School of Public Policy, University of Connecticut, Storrs, Connecticut, USA.
Health Econ. 2024 Aug;33(8):1895-1925. doi: 10.1002/hec.4839. Epub 2024 May 23.
Prior to the 2014 Affordable Care Act (ACA) expansion, 37% of young adults ages 19-25 in the United States were low-income and a third lacked health insurance coverage-both the highest rates for any age group in the population. The ACA's Medicaid eligibility expansion, therefore, would have been significantly beneficial to low-income young adults. This study evaluates the effect of the ACA Medicaid expansion on the health, health care access and utilization, and financial well-being of low-income young adults ages 19-25. Using 2010-2017 National Health Interview Survey data, I estimate policy effects by applying a difference-in-differences design leveraging the variation in state implementation of the expansion policy. I show that Medicaid expansion improved health insurance coverage, health care access, and financial well-being for low-income young adults in expansion states, but had no effect on their health status and health care utilization. I also find that the policy was associated with larger gains in health coverage for racial minorities relative to their Non-Hispanic White counterparts. With the continued health policy reform debates at the state and federal levels, the empirical evidence from this study can help inform policy decisions that aim to improve health care access and utilization among disadvantaged groups.
在 2014 年平价医疗法案(ACA)扩大之前,美国 19-25 岁的年轻成年人中有 37%是低收入者,三分之一的人没有医疗保险,这两个比例都是所有年龄组中最高的。因此,ACA 的医疗补助资格扩大将对低收入的年轻成年人有显著的好处。本研究评估了 ACA 医疗补助扩大对 19-25 岁低收入年轻成年人的健康、医疗保健获取和利用以及经济福利的影响。利用 2010-2017 年国家健康访谈调查数据,我通过应用差异中的差异设计,利用扩大政策在各州实施的差异,估计了政策效果。我表明,医疗补助扩大提高了扩展示范州低收入年轻成年人的医疗保险覆盖范围、医疗保健获取和经济福利,但对他们的健康状况和医疗保健利用没有影响。我还发现,该政策与非西班牙裔白人相比,使少数族裔在健康保险覆盖方面的收益更大。随着州和联邦层面持续的医疗政策改革辩论,本研究的实证证据可以帮助为旨在改善弱势群体医疗保健获取和利用的政策决策提供信息。