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Medicaid Expansion For Adults Had Measurable ‘Welcome Mat’ Effects On Their Children
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.
Journal Article
What to do when your family can't afford health care
Explains what healthcare and insurance are and why they are so crucial, and also explains the many different low-cost insurance options that are available so that every family can get the care they need.
Book
Eligibility Assistance Increases Insurance Enrollment Within Community Health Centers But Not At The State Level
Although ample evidence exists that community health centers lower federal medical expenditures, it has been hypothesized that the eligibility assistance offered by staff at health centers could also increase insurance enrollment and federal costs. We analyzed the effects of eligibility assistance on insurance enrollment at both the health center and state levels. Using multivariate panel analysis with two-way fixed effects, we examined effects of eligibility assistance during the period 2016-23 to determine how insurance enrollment is affected at the health center and state levels. Data sources were administrative data from health centers and state-level enrollment data from Medicaid, the Children's Health Insurance Program (CHIP), and health insurance Marketplaces. Higher levels of eligibility assistance staffing are associated with modest increases in numbers of Medicaid and CHIP enrollees at health centers and modest reductions in numbers of uninsured patients. However, neither eligibility assistance nor overall health center size significantly affect state-level enrollment for any of the programs. Eligibility assistance modestly increases insurance coverage among health center patients, which improves health centers' financial status and patient care capacity. But this assistance does not significantly increase overall Medicaid, CHIP, or Marketplace enrollment, nor does it raise federal expenditures.
Journal Article
Underwater : loss, flood insurance, and the moral economy of climate change in the United States
\"Communities around the United States face the threat of being underwater. This is not only a matter of rising waters reaching the doorstep. It is also the threat of being financially underwater, owning assets worth less than the money borrowed to obtain them. Many areas around the country may become economically uninhabitable before they become physically unlivable. In Underwater, Rebecca Elliott explores how families, communities, and governments confront problems of loss as the climate changes. She offers the first in-depth account of the politics and social effects of the U.S. National Flood Insurance Program (NFIP), which provides flood insurance protection for virtually all homes and small businesses that require it. In doing so, the NFIP turns the risk of flooding into an immediate economic reality, shaping who lives on the waterfront, on what terms, and at what cost. Drawing on archival, interview, ethnographic, and other documentary data, Elliott follows controversies over the NFIP from its establishment in the 1960s to the present, from local backlash over flood maps to Congressional debates over insurance reform. Though flood insurance is often portrayed as a rational solution for managing risk, it has ignited recurring fights over what is fair and valuable, what needs protecting and what should be let go, who deserves assistance and on what terms, and whose expectations of future losses are used to govern the present. An incisive and comprehensive consideration of the fundamental dilemmas of moral economy underlying insurance, Underwater sheds new light on how Americans cope with loss as the water rises\"-- Provided by publisher.
Book
Medicaid 'Unwinding:' Much Of The Reduction In Medicaid-Paid Prescriptions Was Offset By Increased Commercial Coverage
With the expiration of the Medicaid continuous coverage condition on March 31, 2023, states began returning to regular eligibility renewals in Medicaid and the Children's Health Insurance Program (CHIP). Because of incompleteness of administrative data and lags in the availability of survey data, there is limited understanding of how this \"unwinding\" process has affected insurance coverage or access to care. Using data from IQVIA PayerTrak, a large, nationally representative, all-payer pharmacy transactions database, we examined the trends in prescription drug use during the unwinding period. Leveraging state variation in Medicaid coverage termination start dates, we found that although prescriptions paid for by Medicaid or CHIP fell during unwinding, this decline was mostly offset by an increase in commercial-paid prescriptions. Total prescriptions were unchanged, suggesting that the unwinding did not result in reduced access to medications.
Journal Article
Continuous Eligibility Policies And CHIP Structure Affected Children's Coverage Loss During Medicaid Unwinding
In April 2023, with the \"unwinding\" of the Families First Coronavirus Response Act (FFCRA) continuous enrollment provisions in Medicaid, states were permitted to commence redetermination and disenrollment procedures for Medicaid beneficiaries. Using Centers for Medicare and Medicaid Services monthly state enrollment data for forty-nine states and Washington, D.C., from the period January 2021-December 2023, we examined changes in children's Medicaid and Children's Health Insurance Program (CHIP) coverage during the Medicaid unwinding, both overall and by whether states had previous twelve-month continuous eligibility policies for children and by the structure of states' programs for CHIP. We found substantially lower Medicaid and CHIP enrollment among children during the unwinding than during the FFCRA period, with lower levels of coverage declines among children in states that had previous twelve-month continuous eligibility policies and states with a program structure of separate CHIP or Medicaid expansion CHIP, rather than combination CHIP. These findings highlight the consequences of the FFCRA unwinding for children's Medicaid and CHIP enrollment, as well as potential state health policies that can promote coverage continuity and prevent further coverage loss for children moving forward.
Journal Article
Children's Health Insurance Coverage: Progress, Problems, And Priorities For 2021 And Beyond
Expansion of Medicaid and establishment of the Children's Health Insurance Program (CHIP) represent a significant success story in the national effort to guarantee health insurance for children. That success is reflected in the high rates of coverage and health care access achieved for children, including those in low-income families. But significant coverage gaps remain-gaps that have been increasing since 2016 and are likely to accelerate with the coronavirus disease 2019 (COVID-19) pandemic and the associated recession. Using National Health Interview Survey data, we found that the proportion of uninsured children was 5.5 percent in 2018. Children continue to face coverage interruptions, and Latino, adolescent, and noncitizen children continue to face elevated risks of being uninsured. Although we note the benefits of a universal, federally financed, single-payer approach to coverage, we also offer two possible reform pathways that can take place within the current multipayer system, aimed at ensuring coverage, access, continuity, and comprehensiveness to move the nation closer to the goal of providing the health care that children need to reach their full potential and to reduce racial and economic inequalities.
Journal Article
State And Federal Coverage For Pregnant Immigrants: Prenatal Care Increased, No Change Detected For Infant Health
Expanded health insurance coverage for pregnant immigrant women who are in the United States lawfully as well as those who are in the country without documentation may address barriers in access to pregnancy-related care. We present new evidence on the impact of states' public health insurance expansions for pregnant immigrant women (both state-funded and expansions under the children's Health Insurance Program) on their prenatal care use, mode of delivery, and infant health. Our quasi-experimental design compared changes in immigrant women's outcomes in states expanding coverage to changes in outcomes for nonimmigrant women in the same state and to women in nonexpanding states. We found that prenatal care use increased among all immigrant women following coverage expansion and that cesarean section increased among immigrant women with less than a high school diploma. We found no effects on the incidence of low birthweight, preterm birth, being small for gestational age, or infant death. State public insurance programs that cover pregnant immigrant women appear to have improved prenatal care utilization without observable changes in infant health or mortality.
Journal Article