Shubeck Sarah P, Crawford Emily, Notowidigdo Matthew J
Department of Surgery, Biological Sciences Division, University of Chicago, Chicago, Illinois.
Booth School of Business, University of Chicago, Chicago, Illinois.
JAMA Health Forum. 2025 Jun 7;6(6):e251467. doi: 10.1001/jamahealthforum.2025.1467.
Many individuals in the US face a high risk of losing their health insurance coverage and experiencing insurance churn, especially those enrolled in Medicaid. Prior research has found that the risk of losing insurance coverage remains high in the US even after the Patient Protection and Affordable Care Act significantly reduced the number of uninsured individuals.
To estimate whether the Families First Coronavirus Response Act (FFCRA) decreased insurance churn.
DESIGN, SETTING, AND PARTICIPANTS: This study used 2 quasi-experimental approaches: an interrupted time series approach and a difference-in-difference approach. Both approaches use individual-level data from the Medical Expenditure Panel Survey from January 2015 to December 2022. In the difference-in-difference analysis comparing individuals with Medicaid to individuals with private health insurance coverage, the probability that insured individuals aged 2 to 64 years lose insurance over the next 12 months before and after the FFCRA was estimated. Data were analyzed from January to November 2024.
Primary outcome was the share of insured individuals who lost insurance coverage over the next 12 months. This measure was defined for all insured individuals and defined separately for individuals with Medicaid and for individuals with private insurance coverage.
The sample included 96 473 individuals. Of these, 46 779 (49.7%) were male, and the mean (SD) age was 31.9 (18.1) years. In the interrupted time series analysis, the FFCRA was associated with a reduction in insurance churn by 2.06 percentage points (β = -0.021; 95% CI, -0.024 to -0.018; P < .001). In the difference-in-difference analysis, the FFRCA reduced Medicaid churn by 5.51 percentage points (β = -0.055; 95% CI, -0.060 to -0.050; P < .001). Combining these estimates, 65.0% (95% CI, 54.8-75.3) of the reduction in insurance churn came from the reduction in Medicaid churn.
In this study, the FFCRA was associated with a significantly decreased risk of losing health insurance. Without the FFCRA, an estimated 2.94 million individuals with Medicaid would have lost insurance coverage each year during the COVID-19 public health emergency.
美国许多人面临失去医疗保险覆盖范围并经历保险变动的高风险，尤其是那些参加医疗补助计划（Medicaid）的人。先前的研究发现，即使在《患者保护与平价医疗法案》大幅减少了未参保人数之后，美国失去保险覆盖范围的风险仍然很高。
评估《家庭第一冠状病毒应对法案》（FFCRA）是否减少了保险变动。
设计、背景和参与者：本研究采用了两种准实验方法：中断时间序列法和差异分析法。两种方法都使用了2015年1月至2022年12月医疗支出面板调查的个体层面数据。在将参加医疗补助计划的人与参加私人医疗保险的人进行比较的差异分析中，估计了2至64岁参保个体在FFCRA前后未来12个月内失去保险的概率。数据于2024年1月至11月进行分析。
主要结局是在接下来12个月内失去保险覆盖范围的参保个体比例。该指标针对所有参保个体进行定义，并分别针对参加医疗补助计划的个体和参加私人保险的个体进行定义。
样本包括96473人。其中，46779人（49.7%）为男性，平均（标准差）年龄为31.9（18.1）岁。在中断时间序列分析中，FFCRA与保险变动减少2.06个百分点相关（β = -0.021；95%置信区间，-0.024至-0.018；P <.001）。在差异分析中，FFRCA使医疗补助计划的变动减少了5.51个百分点（β = -0.055；95%置信区间，-0.060至-0.050；P <.001）。综合这些估计，保险变动减少量的65.0%（95%置信区间，54.8 - 75.3）来自医疗补助计划变动的减少。
在本研究中，FFCRA与失去医疗保险的风险显著降低相关。如果没有FFCRA，估计在新冠疫情公共卫生紧急状态期间，每年有294万参加医疗补助计划的人会失去保险覆盖范围。
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