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Health-Related Outcomes among the Poor: Medicaid Expansion vs. Non-Expansion States

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  • Xuesong Han
  • Binh T Nguyen
  • Jeffrey Drope
  • Ahmedin Jemal

Abstract

Introduction: States’ decisions not to expand Medicaid under the Affordable Care Act (ACA) could potentially affect access to care and health status among their low-income residents. Methods: The 2010–2012 nationally representative Medical Expenditure Panel Survey data were analyzed in 2015 to compare 9755 low-income adults aged 18–64 years from Medicaid-expanding states with 7455 adults from nonexpanding states. Multivariate logistic regression models were fitted to evaluate the differences in access to care, receipt of preventive services, quality of care, attitudes about health and self-reported health status by Medicaid expansion status. The differences in care utilization and medical expenditures between the two groups were examined using a 2-part modeling approach. Results: Compared to their counterparts in Medicaid expansion states, low income adults in the nonexpanding states were more likely to be black and reside in rural areas and were less likely to have a usual source of care (prevalence ratio[PR] 0.86, 95% confidence interval[CI] 0.82–0.91) and recommended preventive services such as dental checkups (PR = 0.86; CI = 0.79–0.94), routine checks (PR = 0.89; CI = 0.83–0.95), flu vaccinations (PR = 0.89; CI = 0.81–0.98), and blood pressure checks (PR = 0.96; CI = 0.94–0.99). They also had less care utilization, fewer prescriptions, and less medical expenditures, but more out-of-pocket expenditures (all p-value

Suggested Citation

  • Xuesong Han & Binh T Nguyen & Jeffrey Drope & Ahmedin Jemal, 2015. "Health-Related Outcomes among the Poor: Medicaid Expansion vs. Non-Expansion States," PLOS ONE, Public Library of Science, vol. 10(12), pages 1-11, December.
  • Handle: RePEc:plo:pone00:0144429
    DOI: 10.1371/journal.pone.0144429
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    References listed on IDEAS

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    1. Barbaresco, Silvia & Courtemanche, Charles J. & Qi, Yanling, 2015. "Impacts of the Affordable Care Act dependent coverage provision on health-related outcomes of young adults," Journal of Health Economics, Elsevier, vol. 40(C), pages 54-68.
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    1. Joan Costa-Font & Nilesh Raut & Courtney H. Van Houtven, 2024. "Medicaid Expansion and the Mental Health of Spousal Caregivers," Review of Economics of the Household, Springer, vol. 22(3), pages 1047-1084, September.
    2. Naomi Zewde, 2020. "The individual welfare effects of the Affordable Care Act for previously uninsured adults," International Journal of Health Economics and Management, Springer, vol. 20(2), pages 121-143, June.
    3. Etti G. Baranoff & Thomas W. Sager & Bo Shi & Dalit Baranoff, 2023. "On the financial superiority of Medicaid specialist insurers: a novel transactions cost/supply chain approach," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 48(1), pages 32-67, January.
    4. Witrick, Brian & Dotson, Timothy S. & Annie, Frank & Kimble, Wesley & Kemper, Emily & Hendricks, Brian, 2023. "Poverty and population health – The need for A Paradigm shift to capture the working poor and better inform public health planning," Social Science & Medicine, Elsevier, vol. 336(C).
    5. Bjoerkheim, Markus & Sigaud, Liam & Ampaabeng, Kofi, 2023. "The Effect of the Affordable Care Act's Medicaid Expansion on the Mental Health Of Already-Enrolled Medicaid Beneficiaries," Working Papers 12430, George Mason University, Mercatus Center.
    6. Jihee Song & Jeong Nam Kim & Scott Tomar & Lauren N. Wong, 2021. "The Impact of the Affordable Care Act on Dental Care: An Integrative Literature Review," IJERPH, MDPI, vol. 18(15), pages 1-21, July.
    7. Romero, Toni & Ponomariov, Branco, 2023. "The effect of medicaid expansion on access to healthcare, health behaviors and health outcomes between expansion and non-expansion states," Evaluation and Program Planning, Elsevier, vol. 99(C).

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