Healthcare and the Wellbeing of Low-income Families

 描述：在我们对公共医疗保险覆盖范围如何影响家庭财务状况的理解方面存在着关键的差距。由于财务保护是健康保险的基本目的，因此，如果没有关于公共健康保险对家庭财务状况影响的可信、可推广的证据，就无法评估医疗补助等主要公共健康保险计划的成本和收益。尽管这一问题很重要，但没有在国家一级就这一问题进行研究。这个项目的长期目标是更好地了解公共健康保险覆盖范围对家庭财务状况的影响。本申请的目的是评估《平价医疗法案》（ACA）扩大医疗补助计划对家庭债务、信用评分、拖欠、破产和其他金融稳定措施的影响。最高法院最近的决定允许各州选择是否按照ACA的意图扩大其医疗补助计划，到目前为止，已有22个州宣布他们将不参与医疗补助计划的扩大。各州在扩展选择上的这种差异提供了一个机会，可以评估医疗补助覆盖范围对低收入成年人财务结果的影响。核心假设是，获得医疗补助覆盖范围将改善低收入成年人的财务状况，这些改善将因人口群体和国家扩张前的特征而异。在先前公共健康保险扩张的强有力的初步结果的指导下，这一假设将通过追求三个具体目标进行测试：1）获得ACA的医疗补助扩张对一系列广泛的财务福祉措施的影响的国家估计，包括信用评分，拖欠行为，债务，第三方收款和破产; 2）评估医疗补助覆盖范围对具有不同人口特征的个人的财务状况的差异影响，3）评估医疗补助覆盖范围对财务状况的差异影响。由于州医疗补助计划的慷慨程度和安全网服务的可用性而不同的地方。为了实现这些目标，我们将使用一个创新的，强大的，新的数据集，每个季度观察超过3800万份个人信用报告，其中包含详细的财务数据。这项研究将提供及时、相关的公共卫生知识，帮助各级政策制定者准确评估扩大公共健康保险的成本和效益。

 DESCRIPTION: There is a critical gap in our understanding of how public health insurance coverage affects the financial well- being of households. Because financial protection is a fundamental purpose of health insurance coverage, the costs and benefits of major public health insurance programs such as Medicaid cannot be assessed without credible, generalizable evidence on the impact of public health insurance coverage on household financial well-being. Despite its importance, there are no studies conducted at a national level on this topic. The long- term goal of this project is to better understand the effect of public heath insurance coverage on household financial well-being. The objective in this particular application is to assess the effect of the expansion of the Medicaid program resulting from the Affordable Care Act (ACA) on household debt, credit score, delinquency, bankruptcy and other measures of financial stability. The recent Supreme Court decision allowed states to choose whether or not to expand their Medicaid program as the ACA intended, and to date, twenty-two states have announced that they will not participate in the Medicaid expansion. This variation in expansion choices by states provides an opportunity to evaluate the effect of Medicaid coverage on the financial outcomes of low- income adults. The central hypothesis is that gaining Medicaid coverage will improve financial outcomes among low-income adults, and that these improvements will vary across demographic groups and across the pre-expansion characteristics of the state. Guided by strong preliminary results from a previous public health insurance expansion, this hypothesis will be tested by pursuing three specific aims: 1) Obtain national estimates of the effect of the Medicaid expansions of the ACA on a broad set of measures of financial well- being including credit score, delinquency behavior, debt, third-party collections, and bankruptcy; 2) Evaluate the differential effect of Medicaid coverage on financial well-being across individuals with different demographic characteristics and 3) Evaluate the differential effect of Medicaid coverage on financial well-being across localities that differ by te generosity of the state Medicaid program and the availability of safety net services. To accomplish these aims, we will use an innovative, powerful, new data set of over 38 million individual credit reports observed each quarter containing detailed financial data. This research will provide timely, relevant public health knowledge that will help policymakers at all levels accurately assess the costs and benefits of public health insurance expansions.