Abstract
BackgroundThe Affordable Care Act Medicaid expansion improved access to health insurance among low-income populations. We sought to examine the spillover benefits of the ACA Medicaid expansion on ability to afford rent/mortgage and purchase of nutritious meals.MethodsUsing data from the Behavioral Risk Factor Surveillance System (BRFSS) we analyzed individuals aged 18–64 years residing in 12 U.S. states (including five ACA Medicaid expansion states) in 2015. Our treatment of interest was access to health insurance, instrumented by the ACA Medicaid expansion. Our outcome variables were: worry or stress about having sufficient money to pay the rent or mortgage and to purchase nutritious meals. We conducted a two-stage least squares instrumental variables regression.ResultsA 10%-point increase in the proportion of those who obtained health insurance following the ACA Medicaid expansion reduced the probability of being worried and stressed related to purchasing nutritious meals by 7.2% points (95% CI: 1.3–13.2) as well as paying the rent or mortgage by 8.6% points (95% CI: 2.5–14.7) among people living below 138% of the federal poverty level (FPL). The ACA Medicaid expansion was not associated with access to health insurance among those living over 138% of FPL, and obtaining health insurance did not influence stress or worry in relation to affording rent/mortgage or meals in this income group.ConclusionsImproved access to health insurance contributed to reducing worry and stress associated with paying rent/mortgage or purchasing meals among low-income people. Expanding health insurance access may have contributed to increasing the disposable income of low income groups.
Highlights
The Affordable Care Act Medicaid expansion improved access to health insurance among lowincome populations
In the first stage regression, among people with 138% or less of federal poverty level (FPL), we found that the people living in Medicaid expansion states were significantly more likely to have obtained health insurance (F-statistic of 20.47), suggesting that the Affordable Care Act (ACA) Medicaid expansion is a strong instrument
We found that a 10%-point increase in having health insurance reduced the likelihood of stress or worries related to buying nutritious meals by 7.2% (95%CI: 1.3, 13.2)
Summary
The Affordable Care Act Medicaid expansion improved access to health insurance among lowincome populations. We sought to examine the spillover benefits of the ACA Medicaid expansion on ability to afford rent/mortgage and purchase of nutritious meals. Catastrophic medical expenditure is the leading cause of bankruptcy in the United States [1]. Under the Affordable Care Act (ACA), Medicaid eligibility was expanded to low-income adults with incomes below 138% of the federal poverty level (FPL) in 2014 in several states [3]. The ACA legislation succeeded in expanding insurance coverage [4,5,6] and reduced the probability of such an event of medical bankruptcy [7]. Access to health insurance contributes to health directly by providing people with preventive care and treatment [8], and indirectly by reducing out-of-pocket medical expenditures, and alleviating the stress or worry associated with being uninsured [6, 9,10,11]
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