The Medicaid expansion in the age of COVID-19: Effects on coverage, access, use, financial stress, and health.

摘要 新型冠状病毒大流行对美国人的健康和福祉构成了前所未有的威胁， 特别是低收入和少数族裔美国人以及那些健康状况不佳或在经济危机中失去工作的人， 低迷拟议的项目将审查获得负担得起的健康保险的保护作用， 贫困和低收入的美国人在重大的健康，经济和社会破坏他们的生活。 获得负担得起的医疗保险各州不同，因为只有35个州和哥伦比亚特区 将医疗补助扩大到所有收入低于贫困线138%的工作年龄成年人 根据《平价医疗法案》拟议项目有三个具体目标： 目标1.评估医疗补助扩大对成年人保险覆盖范围的保护作用， 在COVID-19大流行爆发后，儿童的生活受到影响。 目标2.为了评估医疗补助扩大对获得和使用医疗保健的保护作用， 新冠肺炎疫情爆发后的医疗开支及财务压力。 目标3.评估医疗补助扩展对健康结果的保护作用，包括身体健康。 在COVID-19大流行爆发后，为成人和儿童提供心理健康服务。 我们还将评估对弱势群体（包括穷人和低收入者）的保护效果有何不同。 有收入者、非裔美国人和西班牙裔美国人、健康状况不佳者和失业者。 我们将采用两项互补的全国性调查-全国健康访谈调查（NHIS）和 医疗支出专题调查（MEPS）-对跨越2010年开始的数据进行分阶段分析， 流行病NHIS涵盖了许多结果，特别是详细的经济压力，儿童的 心理健康和一些健康行为。MEPS有更详细的成年人心理健康措施， 卫生保健使用和支出，其面板设计使我们能够使用分析方法， 对受试者特征进行综合控制。然而，MEPS数据直到后来才可用。 我们将使用回归分析来模拟研究结果作为个体特征的函数; 基线状态特征;随时间变化的局部区域特征，包括大流行的严重程度、 经济衰退，国家政策旨在减缓大流行病的传播，以及遵守社会 距离;以及各州医疗补助扩张状况与当地特征之间的相互作用。我们 这种方法将使我们能够量化医疗补助扩展对研究结果的保护作用， 评估这些影响发生的主要途径。拟议项目将评估以下方面的价值： 在COVID-19大流行期间，贫困和低收入人群获得负担得起的医疗保险，但 这些经验教训可以推广到其他经济衰退和公共卫生危机、自然和人为灾害， 以及在正常时期经历健康或经济挫折的人。

Abstract The COVID-19 pandemic has posed an unprecedented threat to the health and well-being of Americans, especially low-income and minority Americans and those in poor health or who lost jobs in the economic downturn. The proposed project will examine the protective effect of access to affordable health insurance for poor and low-income Americans in the setting of major health, economic, and social disruptions to their lives. Access to affordable health insurance differs across states because only 35 states and the District of Columbia have adopted the Medicaid expansion to all working-age adults with incomes below 138% of poverty permitted under the Affordable Care Act. The proposed project has three Specific Aims: Aim 1. To assess the protective effects of the Medicaid expansion on insurance coverage for adults and children following the onset of the COVID-19 pandemic. Aim 2. To assess the protective effects of the Medicaid expansion on access to and use of health care, health care expenditures, and financial stress following the onset of the COVID-19 pandemic. Aim 3. To assess the protective effects of the Medicaid expansion on health outcomes, including physical and mental health, for adults and children following the onset of the COVID-19 pandemic. We will also assess how the protective effects differ for disadvantaged persons including poor and low- income persons, African Americans and Hispanics, persons in poor health, and persons who lose their jobs. We will employ two complementary national surveys—the National Health Interview Survey (NHIS) and the Medical Expenditure Panel Survey (MEPS)—in a phased analysis of data straddling the onset of the pandemic. NHIS covers numerous outcomes, with especially detailed measures of financial stress, children's mental health, and some health behaviors. MEPS has more detailed measures of adults' mental health and health care use and expenditures, and its panel design enables us to use analytic methods that more comprehensively control for subjects' characteristics. However, MEPS data are not available until later. We will use regression analysis to model the study outcomes as functions of individual characteristics; baseline state characteristics; time-varying local area characteristics including pandemic severity, depth of the economic downturn, state policies intended to slow spread of the pandemic, and adherence to social distancing; and interactions between states' Medicaid expansion status and local area characteristics. Our approach will enable us to quantify the protective effects of the Medicaid expansion on the study outcomes and assess the main pathways through which these effects occur. The proposed project will assess the value of access to affordable health insurance for poor and low-income persons during the COVID-19 pandemic, but its lessons will be generalizable to other recessions and public health crises, natural and man-made disasters, and people who experience health or economic setbacks in normal times.