Changes in Health Care Access and Utilization for Low-SES Adults Aged 51-64 Years After Medicaid Expansion

• Published in: The journals of gerontology. Series B, Psychological sciences and social sciences Vol. 76; no. 6; p. 1218
• Main Authors: Tipirneni, Renuka, Levy, Helen G, Langa, Kenneth M, McCammon, Ryan J, Zivin, Kara, Luster, Jamie, Karmakar, Monita, Ayanian, John Z
• Format: Journal Article
• Language: English
• Published: United States 14.06.2021
• Subjects: Female; Health Services Accessibility - trends; Health Status; Hospitalization - trends; Humans; Insurance Coverage - trends; Male; Medicaid - statistics & numerical data; Middle Aged; Outcome Assessment, Health Care; Patient Protection and Affordable Care Act; United States; United States; Hospitalization; Medicaid; Affordable Care Act; Retirement
• ISSN: 1758-5368
• DOI: 10.1093/geronb/gbaa123

Whether the Affordable Care Act (ACA) insurance expansions improved access to care and health for adults aged 51-64 years has not been closely examined. This study examined longitudinal changes in access, utilization, and health for low-socioeconomic status adults aged 51-64 years before and after the ACA Medicaid expansion. Longitudinal difference-in-differences (DID) study before (2010-2014) and after (2016) Medicaid expansion, including N = 2,088 noninstitutionalized low-education adults aged 51-64 years (n = 633 in Medicaid expansion states, n = 1,455 in nonexpansion states) from the nationally representative biennial Health and Retirement Study. Outcomes included coverage (any, Medicaid, and private), access (usual source of care, difficulty finding a physician, foregone care, cost-related medication nonadherence, and out-of-pocket costs), utilization (outpatient visit and hospitalization), and health status. Low-education adults aged 51-64 years had increased rates of Medicaid coverage (+10.6 percentage points [pp] in expansion states, +3.2 pp in nonexpansion states, DID +7.4 pp, p = .001) and increased likelihood of hospitalizations (+9.2 pp in expansion states, -1.1 pp in nonexpansion states, DID +10.4 pp, p = .003) in Medicaid expansion compared with nonexpansion states after 2014. Those in expansion states also had a smaller increase in limitations in paid work/housework over time, compared to those in nonexpansion states (+3.6 pp in expansion states, +11.0 pp in nonexpansion states, DID -7.5 pp, p = .006). There were no other significant differences in access, utilization, or health trends between expansion and nonexpansion states. After Medicaid expansion, low-education status adults aged 51-64 years were more likely to be hospitalized, suggesting poor baseline access to chronic disease management and pent-up demand for hospital services.