The Effects of the Affordable Care Act Medicaid Expansion on Informal Care

摘要 超过70%的65岁或65岁以上的老年人需要具有基本功能的照顾者的帮助 在他们一生中的某些时刻，大部分护理都是由家人和朋友非正式地提供的。这些非正式的 照顾者，特别是那些患有阿尔茨海默病和阿尔茨海默病相关老年人的人 痴呆症(AD/ADRD)，承担着巨大的身体、生理和经济成本，这限制了他们提供 关心。最近根据《患者保护和平价医疗法案》(ACA-ME)扩大的医疗补助 已被证明大幅增加了医疗保险覆盖面和医疗保健利用率，改善了 参与者的身心健康和经济安全，并影响其劳动力市场的结果。全 这些影响可能是ACA-ME影响非正式护理的潜在机制。然而， 尽管有大量关于ACA-ME的研究，但对其对老年人非正式护理的影响知之甚少 成年人。我们建议通过检查ACA-ME对提供给 由年长的成年人接收。具体地说，我们将使用差异中的差异方法并比较非正式的 生活在扩大医疗补助计划的州的个人的护理提供和接受情况 在扩大后，相对于非正规护理提供和接受的变化，可比 在同一时期生活在非扩张状态的个人。我们将利用美国时间使用调查来 衡量18岁低收入成年人向提供的非正式照顾，这些人最有可能受到 ACA-ME。我们将使用健康退休研究来衡量老年人接受的非正式护理。通过 考虑到ACA-ME对非正规护理的溢出效应，拟议的项目将对 政策制定者有兴趣设计更有效的政策来维持甚至增加非正式产品的供应 注意满足不断增长的需求，以及对ACA有兴趣的人- 我。

Abstract Over 70 percent of older adults aged 65 or older require assistance from caregivers with basic functions at some point in their lifetime, and most of that care is provided informally by families and friends. These informal caregivers, especially those to older adults with Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD), bear huge physical, phycological, and financial costs which limit their ability to provide care. The most recent Medicaid expansion under the Patient Protection and Affordable Care Act (ACA-ME) has been shown to substantially increase health insurance coverage and health care utilization, improve enrollees’ physical and mental health and financial security, and influence their labor market outcomes. All these effects could be potential mechanisms through which the ACA-ME impacts informal care. However, despite the large number of studies on ACA-ME, little is known about its effects on informal care for older adults. We propose to fill this gap by examining the effects of the ACA-ME on informal care provided to and received by older adults. Specifically, we will use a difference-in-differences approach and compare informal care provision and receipt among individuals living in states that expanded their Medicaid program before and after the expansion relative to the change in informal care provision and receipt experienced by comparable individuals living in non-expansion states over the same period. We will use the American Time Use Survey to measure informal care provided by low-income adults aged 18 to 64 who are most likely to be affected by the ACA-ME. We will use the Health Retirement Study to measure informal care received by older adults. By considering this spillover effect of the ACA-ME on informal care, the proposed project will be important for policymakers interested in designing more effective policies to sustain or even increase the supply of informal care to meet the escalating demand and for those interested in a more comprehensive evaluation of the ACA- ME.