Implementing federal health reform in the States: who is included and excluded and what are their characteristics?

Abstract

To estimate the characteristics and number of nonelderly adults eligible and ineligible for Affordable Care Act (ACA) expansions. Two secondary data sources are used in this analysis: the 2008 Panel of the Survey of Income and Program Participation (SIPP) and the 2009 American Community Survey (ACS). We use multiple imputation to incorporate model-based uncertainty into the prediction of immigration status into the ACS from the SIPP. Key variables include place of birth, year of entry to the U.S., and health insurance coverage. No primary data are used in this study. We estimate that potentially 3.5million nonelderly adults will be excluded from the ACA Medicaid Expansion and 2million from the health insurance exchanges because of their immigration status. We also find significant differences in estimates of excluded nonelderly adults across states. Over 15 percent of income-eligible uninsured nonelderly adults will be potentially excluded from the ACA coverage expansions due to their immigration status. Policy makers must be careful to exclude ineligible nonelderly adults before estimating the impact of the ACA on coverage rates.