Identifying Associations Between State Medicaid Expansion Decisions and Spatial Disparities in County Insurance Rate Changes Under the Affordable Care Act

Danielle Christine Rhubart ()
Additional contact information
Danielle Christine Rhubart: Wright State University

Population Research and Policy Review, 2017, vol. 36, issue 1, No 5, 109-135

Abstract: Abstract By the end of 2014, twenty-four states rejected Medicaid expansion, providing a unique opportunity to examine changes in insurance coverage rates after the implementation of the Affordable Care Act within and between states that did versus did not expand Medicaid. Using multilevel regression analyses of county-level non-elderly adult small area health insurance estimates (N = 3135) from the US Census Bureau, several important findings emerge. Compared to counties located in states that did not expand Medicaid, counties located in states that did expand experienced significantly larger increases in adult health insurance coverage rates between 2013 and 2014, net of the county baseline insurance coverage rate, socioeconomic and demographic composition, and labor market characteristics. In states that did not expand Medicaid, counties with larger shares of vulnerable residents (i.e., poor adults and low education) experienced lagging improvements in health insurance coverage. However, counties in states that expanded Medicaid were protected from several of these exacerbated disparities, and in some cases, experienced larger insurance coverage improvements than counties with less disadvantaged populations. These findings suggest that although insurance coverage increased in nearly all counties between 2013 and 2014, increases would have been larger and disparities would have been further alleviated if more states with highly concentrated vulnerable populations had expanded Medicaid.

Keywords: Health insurance; Disparities; ACA; Medicaid Expansion (search for similar items in EconPapers)
Date: 2017
References: View references in EconPapers View complete reference list from CitEc
Citations:

Downloads: (external link)
http://link.springer.com/10.1007/s11113-016-9414-0 Abstract (text/html)
Access to full text is restricted to subscribers.

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:kap:poprpr:v:36:y:2017:i:1:d:10.1007_s11113-016-9414-0

Ordering information: This journal article can be ordered from
http://www.springer. ... es/journal/11113/PS2

DOI: 10.1007/s11113-016-9414-0

Access Statistics for this article

Population Research and Policy Review is currently edited by D.A. Swanson

More articles in Population Research and Policy Review from Springer, Southern Demographic Association (SDA)
Bibliographic data for series maintained by Sonal Shukla () and Springer Nature Abstracting and Indexing ().