Effects of the Medicaid expansion under the Affordable Care Act on health insurance coverage,health care access,and use for people with disabilities |
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| Institution: | 1. Department of Clinical Pharmacy and Translational Science, University of Tennessee College of Pharmacy, 881 Madison Avenue, Room 214, Memphis, TN 38163, USA;2. Department of Economics, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA;3. School of Public Policy, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA;1. Oklahoma State University Center for Health Sciences, College of Osteopathic Medicine, Office of Medical Student Research, Tulsa, OK, USA;2. Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA;3. Department of Surgery, Oklahoma State Medical Center, Tulsa, OK, USA;4. Department of Internal Medicine, University of Oklahoma, School of Community Medicine, Tulsa, OK, USA;5. Department of Family Medicine, Alliance Health, Durant, OK, USA;1. Department of Health Sciences, Northern Arizona University, 1100 S. Beaver Street Room 488, Flagstaff, AZ, 86011, United States;2. School of Social Work, Boston University, 264 Bay State Road, Boston, MA, 02215, United States;3. Department of Disabilities and Human Development, University of Illinois at Chicago, 1640 Roosevelt Road, Chicago, IL, 60608, United States;4. Combined Counseling/School Psychology Program, Northern Arizona University, 801 Knoles Drive, Flagstaff, AZ, 86011, United States;5. Massachusetts General Hospital Biostatistics Center, 50 Staniford Street, Boston, MA, 02114, United States;6. Department of Global Health, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, United States;7. Division of Pediatric Health Outcomes Research, Massachusetts General Hospital, 125 Nashua Street, Boston, MA, 02114, United States;8. Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, United States;1. School of Medical Sciences, University of Campinas, Campinas, SP, 13083-887, Brazil;2. Department of Kinesiology, University of Wisconsin-Eau Claire, Eau Claire, WI, 54702, USA;3. Department of Physical Therapy, College of Health Professions, Wichita State University, Wichita, KS, 67260-0043, USA;4. Department of Kinesiology, Mississippi State University, Starkville, MS, 39762, USA;1. Research and Training Center on Disability in Rural Communities, University of Montana, USA;2. Research and Training Center on Independent Living, The University of Kansas, USA;1. Department of Psychology, University of Copenhagen, Denmark;2. School of Health Sciences, University of Iceland, Iceland;3. School of Teacher Education, Charles Sturt University, Australia;1. School of Health Technology and Management, Stony Brook University, Stony Brook, United States;2. College of Arts and Sciences, Whitworth University, United States;3. Renaissance School of Medicine, Stony Brook University, Stony Brook, United States |
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| Abstract: | BackgroundPeople with disabilities have higher health care needs, service utilization, and expenditures. They are also more likely to lack insurance and experience unmet need for medical care. There has been limited research on the effects of the Affordable Care Act Medicaid expansion on people with disabilities.ObjectiveTo examine the effects of the Medicaid expansion on health insurance coverage, access, and service use for working-age adults with disabilities.MethodsA retrospective study using 11 years (2007–2017) of data from the Medical Expenditure Panel Survey - Household Components, linked to Area Health Resource Files and Local Area Unemployment Statistics (N = 40,995). Difference-in-differences multinomial logistic and linear probability models with state and year fixed-effects were used to estimate the effects.ResultsWe found strong evidence of increased Medicaid coverage in expansion states (3.2 to 5.0 percentage points), reasonably strong evidence of reduced private insurance coverage (?2.2 to ?2.5 percentage points), and some evidence of reduced uninsured rate (from no effect to ?3.7 percentage points). Results suggest that the increase in Medicaid coverage was due at least in part to the “crowd-out” of private insurance in expansion states. No statistically significant effects were detected for access and use outcomes.ConclusionsFindings suggest that state Medicaid expansions led to an increase in Medicaid coverage and a decrease in private insurance coverage as well as the uninsured. However, no evidence was found for health care access and use outcomes. Further research into access and use is needed when more data become available for the post-expansion period. |
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| Keywords: | Medicaid expansion Disabilities Health insurance Access Affordable Care Act |
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