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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 14 of 14 Research Studies DisplayedMellor JM, McInerney M, Garrow RC
The impact of Medicaid expansion on spending and utilization by older low-income Medicare beneficiaries.
This study examined indirect spillover effects of Affordable Care Act (ACA) Medicaid expansions to working-age adults on health care coverage, spending, and utilization by older low-income Medicare beneficiaries. The authors used data from the 2010-2018 Health and Retirement Study survey linked to annual Medicare beneficiary summary files. They estimated individual-level difference-in-differences models of total spending for inpatient, institutional outpatient, physician/professional provider services; inpatient stays, outpatient visits, physician visits; and Medicaid and Part A and B Medicare coverage. They also compared changes in outcomes before and after Medicaid expansion in expansion versus nonexpansion states. The sample included low-income respondents aged 69 and older with linked Medicare data, enrolled in full-year traditional Medicare, and living in the community. ACA Medicaid expansion was associated with a 9.8 percentage point increase in Medicaid coverage, a 4.4 percentage point increase in having any institutional outpatient spending, and a positive but statistically insignificant 2.4 percentage point change in Part B enrollment.
AHRQ-funded; HS025422.
Citation: Mellor JM, McInerney M, Garrow RC .
The impact of Medicaid expansion on spending and utilization by older low-income Medicare beneficiaries.
Health Serv Res 2023 Oct; 58(5):1024-34. doi: 10.1111/1475-6773.14155..
Keywords: Medicaid, Medicare, Low-Income, Healthcare Utilization, Healthcare Costs, Health Insurance
Roberts ET, Kwon Y, Hames AG
Racial and ethnic disparities in health care use and access associated with loss of Medicaid supplemental insurance eligibility above the federal poverty level.
The purpose of this study was to examine whether exceeding the income threshold for Medicaid, which causes a sudden loss of Medicaid eligibility, is related with higher racial and ethnic disparities in access to and use of care. The researchers evaluated Medicare beneficiaries with incomes 0% to 200% of FPL from the 2008 to 2018 biennial waves of the Health and Retirement Study linked to Medicare administrative data. To identify racial and ethnic disparities related with the loss of Medicaid eligibility, the researchers compared discontinuities in outcomes among Black and Hispanic beneficiaries and White beneficiaries. Analyses were conducted between January 1, 2022, and October 1, 2022. The primary outcomes were patient-reported challenges accessing care due to cost and outpatient service use, medication fills, and hospitalizations measured from Medicare administrative data. The study included 8,144 participants representing 151,282, 957 weighted person-years in the community-dwelling population of Medicare beneficiaries aged 50 years and older and incomes less than 200% of the federal poverty level (FPL). Study findings indicate that exceeding the Medicaid eligibility threshold was related with a 43.8 percentage point (pp) lower probability of Medicaid enrollment among Black and Hispanic Medicare beneficiaries and a 31.0 pp lower probability of Medicaid enrollment among White beneficiaries. Among Black and Hispanic beneficiaries, exceeding the threshold was associated with increased cost-related barriers to care, lower outpatient use, and fewer medication fills, but it was not associated with a statistically significant discontinuity in hospitalizations. Discontinuities in these outcomes were smaller or nonsignificant among White beneficiaries. Consequently, exceeding the threshold was associated with widened disparities, including greater reductions in outpatient service use and medication fills among Black and Hispanic vs White beneficiaries.
AHRQ-funded; HS026727.
Citation: Roberts ET, Kwon Y, Hames AG .
Racial and ethnic disparities in health care use and access associated with loss of Medicaid supplemental insurance eligibility above the federal poverty level.
JAMA Intern Med 2023 Jun; 183(6):534-43. doi: 10.1001/jamainternmed.2023.0512..
Keywords: Disparities, Racial and Ethnic Minorities, Medicaid, Access to Care, Health Insurance, Low-Income, Access to Care
Ndumele CD, Sommers BD, Trivedi AN
The ACA's 65th birthday challenge: moving from Medicaid to Medicare.
Following the Affordable Care Act’s coverage expansion, many newly-insured older enrollees will lose Medicaid coverage on their 65th birthday and transition from Medicaid to Medicare as their primary insurer. This article discusses the transition in primary health insurance coverage that includes changes to benefits, patient cost-sharing, and provider reimbursement, which could have profound consequences on the use of health services and associated health outcomes for low-income seniors.
AHRQ-funded; HS021291.
Citation: Ndumele CD, Sommers BD, Trivedi AN .
The ACA's 65th birthday challenge: moving from Medicaid to Medicare.
J Gen Intern Med 2015 Nov;30(11):1704-6. doi: 10.1007/s11606-015-3328-0..
Keywords: Health Insurance, Medicare, Elderly, Low-Income
Garcia Mosqueira A, Hua LM, Sommers BD
Racial differences in awareness of the Affordable Care Act and application assistance among low-income adults in three Southern states.
The researchers explored potential factors related to racial/ethnic differences in ACA enrollment - awareness of the law and receipt of application assistance such as navigator services. Their results highlight the importance of ACA outreach efforts to increase awareness among low-income and less educated populations to close existing disparities in coverage.
AHRQ-funded; HS021291.
Citation: Garcia Mosqueira A, Hua LM, Sommers BD .
Racial differences in awareness of the Affordable Care Act and application assistance among low-income adults in three Southern states.
Inquiry 2015 Oct 8;52. doi: 10.1177/0046958015609607.
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Keywords: Disparities, Health Insurance, Low-Income, Medicaid, Racial and Ethnic Minorities
Golberstein E, Gonzales G, Sommers BD
California's early ACA expansion increased coverage and reduced out-of-pocket spending for the state's low-income population.
The researchers used data from the National Health Interview Survey to examine the impact of California’s Low Income Health Program. Their study demonstrates that the county-by-county rollout of expanded public insurance coverage in California significantly increased coverage, by 7 percentage points, and significantly reduced the likelihood of any family out-of-pocket medical spending in the previous year, by 10 percentage points, among low-income adults.
AHRQ-funded; HS021291.
Citation: Golberstein E, Gonzales G, Sommers BD .
California's early ACA expansion increased coverage and reduced out-of-pocket spending for the state's low-income population.
Health Aff 2015 Oct;34(10):1688-94. doi: 10.1377/hlthaff.2015.0290..
Keywords: Low-Income, Healthcare Costs, Health Insurance, Uninsured
Sommers BD, Maylone B, Nguyen KH
The impact of state policies on ACA applications and enrollment among low-income adults in Arkansas, Kentucky, and Texas.
The researchers surveyed nearly 3,000 low-income adults in late 2014 to compare experiences in three states with markedly different policies: Kentucky, Arkansas, and Texas. They found that application rates, successful enrollment, and positive experiences with the ACA were highest in Kentucky, followed by Arkansas, with Texas performing worst. Limited awareness remains a critical barrier: Fewer than half of adults had heard some or a lot about the coverage expansions.
AHRQ-funded; HS021291.
Citation: Sommers BD, Maylone B, Nguyen KH .
The impact of state policies on ACA applications and enrollment among low-income adults in Arkansas, Kentucky, and Texas.
Health Aff 2015 Jun;34(6):1010-8. doi: 10.1377/hlthaff.2015.0215..
Keywords: Policy, Low-Income, Medicaid, Health Insurance
Hudson JL, Hill SC, Selden TM
AHRQ Author: Hudson JL, Hill SC, Selden TM
If rollbacks go forward, up to 14 million children could become ineligible for public or subsidized coverage by 2019.
This study investigated the potential health insurance options available to low-income children if federal CHIP funding ends in 2017 or if federal requirements change in 2019, allowing states to roll back Medicaid- and CHIP-eligibility thresholds to minimum levels. It found that the percentage of low-income children ineligible for public coverage or subsidized Marketplace coverage would increase from 22 percent in 2014 (12.5 million children) to 46 percent after 2019 (26.5 million children).
Citation: Hudson JL, Hill SC, Selden TM .
If rollbacks go forward, up to 14 million children could become ineligible for public or subsidized coverage by 2019.
Health Aff 2015 May;34(5):864-70. doi: 10.1377/hlthaff.2015.0004..
Keywords: Children's Health Insurance Program (CHIP), Children/Adolescents, Health Insurance, Low-Income
Hill SC
AHRQ Author: Hill SC
Medicaid expansion in opt-out states would produce consumer savings and less financial burden than exchange coverage.
This study simulated potential differences in out-of-pocket spending for uninsured adults gaining eligibility for Marketplace coverage (silver plan) because their states have not used the provisions of the Affordable Care Act to expand Medicaid. Compared with having a Marketplace silver plan, being able to take advantage to expanded Medicaid would reduce average out-of-pocket spending by more than 50 percent for these adults and their families.
AHRQ-authored.
Citation: Hill SC .
Medicaid expansion in opt-out states would produce consumer savings and less financial burden than exchange coverage.
Health Aff. 2015 Feb;34(2):340-9. doi: 10.1377/hlthaff.2014.1058..
Keywords: Healthcare Costs, Health Insurance, Policy, Low-Income, Medicaid, Uninsured
Lee J, Ding R, Zeger SL
Impact of subsidized health insurance coverage on emergency department utilization by low-income adults in Massachusetts.
The authors aimed to estimate the change in emergency department (ED) utilization per individual among a cohort who qualified for subsidized health insurance following the Massachusetts health care reform. They concluded that expanding subsidized health insurance did not uniformly change ED utilization for all newly insured low-income adults in Massachusetts.
AHRQ-funded; HS017957.
Citation: Lee J, Ding R, Zeger SL .
Impact of subsidized health insurance coverage on emergency department utilization by low-income adults in Massachusetts.
Med Care 2015 Jan;53(1):38-44. doi: 10.1097/mlr.0000000000000279.
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Keywords: Emergency Department, Healthcare Utilization, Health Insurance, Policy, Low-Income
Fiscella K, Geiger HJ
Caring for the poor in the 21st century: enabling community health centers for a new era.
This article discusses various challenges facing community health centers (CHCs) in the 21st century. These include: potential erosion of the Medicaid prospective payment system, the failure of many States to expand Medicaid, the growth of accountable care organizations, the growth of high deductible health insurance for the privately insured, and increased competition for primary care clinicians.
AHRQ-funded; HS022440
Citation: Fiscella K, Geiger HJ .
Caring for the poor in the 21st century: enabling community health centers for a new era.
J Health Care Poor Underserved. 2014 Nov;25(4):2044-52. doi: 10.1353/hpu.2014.0182..
Keywords: Low-Income, Primary Care, Medicaid, Health Insurance
Epstein AM, Sommers BD, Kuznetsov Y
Low-income residents in three states view Medicaid as equal to or better than private coverage, support expansion.
The authors explored what low-income Americans think about Medicaid. They found that nearly 80 percent of their telephone survey sample favored Medicaid expansion, and approximately two-thirds of uninsured respondents said that they planned to apply for either Medicaid or subsidized private coverage in 2014. Most viewed having Medicaid as better than being uninsured and at least as good as private insurance in overall quality and affordability.
AHRQ-funded; HS021291.
Citation: Epstein AM, Sommers BD, Kuznetsov Y .
Low-income residents in three states view Medicaid as equal to or better than private coverage, support expansion.
Health Aff 2014 Nov;33(11):2041-7. doi: 10.1377/hlthaff.2014.0747.
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Keywords: Health Insurance, Policy, Low-Income, Medicaid, Uninsured
Hill SC, Abdus S, Hudson JL
AHRQ Author: Hill SC, Hudson JL, Selden TM
Adults in the income range for the Affordable Care Act's Medicaid expansion are healthier than pre-ACA enrollees.
The investigators used MEPS data to compare nondisabled adults enrolled in Medicaid prior to the ACA with two other groups: adults who were eligible for Medicaid but not enrolled in it, and adults who were in the income range for the ACA's Medicaid expansion and thus newly eligible for coverage. They found that both the newly eligible and those eligible before the ACA but not enrolled were healthier on several measures than pre-ACA enrollees. They concluded that by expanding Medicaid eligibility, states could provide coverage to millions of healthier adults as well as to millions who have chronic conditions and who need care.
AHRQ-authored.
Citation: Hill SC, Abdus S, Hudson JL .
Adults in the income range for the Affordable Care Act's Medicaid expansion are healthier than pre-ACA enrollees.
Health Aff 2014 Apr;33(4):691-9. doi: 10.1377/hlthaff.2013.0743.
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Keywords: Health Insurance, Policy, Health Status, Low-Income, Medicaid, Medical Expenditure Panel Survey (MEPS)
Politi MC, Kaphingst KA, Kreuter M
Knowledge of health insurance terminology and details among the uninsured.
This study examined currently uninsured individuals’ understanding of terminology and details in health care plans in a series of interviews of a small mostly low-income and African American population. It found that the cost of the premium and having fixed costs through co-payments rather than coinsurance were very important so that individuals could budget as best as possible.
AHRQ-funded; HS020309.
Citation: Politi MC, Kaphingst KA, Kreuter M .
Knowledge of health insurance terminology and details among the uninsured.
Med Care Res Rev 2014 Feb;71(1):85-98. doi: 10.1177/1077558713505327..
Keywords: Uninsured, Low-Income, Health Insurance
Sommers BD, Kenney GM, Epstein AM
New evidence on the Affordable Care Act: coverage impacts of early Medicaid expansions.
Since 2010 California, Connecticut, Minnesota, and Washington, D.C., have taken advantage of the Affordable Care Act’s option to expand coverage earlier to a portion of low-income childless adults. The researchers present new data on these expansions focusing on several questions including the extent to which childless adults’ new enrollment in Medicaid result from extending coverage to uninsured people as opposed to replacing private coverage.
AHRQ-funded; HS021291.
Citation: Sommers BD, Kenney GM, Epstein AM .
New evidence on the Affordable Care Act: coverage impacts of early Medicaid expansions.
Health Aff 2014 Jan;33(1):78-87. doi: 10.1377/hlthaff.2013.1087..
Keywords: Low-Income, Uninsured, Medicaid, Health Insurance