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1.
Health Econ ; 33(11): 2439-2449, 2024 Nov.
Article in English | MEDLINE | ID: mdl-39103746

ABSTRACT

Evidence is mixed on whether increased access to insurance, specifically through the ACA's Medicaid expansion, exacerbated the opioid public health crisis through increased opioid prescribing. Using survey data on retail prescription drug fills from 2008 to 2019, we did not find a significant relationship between Medicaid expansion and opioid prescribing in the newly eligible Medicaid population. It may be that the dangers of opioids were known well enough by the time of the Medicaid expansion that lack of access to care was no longer a binding constraint on opioid prescription receipt.


Subject(s)
Analgesics, Opioid , Medicaid , United States , Medicaid/statistics & numerical data , Humans , Analgesics, Opioid/therapeutic use , Patient Protection and Affordable Care Act , Adult , Female , Male , Drug Prescriptions/statistics & numerical data , Drug Prescriptions/economics , Health Services Accessibility , Middle Aged , Surveys and Questionnaires
2.
J Gen Intern Med ; 36(7): 1997-2003, 2021 07.
Article in English | MEDLINE | ID: mdl-33772437

ABSTRACT

OBJECTIVE: To estimate insurance disparities across non-standard employment categories and to determine how coverage disparities shifted following health reform in 2014. METHODS: We analyzed nationally representative data on working-age adults from the Medical Expenditure Panel Survey (MEPS) (2010-2012 and 2015-2017, N=79,182) to estimate insurance rates across three groups of non-standard workers (full-time temporary workers, freelancers, and part-time workers) compared to standard workers. RESULTS: Uninsurance decreased after health reform for all groups of non-standard workers, ranging from a 10.0- to 14.3-percentage point decline (p<0.001). Yet, uninsurance rates remained high for freelancers (30.8%), full-time temporary workers (25.1%), and part-time workers (17.9%) relative to standard workers (11.9%) in 2015-2017 (p<0.001). Residence in a Medicaid expansion state was associated with lower uninsurance rates for all categories of workers. CONCLUSIONS: Workers in non-standard jobs continue to face challenges obtaining health insurance coverage. Our findings highlight the continued high risk of uninsurance for full-time temporary workers and freelancers.


Subject(s)
Health Care Reform , Insurance, Health , Adult , Employment , Humans , Insurance Coverage , Medicaid , Medically Uninsured , Patient Protection and Affordable Care Act , United States/epidemiology
3.
Ann Emerg Med ; 65(6): 664-672.e2, 2015 Jun.
Article in English | MEDLINE | ID: mdl-25769461

ABSTRACT

STUDY OBJECTIVE: Since September 2010, the Patient Protection and Affordable Care Act has allowed young adults to remain as dependents on their parents' private health plans until age 26 years. This insurance expansion could improve the efficiency of medical care delivery by reducing unnecessary emergency department (ED) use. We evaluated the effect of this provision on ED use among young adults. METHODS: We used a nationally representative ED visit database of more than 17 million visits from 2007 to 2011. Our analysis compared young adults aged 19 to 25 years (the age group targeted by the law) with slightly older adults aged 27 to 29 years (control group), before and after the implementation of the law. RESULTS: The quarterly ED-visit rate decreased by 1.6 per 1,000 population (95% confidence interval 1.2 to 2.1) among targeted young adults after the implementation of the provision, relative to a comparison group. The decrease was concentrated among women, weekday visits, nonurgent conditions, and conditions that can be treated in other settings. We found no effect among weekend visits or visits due to injuries or urgent conditions. The provision also changed the health insurance composition of ED visits; the fraction of privately insured young adults increased, whereas the fraction of those insured through Medicaid and those uninsured decreased. CONCLUSION: The Patient Protection and Affordable Care Act dependent coverage expansion was associated with a statistically significant yet modest decrease in ED use, concentrated in the types of ED visits that were likely to be responsive to changes to insurance status. In response to the law, young adults appeared to have altered their visit pattern to reflect a more efficient use of medical care.


Subject(s)
Emergency Service, Hospital/statistics & numerical data , Insurance Coverage/legislation & jurisprudence , Patient Protection and Affordable Care Act/statistics & numerical data , Adult , Age Factors , Emergency Service, Hospital/legislation & jurisprudence , Female , Humans , Insurance Coverage/statistics & numerical data , Male , Young Adult
4.
Health Econ ; 24(2): 206-23, 2015 Feb.
Article in English | MEDLINE | ID: mdl-24227184

ABSTRACT

This paper investigates the impact of the macroeconomy on the health insurance coverage of Americans using panel data from the Survey of Income and Program Participation for 2004-2010, a period that includes the Great Recession of 2007-2009. We find that a one percentage point increase in the state unemployment rate is associated with a 1.67 percentage point (2.12%) reduction in the probability that men have health insurance; this effect is strongest among college-educated, white, and older (50-64 years old) men. For women and children, health insurance coverage is not significantly correlated with the unemployment rate, which may be the result of public health insurance acting as a social safety net. Compared with the previous recession, the health insurance coverage of men is more sensitive to the unemployment rate, which may be due to the nature of the Great Recession.


Subject(s)
Economic Recession/statistics & numerical data , Insurance Coverage/statistics & numerical data , Insurance, Health/statistics & numerical data , Unemployment/statistics & numerical data , Adolescent , Adult , Age Factors , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Medical Assistance/statistics & numerical data , Medically Uninsured/statistics & numerical data , Middle Aged , Sex Factors , Socioeconomic Factors , Young Adult
5.
Health Serv Res ; 2024 Oct 14.
Article in English | MEDLINE | ID: mdl-39402858

ABSTRACT

OBJECTIVE: To decompose the mental health disparities between breast cancer patients and survivors (hereafter survivors) of racial and ethnic minority groups and non-Hispanic White survivors into the contributions of individual-, interpersonal-, community-, and societal-level determinants. DATA SOURCES AND STUDY SETTING: We used data from the 2010-2020 Medical Expenditure Panel Survey Household Component (MEPS-HC). Our primary outcome was whether the person had mental health conditions or not. STUDY DESIGN: We employed the Kitagawa-Oaxaca-Blinder (KOB) method to understand to what extent the differences in outcomes were explained by the differences in the determinants between non-Hispanic Black or Hispanic breast cancer survivors and non-Hispanic White survivors. We also bifurcated the Hispanic sample analysis by the US-born status (and county of origin). DATA COLLECTION/EXTRACTION METHODS: Confidential geographic identifiers are utilized to supplement the MEPS-HC data with information on community characteristics and local healthcare resources. PRINCIPAL FINDINGS: The prevalence of mental health conditions among non-Hispanic Black and Hispanic breast cancer survivors was 26.1% (95% CI: 20.4, 31.7) and 28.3% (95% CI: 21.9, 34.6), respectively. These rates were higher than those for their non-Hispanic White counterparts, 19.7% (95% CI: 17.4, 21.9). In our KOB model, the disparity between non-Hispanic Black and White survivors was fully explained by differences in education, health, and family structure, with community- and societal-level determinants playing no significant role. Conversely, our KOB model did not explain any of the overall differences between Hispanic and non-Hispanic White survivors. However, for foreign-born Hispanic survivors, the disparity was fully explained by a combination of individual- and societal-level determinants. CONCLUSIONS: Our findings, which identify specific individual-, interpersonal-, and societal- determinants that were associated with racial and ethnic differences in mental health, can be used by clinicians and policymakers to proactively address racial and ethnic disparities in health.

6.
Health Aff (Millwood) ; 42(1): 26-34, 2023 01.
Article in English | MEDLINE | ID: mdl-36623225

ABSTRACT

Medicaid expansions under the Affordable Care Act (ACA) dramatically increased access to insurance coverage. We examined whether the 2014 ACA Medicaid expansions also mitigated existing racial or ethnic disparities in preventable hospitalizations and emergency department (ED) visits. Using inpatient data from twenty-nine states and ED data from twenty-six states for the period 2011-18, we found that Medicaid expansions decreased disparities in preventable hospitalizations and ED visits between non-Hispanic Black and White nonelderly adults by 10 percent or more. There were no significant effects on disparities between Hispanic and non-Hispanic White nonelderly adults, possibly reflecting lower baseline differences and, separately, persisting coverage disparities. These findings highlight sustained improvements in community-level care for non-Hispanic Black populations, who historically lack access to care. Our findings also suggest access barriers experienced by Hispanic adults that need to be addressed beyond Medicaid eligibility expansion.


Subject(s)
Medicaid , Patient Protection and Affordable Care Act , Adult , United States , Humans , Healthcare Disparities , Health Services Accessibility , Hospitalization , Emergency Service, Hospital , Insurance Coverage
7.
Health Aff (Millwood) ; 42(5): 721-726, 2023 05.
Article in English | MEDLINE | ID: mdl-37126753

ABSTRACT

The COVID-19 pandemic had the potential to alter patterns of health insurance coverage in the US. Using data from the Medical Expenditure Panel Survey, we found increased stability of Medicaid coverage for children and nonelderly adults during the first year of the pandemic. Fewer people who had Medicaid in 2019 became uninsured in 2020 (4.3 percent) than in 2018-19 (7.8 percent).


Subject(s)
COVID-19 , Insurance, Health , Adult , Child , United States , Humans , Pandemics , Medicaid , Medically Uninsured , Insurance Coverage
8.
J Subst Abuse Treat ; 132: 108645, 2022 01.
Article in English | MEDLINE | ID: mdl-34728135

ABSTRACT

INTRODUCTION: High out-of-pocket spending has been a barrier to treatment for the estimated 2.0 million Americans suffering from opioid use disorders (OUD). This paper provides national estimates of financial costs faced by the population receiving retail medications for OUD (MOUD). METHODS: We used pooled annual data from the 2011-2017 Medical Expenditure Panel Survey (MEPS), a nationally representative sample of the civilian noninstitutionalized population in the United States. The sample includes individuals who reported filling a retail prescription for buprenorphine or naltrexone, the two most common medications available from retail pharmacies to treat OUD. The main outcome is out-of-pocket spending of retail MOUD prescriptions per fill and per person. RESULTS: Patients with retail MOUD prescriptions spent 3.4 times more out-of-pocket for prescriptions on average than the rest of the U.S. population, with 18.8% of this population paying entirely out-of-pocket for their MOUD prescriptions. Insurance coverage is associated with reduced annual out-of-pocket MOUD expenditures between $316 and $328 per year. CONCLUSIONS: Future policies that expand insurance and address out-of-pocket spending on MOUD could increase access to medications among individuals with OUD.


Subject(s)
Buprenorphine , Opioid-Related Disorders , Analgesics, Opioid/therapeutic use , Buprenorphine/therapeutic use , Health Expenditures , Humans , Naltrexone/therapeutic use , Opioid-Related Disorders/drug therapy , Opioid-Related Disorders/epidemiology , Prescriptions , United States
9.
Health Serv Res ; 56(2): 310-322, 2021 04.
Article in English | MEDLINE | ID: mdl-33395731

ABSTRACT

OBJECTIVE: To examine individual- and community-level factors associated with racial/ethnic differences in individuals' opioid prescription use. DATA SOURCES: Outpatient opioid prescription utilization and demographic, socioeconomic, and health characteristics from a nationally representative sample of the US noninstitutionalized civilian population obtained from 2013-2016 Medical Expenditure Panel Survey (MEPS) data and combined with 2012-2016 American Community Survey data and 2015 Health Area Resources File data. STUDY DESIGN: We use the Oaxaca-Blinder decomposition method to disaggregate racial/ethnic differences in prescription opioid utilization into differences explained by underlying predisposing, enabling and need characteristics, and unexplained differences. DATA COLLECTION/EXTRACTION METHODS: We use restricted-use geographic identifiers to supplement the MEPS data with information on community characteristics and local health care resources. PRINCIPAL FINDINGS: The average annual rate of any outpatient opioid prescription use was higher for non-Hispanic whites (15.8%; standard errors [SE]: 0.3) than for non-Hispanic blacks and Hispanics by 1.4 percentage points (SE: 0.5) and 6.2 percentage points (SE: 0.4), respectively. The smaller difference between non-Hispanic blacks and whites is not explained by the differences in the risk factors, while almost all the difference between Hispanics and non-Hispanic whites can be explained by the differences in the means of the risk factors. The differences in the prevalence of pain, the rate of being United States-born, and the racial/ethnic composition of the community explain 2.4 (SE: 0.2), 1.4 (SE: 0.3), and 1.9 (SE: 0.4) percentage-point differences, respectively. Pain prevalence explains the difference regardless of opioid potency, while foreign-born status and community racial/ethnic composition explain the difference in higher-potency opioid utilization only. CONCLUSIONS: This study underscores the importance of accounting for both individual and community characteristics when investigating patterns in opioid use. Our results could assist policy makers in tailoring strategies to promote safer and more effective pain management based on individual and community characteristics.


Subject(s)
Analgesics, Opioid/administration & dosage , Opioid-Related Disorders/ethnology , Pain/drug therapy , Pain/ethnology , Social Determinants of Health/ethnology , Adolescent , Adult , Analgesics, Opioid/therapeutic use , Ethnicity , Female , Health Knowledge, Attitudes, Practice , Health Status , Humans , Male , Middle Aged , Racial Groups , Residence Characteristics , Risk Factors , Socioeconomic Factors , United States , Young Adult
10.
Inquiry ; 57: 46958020952920, 2020.
Article in English | MEDLINE | ID: mdl-33161820

ABSTRACT

The Affordable Care Act (ACA) required coordination between Marketplaces, Medicaid, and the Children's Health Insurance Program (CHIP) in an effort to streamline application processes and improve enrollment. We use 2013-2018 data from the American Community Survey and difference-in-difference models to estimate the relationship between Marketplace policy and increases in Medicaid/CHIP coverage observed among pre-ACA eligible children after the implementation of the ACA ("welcome mat effects"). Our sample includes non-disabled, citizen children (0-18) at 139-250% FPL who were Medicaid-/CHIP-eligible before (and after) the implementation of the ACA. Marketplace policies studied include state-based versus federally-facilitated, and whether the Marketplace had authority to directly enroll Medicaid-/CHIP-eligible applicants into public coverage. Models also control for ACA adult Medicaid expansion policy and provide the first estimates in this literature for non-expansion states. Welcome mat effects were present among all Marketplace and expansion policy categories. However, public coverage increased more in states that empowered their Marketplace to enroll publicly-eligible applicants directly into Medicaid/CHIP and these results were driven by enrollment policy, not by choice of state-based versus federal based Marketplaces. Welcome mat effects were largest in expansion states (for most years) and among children whose parents did not hold employer-sponsored insurance coverage. Ranging from 9 to 13 percentage points, these estimates are larger than those found among other subgroups of children in the welcome mat literature. Although there is evidence of lagged effects for both welcome mat effects and the role of Marketplace policy in non-expansion states, by 2018 we find no differences in these measures by expansion policy.


Subject(s)
Children's Health Insurance Program , Insurance Coverage , Patient Protection and Affordable Care Act , Adult , Child , Humans , Insurance, Health , Medicaid , Policy , United States
11.
Health Aff (Millwood) ; 37(10): 1669-1672, 2018 10.
Article in English | MEDLINE | ID: mdl-30273027

ABSTRACT

Historically, part-time workers have been more likely to be uninsured than their full-time peers. Data from the 2010-15 Medical Expenditure Panel Survey show that coverage differences by work hours declined after 2014. Uninsurance declined more for part-time workers, with pathways to coverage varying by state Medicaid expansion status.


Subject(s)
Employment/trends , Insurance Coverage/statistics & numerical data , Insurance, Health/statistics & numerical data , Medicaid/statistics & numerical data , Medically Uninsured/statistics & numerical data , Adult , Humans , Insurance Coverage/legislation & jurisprudence , Insurance, Health/legislation & jurisprudence , Medicaid/legislation & jurisprudence , Middle Aged , Surveys and Questionnaires , United States
12.
Health Aff (Millwood) ; 37(8): 1238-1242, 2018 08.
Article in English | MEDLINE | ID: mdl-30080453

ABSTRACT

Little is known about how the Affordable Care Act might have differentially affected insurance coverage for self-employed workers, wage earners with and without offers of employer-sponsored insurance, and people not employed. We found that the self-employed and wage earners without employer coverage offers had coverage gains equal to or greater than those of people not employed.


Subject(s)
Employment/classification , Insurance Coverage/trends , Insurance, Health/trends , Adult , Humans , Middle Aged , Regression Analysis , Surveys and Questionnaires , United States , Young Adult
13.
Health Aff (Millwood) ; 36(9): 1643-1651, 2017 09 01.
Article in English | MEDLINE | ID: mdl-28874493

ABSTRACT

Before the implementation of the Affordable Care Act (ACA), most children in low-income families were already eligible for public insurance through Medicaid or the Children's Health Insurance Program. Increased coverage observed for these children since the ACA's implementation suggest that the legislation potentially had important spillover or "welcome mat" effects on the number of eligible children enrolled. This study used data from the 2013-15 American Community Survey to provide the first national-level (analytical) estimates of welcome-mat effects on children's coverage post ACA. We estimated that 710,000 low-income children gained coverage through these effects. The study was also the first to show a link between parents' eligibility for Medicaid and welcome-mat effects for their children under the ACA. Welcome-mat effects were largest among children whose parents gained Medicaid eligibility under the ACA expansion to adults. Public coverage for these children increased by 5.7 percentage points-more than double the 2.7-percentage-point increase observed among children whose parents were ineligible for Medicaid both pre and post ACA. Finally, we estimated that if all states had adopted the Medicaid expansion, an additional 200,000 low-income children would have gained coverage.


Subject(s)
Eligibility Determination/statistics & numerical data , Medicaid/legislation & jurisprudence , Medicaid/statistics & numerical data , Parents , Patient Protection and Affordable Care Act/legislation & jurisprudence , Patient Protection and Affordable Care Act/statistics & numerical data , Adult , Child , Children's Health Insurance Program/statistics & numerical data , Children's Health Insurance Program/trends , Health Services Accessibility/statistics & numerical data , Health Services Accessibility/trends , Humans , Insurance Coverage/statistics & numerical data , Insurance, Health/statistics & numerical data , Medicaid/economics , Medicaid/trends , Patient Protection and Affordable Care Act/economics , Patient Protection and Affordable Care Act/trends , Poverty , Surveys and Questionnaires , United States
14.
Health Aff (Millwood) ; 35(1): 111-8, 2016 Jan.
Article in English | MEDLINE | ID: mdl-26733708

ABSTRACT

Medicaid expansion undertaken through the Affordable Care Act (ACA) is already producing major changes in insurance coverage and access to care, but its potential impacts on the labor market are also important policy considerations. Economic theory suggests that receipt of Medicaid might benefit workers who would no longer be tied to specific jobs to receive health insurance (known as job lock), giving them more flexibility in their choice of employment, or might encourage low-income workers to reduce their hours or stop working if they no longer need employment-based insurance. Evidence on labor changes after previous Medicaid expansions is mixed. To view the impact of the ACA on current labor market participation, we analyzed labor-market participation among adults with incomes below 138 percent of the federal poverty level, comparing Medicaid expansion and nonexpansion states and Medicaid-eligible and -ineligible groups, for the pre-ACA period (2005-13) and the first fifteen months of the expansion (January 2014-March 2015). Medicaid expansion did not result in significant changes in employment, job switching, or full- versus part-time status. While we cannot exclude the possibility of small changes in these outcomes, our findings rule out the large change found in one influential pre-ACA study; furthermore, they suggest that the Medicaid expansion has had limited impact on labor-market outcomes thus far.


Subject(s)
Employment/statistics & numerical data , Insurance Coverage/statistics & numerical data , Medicaid/economics , Medically Uninsured/statistics & numerical data , Patient Protection and Affordable Care Act/economics , Work Performance/trends , Adult , Cross-Sectional Studies , Female , Health Care Reform/organization & administration , Humans , Insurance Coverage/trends , Male , Medicaid/statistics & numerical data , Middle Aged , Outcome Assessment, Health Care , Poverty , United States , Young Adult
15.
J Health Econ ; 39: 171-87, 2015 Jan.
Article in English | MEDLINE | ID: mdl-25544401

ABSTRACT

The Affordable Care Act of 2010 expanded coverage to young adults by allowing them to remain on their parent's private health insurance until they turn 26 years old. While there is evidence on insurance effects, we know very little about use of general or specific forms of medical care. We study the implications of the expansion on inpatient hospitalizations. Given the prevalence of mental health needs for young adults, we also specifically study mental health related inpatient care. We find evidence that compared to those aged 27-29 years, treated young adults aged 19-25 years increased their inpatient visits by 3.5 percent while mental illness visits increased 9.0 percent. The prevalence of uninsurance among hospitalized young adults decreased by 12.5 percent; however, it does not appear that the intensity of inpatient treatment changed despite the change in reimbursement composition of patients.


Subject(s)
Hospitalization/statistics & numerical data , Insurance, Health/statistics & numerical data , Patient Protection and Affordable Care Act/statistics & numerical data , Adult , Age Factors , Female , Health Services Accessibility/legislation & jurisprudence , Health Services Accessibility/statistics & numerical data , Hospitalization/legislation & jurisprudence , Humans , Insurance, Health/legislation & jurisprudence , Male , Medically Uninsured/statistics & numerical data , United States , Young Adult
18.
Health Econ Policy Law ; 5(4): 459-79, 2010 Oct.
Article in English | MEDLINE | ID: mdl-20478106

ABSTRACT

There has been substantial consolidation among health insurers and hospitals, recently, raising questions about the effects of this consolidation on the exercise of market power. We analyze the relationship between insurer and hospital market concentration and the prices of hospital services. We use a national US dataset containing transaction prices for health care services for over 11 million privately insured Americans. Using three years of panel data, we estimate how insurer and hospital market concentration are related to hospital prices, while controlling for unobserved market effects. We find that increases in insurance market concentration are significantly associated with decreases in hospital prices, whereas increases in hospital concentration are non-significantly associated with increases in prices. A hypothetical merger between two of five equally sized insurers is estimated to decrease hospital prices by 6.7%.


Subject(s)
Economics, Hospital/statistics & numerical data , Hospitals/statistics & numerical data , Insurance Carriers/economics , Insurance, Health/economics , Adult , Aged , Commerce/economics , Commerce/statistics & numerical data , Economic Competition/economics , Economic Competition/statistics & numerical data , Health Services Research/economics , Health Services Research/organization & administration , Health Services Research/statistics & numerical data , Humans , Industry/economics , Industry/organization & administration , Industry/statistics & numerical data , Insurance Carriers/statistics & numerical data , Insurance, Health/organization & administration , Insurance, Health/statistics & numerical data , Middle Aged , Statistics as Topic , United States
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