Medicaid expansion and health care utilization

This is the next  post in my Medicaid-IV series. I presume anyone interested in this post has read all the others in the series, so I don’t have to repeat myself. This post is about the 2005 JHE article by Busch and Duchovny, “Family coverage expansions: Impact on insurance coverage and health care utilization of parents.” Because my interest at the moment is about the “health care utilization” part and not the “insurance coverage” part of the paper, I’ll skip much of the paper (though I read it!).

The relevant part of the abstract reads,

With the passage of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), Medicaid eligibility ceased to be tied to receipt of cash assistance. Since then, states have had a growing number of opportunities to expand health coverage to low-income working families beyond previous AFDC limits. As of 2001, 20 states have raised income eligibility limits for parents to or beyond 100% of the Federal Poverty Level. … [W]e use [1995-2002] Behavioral Risk Factor Surveillance System [data] to examine changes in health care utilization. We find that these expansions increased cancer-screening rates. Of previously uninsured mothers not receiving cancer screening, 29% now receive these screens. Finally, our results indicate the expansions decreased the likelihood that a parent needed to see a doctor but did not because of cost.

Yep, that pretty much sums up the findings. Of course, methods matter. The authors use the same style of instrumental variables method as Currie and Gruber (I told you it had become standard). Since I’ve assumed you’ve read prior series posts, you know what I’m talking about: the key independent variable is Medicaid eligibility and it is instrumented with the average Medicaid eligibility rate under each of the year-state Medicaid rules where the average is computed over a fixed population.

The authors’ conclusion has a nugget worth sharing, just because it is a segue to an important aspect of the ACA’s Medicaid expansion. In the authors’ analysis, they only considered income-based eligibility changes. But there were other changes to Medicaid eligibility during the period of study as well, including elimination or modification of asset tests and income disregards. The ACA’s Medicaid expansion is typically described in terms of income (increasing eligibility up to 133% of the federal poverty level) but it is worth emphasizing that it also eliminates the asset test and income disregards.

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