Changes in Health Care Access and Utilization for Low-SES Adults Age 51-64 after Medicaid Expansion.

TitleChanges in Health Care Access and Utilization for Low-SES Adults Age 51-64 after Medicaid Expansion.
Publication TypeJournal Article
Year of Publication2021
AuthorsTipirneni, R, Levy, HG, Langa, KM, McCammon, RJ, Zivin, K, Luster, J, Karmakar, M, Ayanian, JZ
JournalThe Journal of Gerontology: Series B
Volume76
Issue6
Pagination1218-1230
ISSN Number1758-5368
KeywordsAffordable Care Act, Hospitalization, Medicaid, Retirement
Abstract

OBJECTIVES: Whether the Affordable Care Act (ACA) insurance expansions improved access to care and health for adults age 51-64 has not been closely examined. This study examined longitudinal changes in access, utilization, and health for low-socioeconomic status adults age 51-64 before and after the ACA Medicaid expansion.

METHODS: Longitudinal difference-in-differences (DID) study before (2010-2014) and after (2016) Medicaid expansion, including N=2,088 noninstitutionalized low-education adults age 51-64 (N=633 in Medicaid expansion states, N=1,455 in non-expansion states) from the nationally representative biennial Health and Retirement Study. Outcomes included coverage (any, Medicaid, private), access (usual source of care, difficulty finding doctor, foregone care, cost-related medication nonadherence, out-of-pocket costs), utilization (outpatient visit, hospitalization), and health status.

RESULTS: Low-education adults age 51-64 had increased rates of Medicaid coverage (+10.6 percentage points [pp] in expansion states, +3.2 pp in non-expansion states, DID +7.4 pp, p=0.001) and increased likelihood of hospitalizations (+9.2 pp in expansion states, -1.1 pp in non-expansion states, DID +10.4 pp, p=0.003) in Medicaid expansion compared with non-expansion states after 2014. Those in expansion states also had a smaller increase in limitations in paid work/housework over time, compared to those in non-expansion states (+3.6 pp in expansion states, +11.0 pp in non-expansion states, DID -7.5 pp, p=0.006). There were no other significant differences in access, utilization or health trends between expansion and non-expansion states.

DISCUSSION: After Medicaid expansion, low-education status adults age 51-64 were more likely to be hospitalized, suggesting poor baseline access to chronic disease management and pent-up demand for hospital services.

DOI10.1093/geronb/gbaa123
Citation Key11670
PubMed ID32777052
Grant ListK08 AG056591 / AG / NIA NIH HHS / United States
R01 AG053972 / AG / NIA NIH HHS / United States