The impact of Medicaid expansion on spending and utilization by older low-income Medicare beneficiaries |
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Authors: | Jennifer M. Mellor PhD Melissa McInerney PhD Renee C. Garrow BA Lindsay M. Sabik PhD |
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Affiliation: | 1. Department of Economics, William & Mary, Chancellors Hall, 300 James Blair Drive, Williamsburg, Virginia, 23185 USA;2. Department of Economics, Tufts University, Joyce Cummings Center, 177 College Avenue, Medford, Massachusetts, 02155 USA;3. Federal Reserve Board, 20th Street and Constitution Ave NW, Washington, DC, 20551 USA;4. Department of Health Policy & Management, University of Pittsburgh School of Public Health, 130 DeSoto St., A610, Pittsburgh, Pennsylvania, 15261 USA |
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Abstract: | Objective To examine indirect spillover effects of Affordable Care Act (ACA) Medicaid expansions to working-age adults on health care coverage, spending, and utilization by older low-income Medicare beneficiaries. Data Sources 2010–2018 Health and Retirement Study survey data linked to annual Medicare beneficiary summary files. Study Design We estimated individual-level difference-in-differences models of total spending for inpatient, institutional outpatient, physician/professional provider services; inpatient stays, outpatient visits, physician visits; and Medicaid and Part A and B Medicare coverage. We compared changes in outcomes before and after Medicaid expansion in expansion versus nonexpansion states. Data Collection/Extraction Methods The sample included low-income respondents aged 69 and older with linked Medicare data, enrolled in full-year traditional Medicare, and residing in the community. Principal Findings ACA Medicaid expansion was associated with a 9.8 percentage point increase in Medicaid coverage (95% CI: 0.020–0.176), a 4.4 percentage point increase in having any institutional outpatient spending (95% CI: 0.005–0.083), and a positive but statistically insignificant 2.4 percentage point change in Part B enrollment (95% CI: −0.003 to 0.050, p = 0.079). Conclusions ACA Medicaid expansion was associated with more institutional outpatient spending among older low-income Medicare beneficiaries. Increased care costs should be weighed against potential benefits from increased realized access to care. |
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Keywords: | access/demand/utilization of services aging/elderly/geriatrics health policy/politics/law/regulation Medicaid Medicare |
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