Dataset Information

Medicaid expansion and the Medicaid undercount in the American Community Survey.

ABSTRACT:

Objective

To measure discordance between aggregate estimates of means-tested coverage from the American Community Survey (ACS) and administrative counts and examine the association of discordance with ACA Medicaid expansion.

Data sources

2010-2016 ACS and counts of Medicaid and Children's Health Insurance Program enrollment from the Centers for Medicare & Medicaid Services.

Study design

State-by-year counts of means-tested coverage from the ACS were compared to administrative counts using percentage differences. Discordance was compared for states that did and did not adopt expansion using difference-in-differences. We then contrasted the effect of expansion on means-tested coverage estimated from the ACS with results from administrative data.

Data collection/extraction

Survey and administrative data.

Principal findings

One year before expansion there was a 0.8 and 4 percent overcount in expansion and nonexpansion states, respectively. By 2016, there was a 10.64 percent undercount in expansion states vs a 0.02 percent undercount in nonexpansion states. The ACS suggests that expansion increased means-tested coverage in the full population by three percentage points, relative to five percentage points suggested by administrative records.

Conclusions

Discordance between the ACS and administrative records has increased over time. The ACS underestimates the impact of Medicaid expansion, relative to administrative counts.

SUBMITTER: Boudreaux M

PROVIDER: S-EPMC6863241 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Medicaid expansion and the Medicaid undercount in the American Community Survey.

Boudreaux Michel M Noon James M JM Fried Brett B Pascale Joanne J

Health services research 20191010 6

<h4>Objective</h4>To measure discordance between aggregate estimates of means-tested coverage from the American Community Survey (ACS) and administrative counts and examine the association of discordance with ACA Medicaid expansion.<h4>Data sources</h4>2010-2016 ACS and counts of Medicaid and Children's Health Insurance Program enrollment from the Centers for Medicare & Medicaid Services.<h4>Study design</h4>State-by-year counts of means-tested coverage from the ACS were compared to administrati ...[more]

PMID: 31602631

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Project description:Research objectiveTo explore whether expanded Medicaid helps mitigate the relationship between unemployment due to COVID and being uninsured. Unanticipated unemployment spells are generally associated with disruptions in health insurance coverage, which could also be the case for job losses during the COVID-19 pandemic. Expanded access to Medicaid may insulate some households from long uninsurance gaps due to job loss.Data sourcePhase 1 of the Census Bureau's Experimental Household Pulse Survey covering April 23, 2020-July 21, 2020.Study designWe compare differences in health insurance coverage source and status linked to recent lob losses attributable to the COVID-19 pandemic in states that expanded Medicaid against states that did not expand Medicaid.Data collection/extraction methodsOur analytical dataset was limited to 733,181 non-elderly adults aged 20-64.Principal findingsTwenty-six percent of our study sample experienced an income loss between March 13, 2020, and the time leading up to the survey-16% experienced job losses (e.g., layoff, furlough) due to the COVID-19 crisis, and 11% had other reasons they were not working. COVID-linked job losses were associated with a 20 (p < 0.01) percentage-point (PPT) lower likelihood of having employer-sponsored health insurance (ESI). Relative to persons in states that did not expand Medicaid, persons in Medicaid expansion states experiencing COVID-linked job losses were 9 PPT (p < 0.01) more likely to report having Medicaid and 7 PPT (p < 0.01) less likely to be uninsured. The largest increases in Medicaid enrollment were among people who, based on their 2019 incomes, would not have qualified for Medicaid previously.ConclusionsOur findings suggest that expanded Medicaid eligibility may allow households to stabilize health care needs and they should become detached from private health coverage due to job loss during the pandemic. Households negatively affected by the pandemic are using Medicaid to insure themselves against the potential health risks they would incur while being unemployed.

Dataset Information

Medicaid expansion and the Medicaid undercount in the American Community Survey.

Objective

Data sources

Study design

Data collection/extraction

Principal findings

Conclusions

Publications

Medicaid expansion and the Medicaid undercount in the American Community Survey.

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