Abstract
BackgroundMore than 30 states have either expanded Medicaid or are actively considering expansion. The coverage gains from this policy are well documented, however, the impacts of its increasing coverage on poverty disparity are unclear at the national level.MethodAmerican Community Survey (2012–2018) was used to examine the effects of Medicaid expansion on poverty disparity in insurance coverage for nonelderly adults in the United States. Differences-in-differences-in-differences design was used to analyze trends in uninsured rates by poverty levels: (1) < 138 %, (2) 138–400 % and (3) > 400 % federal poverty level (FPL).ResultsCompared with uninsured rates in 2012, uninsured rates in 2018 decreased by 10.75 %, 6.42 %, and 1.11 % for < 138 %, 138–400 %, and > 400 % FPL, respectively. From 2012 to 2018, > 400 % FPL group continuously had the lowest uninsured rate and < 138 % FPL group had the highest uninsured rate. Compared with ≥ 138 % FPL groups, there was a 2.54 % reduction in uninsured risk after Medicaid expansion among < 138 % FPL group in Medicaid expansion states versus control states. After eliminating the impact of the ACA market exchange premium subsidy, 3.18 % decrease was estimated.ConclusionPoverty disparity in uninsured rates improved with Medicaid expansion. However, < 138 % FPL population are still at a higher risk for being uninsured.
Highlights
More than 30 states have either expanded Medicaid or are actively considering expansion
Data analysis was based on repeated crosssectional national population level data from the 2012– 2018 7-year American Community Survey (ACS) Public Use Microdata Sample (PUMS) files
In the PUMS, files have been de-identified to protect the confidentiality of all individuals and Analytic Strategy This study employed differences-in-differences-in-differences design by comparing the outcome, before and after the intervention for the treatment group and control group
Summary
More than 30 states have either expanded Medicaid or are actively considering expansion. Large disparities in health insurance coverage, related to poverty, have been a long-standing issue in the United States (US) and a significant concern among policymakers and health care professionals. According to the Kaiser Family Foundation, as of 2019, individuals under 200 % FPL accounted for 30 % of the total US population [1]. This large proportion of low-income individuals signifies a need to investigate the disparities in poverty and insurance coverage, and how healthcare reform has impacted coverage. It is imperative to examine the role of poverty and its association with access to care, to gain a deeper understanding of the disparities in the healthcare sector in order to improve health equity
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