RESUMO
Importance: States resumed Medicaid eligibility redeterminations, which had been paused during the COVID-19 public health emergency, in 2023. This unwinding of the pandemic continuous coverage provision raised concerns about the extent to which beneficiaries would lose Medicaid coverage and how that would affect access to care. Objective: To assess early changes in insurance and access to care during Medicaid unwinding among individuals with low incomes in 4 Southern states. Design, Setting, and Participants: This multimodal survey was conducted in Arkansas, Kentucky, Louisiana, and Texas from September to November 2023, used random-digit dialing and probabilistic address-based sampling, and included US citizens aged 19 to 64 years reporting 2022 incomes at or less than 138% of the federal poverty level. Exposure: Medicaid enrollment at any point since March 2020, when continuous coverage began. Main Outcomes and Measures: Self-reported disenrollment from Medicaid, insurance at the time of interview, and self-reported access to care. Using multivariate logistic regression, factors associated with Medicaid loss were evaluated. Access and affordability of care among respondents who exited Medicaid vs those who remained enrolled were compared, after multivariate adjustment. Results: The sample contained 2210 adults (1282 women [58.0%]; 505 Black non-Hispanic individuals [22.9%], 393 Hispanic individuals [17.8%], and 1133 White non-Hispanic individuals [51.3%]) with 2022 household incomes less than 138% of the federal poverty line. On a survey-weighted basis, 1564 (70.8%) reported that they and/or a dependent child of theirs had Medicaid at some point since March 2020. Among adult respondents who had Medicaid, 179 (12.5%) were no longer enrolled in Medicaid at the time of the survey, with state estimates ranging from 7.0% (n = 19) in Kentucky to 16.2% (n = 82) in Arkansas. Fewer children who had Medicaid lost coverage (42 [5.4%]). Among adult respondents who left Medicaid since 2020 and reported coverage status at time of interview, 47.8% (n = 80) were uninsured, 27.0% (n = 45) had employer-sponsored insurance, and the remainder had other coverage as of fall 2023. Disenrollment was higher among younger adults, employed individuals, and rural residents but lower among non-Hispanic Black respondents (compared with non-Hispanic White respondents) and among those receiving Supplemental Nutrition Assistance Program benefits. Losing Medicaid was significantly associated with delaying care due to cost and worsening affordability of care. Conclusions and Relevance: The results of this survey study indicated that 6 months into unwinding, 1 in 8 Medicaid beneficiaries reported exiting the program, with wide state variation. Roughly half who lost Medicaid coverage became uninsured. Among those moving to new coverage, many experienced coverage gaps. Adults exiting Medicaid reported more challenges accessing care than respondents who remained enrolled.
Assuntos
COVID-19 , Acessibilidade aos Serviços de Saúde , Cobertura do Seguro , Medicaid , Humanos , Medicaid/estatística & dados numéricos , Estados Unidos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Adulto , Feminino , Masculino , Cobertura do Seguro/estatística & dados numéricos , Pessoa de Meia-Idade , COVID-19/epidemiologia , Pobreza , Adulto Jovem , ArkansasRESUMO
Importance: Policy changes and the COVID-19 pandemic affected health coverage rates, and the "unwinding" of Medicaid's continuous coverage provision in 2023 and 2024 may cause widespread coverage loss. Recent coverage patterns in national survey and administrative data can inform these issues. Objective: To assess national and state changes in survey-based Medicaid, private insurance, and uninsured rates between 2019 and 2022, as well as how these changes compare with administrative Medicaid enrollment totals. Design, Setting, and Participants: This cross-sectional study analyzes nationally representative survey data for all US residents in the American Community Survey (ACS) from 2019 to 2022 compared with administrative data on Medicaid and the Children's Health Insurance Program from the Centers for Medicare & Medicaid Services (CMS). Data analysis was conducted between June 2023 and January 2024. Exposures: The COVID-19 pandemic, the Medicaid continuous coverage provision, and policy efforts to increase Marketplace coverage. Main Outcomes and Measures: Medicaid coverage (self-reported [ACS] and administratively recorded [CMS]), survey-reported uninsured, Medicare, and private insurance status. Results: A nationally representative sample consisted of 12â¯506â¯584 US residents of all ages (survey-weighted 59.7% aged 19-64 years and 50.6% female). CMS statistics showed an increase in Medicaid coverage of 5.2 percentage points as a share of the population from 2019 to 2022. However, changes in the uninsured rate and survey-reported Medicaid were smaller: -1.2 (95% CI, -1.3 to -1.2) percentage points and 1.3 (95% CI, 1.2-1.4) percentage points, respectively. There was a 3.9 percentage point increase in the ACS's "undercount" of Medicaid enrollment, compared with CMS data, from 2019 to 2022. This undercount was larger among children than adults but smaller in states that recently expanded Medicaid. Rates of additional forms of coverage (such as private insurance) among those in Medicaid also grew during this time. Conclusion and Relevance: In this cross-sectional study, the uninsured rate declined considerably from 2019 to 2022 but was just one-fourth as large as the growth in administrative Medicaid enrollment under the pandemic continuous coverage provision. Survey-based Medicaid growth was far smaller than administrative growth. This suggests that many people who remained enrolled in Medicaid during the pandemic did not realize that their coverage had continued. These findings have implications for projecting uninsured changes during unwinding, as well as the effect of continuous coverage policies on continuity of care.
Assuntos
COVID-19 , Medicaid , Adulto , Criança , Humanos , Idoso , Feminino , Estados Unidos/epidemiologia , Masculino , Estudos Transversais , Pandemias , Medicare , Inquéritos e Questionários , COVID-19/epidemiologiaRESUMO
This study estimates the association between Medicare eligibility and support for recent proposals to expand program participation and benefits.
Assuntos
Definição da Elegibilidade , Medicare , Idoso , Humanos , Benefícios do Seguro , Medicare/legislação & jurisprudência , Estados Unidos , Cobertura do Seguro/legislação & jurisprudênciaRESUMO
Health insurance premiums are primarily understood to pose financial barriers to coverage. However, the need to remit monthly premium payments may also create administrative burdens that negatively affect coverage, even in cases where affordability is a negligible concern. Using 2016-17 data from the Massachusetts health insurance Marketplace and a natural experiment, we evaluated how coverage retention was affected by the introduction of nominal (less than $10 for most enrollees) monthly premiums for plans that previously had $0 premiums. Compared with plans that maintained $0 premiums, those that took on nominal premiums saw enrollment fall by 14 percent over the following year. This attrition was attributable to terminations for nonpayment; most terminations occurred at the end of January, implying that a significant number of affected enrollees never initiated premium payments. These findings suggest that even very small premiums act as enrollment barriers, which may sometimes reflect administrative burdens more than financial hardship. Several policy approaches could mitigate adverse coverage outcomes related to nominal premiums.
Assuntos
Trocas de Seguro de Saúde , Humanos , Massachusetts , PolíticasRESUMO
CONTEXT: Medicaid is the largest health insurance program by enrollment in the United States. The program varies across states across a variety of dimensions, including what it's called; some states use state-specific naming conventions (e.g., MassHealth in Massachusetts). METHODS: In a pre-registered online survey experiment (n = 5,807), we test whether public opinion shifts in response to the use of state-specific Medicaid program names or the provision of information about program enrollment. FINDINGS: We find that replacing "Medicaid" with a state-specific name results in a large increase in the share of respondents reporting that they "haven't heard enough to say" how they feel about the program. This corresponds to a decrease in both favorable and unfavorable attitudes toward the program. Though confusion increases among all partisan groups, there is evidence that the state-specific names may also strengthen positive perceptions among Republicans. Providing enrollment information generally does not affect public opinion. CONCLUSIONS: Our findings offer suggestive evidence that state-specific program names may muddle understanding of the program as a government-provided benefit. Policymakers seeking to bolster support for the program or claim credit for expanding or improving it may be better served simply referring to it as "Medicaid."
Assuntos
Acessibilidade aos Serviços de Saúde , Cobertura do Seguro , Medicaid , Humanos , Acessibilidade aos Serviços de Saúde/economia , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Cobertura do Seguro/economia , Cobertura do Seguro/legislação & jurisprudência , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/economia , Seguro Saúde/legislação & jurisprudência , Seguro Saúde/estatística & dados numéricos , Medicaid/economia , Medicaid/legislação & jurisprudência , Medicaid/estatística & dados numéricos , Dados Preliminares , Estados Unidos/epidemiologiaRESUMO
This cohort study examines insurance transitions after Medicaid disenrollment for Minnesota residents aged 64 years or younger.
Assuntos
Seguro Saúde , Medicaid , Estados Unidos , Humanos , Minnesota , Pessoas sem Cobertura de Seguro de Saúde , Cobertura do SeguroRESUMO
Policy Points A decade after failing to make it into the Affordable Care Act, the public option reemerged as a health reform goal at both the national and state levels, with polls reporting strong, bipartisan support. A 2020 poll that probed both support for one public option approach (Medicare "buy-in") and attitudes toward government suggests that differences in these attitudes could plague reform advocates' efforts. Although the COVID-19 pandemic viscerally highlighted the need for a more coherent health care system-including universal coverage-other recent evolutions in the broader US political context could undermine reform.
Assuntos
COVID-19 , Reforma dos Serviços de Saúde , Idoso , Humanos , Estados Unidos , Patient Protection and Affordable Care Act , Medicare , Pandemias , COVID-19/epidemiologia , PolíticaRESUMO
Importance: Recent subsidy enhancements in Affordable Care Act (ACA) Marketplaces made many low-income enrolles (below 150% of the federal poverty level [FPL]) eligible for 2 free silver-tier plans. eligible for 2 free silver-tier plans. However, an unintended consequence of this structure is that the identity of which silver plans are free will often "turn over" between years, requiring that enrollees actively initiate premium payment (or lose coverage). The prevalence of this free-plan turnover is not known. Objective: To measure the prevalence of free-plan turnover in ACA Marketplaces and to estimate how many enrollees below 150% of FPL are likely to be affected. Design Setting and Participants: This observational cross-sectional study used data on plan offerings and premiums in 33 state ACA Marketplaces using HealthCare.gov in 2021 and 2022, along with estimates of county-level enrollee characteristics and plan selection patterns. The enrollment-weighted share of county markets affected by free-plan turnover was quantified, along with the association of turnover with enrollee and market characteristics. Estimates of the number of affected low-income enrollees were calculated using the data plus statistics reported in past research. Data were analyzed from November 21, 2021, to February 28, 2022. Results: This study found that turnover of zero-premium plans was quite common, with 93% of HealthCare.gov counties (weighted by enrollment) experiencing at least 1 zero-premium plan in 2021 turning over to nonfree in 2022; 84% of counties experienced turnover of all $0 silver plans from 2021 to 2022. This turnover affected an estimated 1.36 million people with incomes below 150% of FPL. Turnover was more common in counties with a higher share of non-White enrollees, in Medicaid nonexpansion states, in counties with more carriers, and in counties with changes in the number of offered plans. Conclusions and Relevance: The findings of this cross-sectional study suggest that owing to the prevalence of zero-premium plan turnover, many low-income ACA enrollees faced elevated risk of disenrollment at the start of 2022. Outreach to affected enrollees and other actions to encourage coverage retention and midyear reenrollment could help mitigate coverage losses.
Assuntos
Trocas de Seguro de Saúde , Estudos Transversais , Humanos , Seguro Saúde , Patient Protection and Affordable Care Act , Pobreza , Estados UnidosRESUMO
Ten years after its enactment, public support for the Affordable Care Act (ACA) still only reaches a scant majority. Candidates for the presidency-and the sitting president-have endorsed health reforms that would radically transition US health care away from the current system upon which the ACA was built. Few opinion surveys to date have captured dominant preferences among alternative health reform policies or characterized attitudes and experiences that might be associated with policy preferences. Using a 2019 nationally representative telephone survey, this article considers how variations in political values, attitudes toward government, and experiences with the health care system relate to competing health reform preferences. Differences between those who favor Medicare for All over building on the ACA largely reflect different levels of satisfaction with the status quo and views of private health insurance. By contrast, differences between ACA supporters and those who would favor replacing it with a state-based alternative reflect sharply different political values and attitudes. Key differences remain significant after controlling for demographic, health, and political characteristics. Overwhelming public support still eludes the ACA, and reaching consensus on future directions for health reform will remain challenging given differences in underlying beliefs.
Assuntos
Atitude , Reforma dos Serviços de Saúde/legislação & jurisprudência , Reforma dos Serviços de Saúde/métodos , Patient Protection and Affordable Care Act , Política , Opinião Pública , Adulto , Idoso , Atenção à Saúde/normas , Feminino , Programas Governamentais/normas , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados Unidos , Adulto JovemRESUMO
In this month's Editorial, PLOS Medicine Academic Editor Zirui Song and his colleague Adrianna McIntyre discuss outcomes and possible futures for the United States Affordable Care Act as it nears the ten year mark.