J Health Care Poor Underserved. 2024;35(3):802-815.
In 2014, the Affordable Care Act (ACA) expanded the role of Medicaid by encouraging states to increase eligibility for lower-income adults. As of 2024, 10 states had not adopted the expanded eligibility provisions of the ACA, possibly due to concerns about the state's share of spending. Using the Medical Expenditure Panel Survey (MEPS), we documented how health care utilization, expenditures, and the overall health status of newly eligible enrollees compare with enrollees who would have been eligible under their states' rules before the ACA. Our estimates suggest that, during 2014-16, newly eligible Medicaid enrollees had worse health and greater utilization and expenditures than previously eligible enrollees. However, during 2017-19, newly and previously eligible enrollees had comparable per capita health expenditures across six types of health spending. We find some evidence that changes in Medicaid enrollment composition muted observed differences between eligibility groups.
2014 年，《平价医疗法案》（ACA）通过鼓励各州提高低收入成年人的资格标准，扩大了医疗补助的作用。截至 2024 年，仍有 10 个州没有采用 ACA 扩大的资格规定，这可能是由于担心州政府的支出份额。利用医疗支出调查（MEPS），我们记录了新符合条件的参保者与在 ACA 之前根据各州规定本应符合条件的参保者相比，其医疗保健利用、支出和整体健康状况有何不同。我们的估计表明，在 2014-16 年期间，新符合条件的医疗补助参保者的健康状况更差，利用和支出也更大。然而，在 2017-19 年期间，新的和以前符合条件的参保者在六种类型的医疗支出方面的人均医疗支出相当。我们发现一些证据表明，医疗补助参保者组成的变化缓和了观察到的符合条件群体之间的差异。
