Association between state Medicaid expansion status and health outcomes during the COVID-19 pandemic.
Health Serv Res
; 57(6): 1332-1341, 2022 Dec.
Article
in English
| MEDLINE | ID: covidwho-1968043
ABSTRACT
OBJECTIVE:
To assess post-COVID-19 changes in insurance coverage, health behaviors, and self-assessed health among low-income, non-elderly adults by state Medicaid expansion status. DATA SOURCES We used nationally representative survey data from the 2016 through 2020 Behavioral Risk Factor Surveillance System (BRFSS). The sample was restricted to adults aged 19-64 with household income below 138 percent of the federal poverty level (N = 179,135). STUDYDESIGN:
We examined a broad set of outcomes related to coverage, health behaviors, and self-assessed health available in the BRFSS. We used a difference-in-differences model to compare changes in outcomes for individuals living in the 35 states and DC that expanded Medicaid under the Affordable Care Act to those in the 15 non-expansion states before and after the COVID-19 pandemic commenced in March 2020. DATA COLLECTION/EXTRACTIONMETHODS:
N/A. PRINCIPALFINDINGS:
We found that the expansions provided some protection for low-income people during the pandemic. In 2020, relative to earlier years, people in expansion states were more likely to report very good or excellent health (4.9 percentage points, 95%CI = 0.022, 0.076; p < 0.01) and physical health (-0.393 days of poor physical health in the past month, 95%CI = -0.714, -0.072; p < 0.05), lower rates of smoking (-1.9 percentage points, 95%CI = -0.041, 0.004; p < 0.10) and heavy drinking (-1.4 percentage points, 95%CI = -0.025, -0.004; p < 0.01), and higher flu vaccination rates (2.8 percentage points, 95%CI = 0.005, 0.051; p < 0.05) than those in non-expansion states. These benefits were particularly salient for Black and Hispanic individuals. We found no significant differences in insurance coverage, exercise, obesity, and self-assessed mental health between expansion and non-expansion states for the overall low-income sample. However, the expansion was associated with greater insurance coverage for Hispanic adults during the pandemic.CONCLUSIONS:
Investments in public health through expanding Medicaid may shield low-income populations from some of the health ramifications of public health emergencies.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Medicaid
/
COVID-19
Type of study:
Experimental Studies
/
Observational study
/
Prognostic study
Topics:
Long Covid
/
Vaccines
Limits:
Adult
/
Humans
/
Middle aged
Country/Region as subject:
North America
Language:
English
Journal:
Health Serv Res
Year:
2022
Document Type:
Article
Affiliation country:
1475-6773.14044
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