Healthcare and the Wellbeing of Low-income Families

 描述：我们对公共医疗保险覆盖范围如何影响家庭财务福利的理解存在严重差距。由于经济保护是医疗保险覆盖的一个基本目的，如果没有可信的、可概括的证据来证明公共医疗保险覆盖范围对家庭财务健康的影响，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。尽管它很重要，但目前还没有在国家一级就这一主题进行的研究。该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健康的影响。此特定应用程序的目标是评估因《平价医疗法案》(ACA)而扩大的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。最高法院最近的裁决允许各州选择是否按照ACA的意图扩大医疗补助计划，到目前为止，已有22个州宣布他们不会参与扩大医疗补助计划。各州在扩展选择上的这种差异为评估医疗补助覆盖范围对低收入成年人财务结果的影响提供了机会。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，而且这些改善将因人口统计群体和该州扩张前的特点而异。在先前公共医疗保险扩展的强劲初步结果的指导下，将通过追求三个具体目标来检验这一假设：1)获得国家对ACA扩大医疗补助对一系列财务健康衡量指标的影响的估计，包括信用评分、拖欠行为、债务、第三方收集和破产；2)评估医疗补助覆盖范围对不同人口特征个人的财务健康的不同影响；3)评估不同地区的医疗补助覆盖范围对财务健康的不同影响，这些地区因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。为了实现这些目标，我们将使用一个创新、强大的新数据集，每个季度观察到的超过3800万份个人信用报告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，帮助各级决策者准确评估扩大公共医疗保险的成本和收益。

 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.