy & Management, School of Public Health and Tropical Medicine, Murphy Institute for Political Economy, Tulane University, New Orleans, Louisiana, USA.
Health Econ. 2024 Jul;33(7):1426-1453. doi: 10.1002/hec.4823. Epub 2024 Mar 11.
Whether Medicaid can function as a safety net to offset health risks created by health insurance coverage losses due to job loss is conditional on (1) the eligibility guidelines shaping the pathway for households to access the program for temporary relief, and (2) Medicaid reimbursement policies affecting the value of the program for both the newly and previously enrolled. We find states with more expansive eligibility guidelines lowered the healthcare access and health risk of coverage loss associated with rising unemployment during the 2007-2009 Great Recession. Rises in cost-related barriers to care associated with unemployment were smallest in states with expansive eligibility guidelines and higher Medicaid-to-Medicare fee ratios. Similarly, states whose Medicaid programs had expansive eligibility guidelines and higher fees saw the smallest recession-linked declines in self-reported good health. Medicaid can work to stabilize access to health care during periods of joblessness. Our findings yield important insights into the alignment of at least two Medicaid policies (i.e., eligibility and payment) shaping Medicaid's viability as a safety net.
医疗补助能否起到安全网的作用，抵消因失业导致的医疗保险覆盖范围损失带来的健康风险，这取决于以下两个方面：（1）确定家庭获得该计划临时救济的途径的资格准则；（2）影响新参保者和已参保者参保价值的医疗补助报销政策。我们发现，在 2007-2009 年大衰退期间，那些资格准则更宽松的州降低了与失业相关的医疗保健获取机会和覆盖范围损失的健康风险。与失业相关的与费用相关的护理障碍的上升幅度在资格准则宽松的州最小，而医疗补助与医疗保险的费用比率较高的州也是如此。同样，那些医疗补助计划资格准则宽松、费用较高的州，在自我报告的健康状况方面，与衰退相关的下降幅度最小。医疗补助可以在失业期间稳定获得医疗保健的机会。我们的研究结果为至少两项医疗补助政策（即资格和支付）的调整提供了重要的见解，这些政策决定了医疗补助作为安全网的可行性。
