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

摘要 超过70%的65岁或以上的老年人需要照顾者的帮助， 大多数照顾是由家人和朋友非正式地提供的。这些非正式 照顾者，特别是那些老年人与阿尔茨海默病和阿尔茨海默病相关的 痴呆症（AD/ADRD），承担巨大的身体，心理和经济成本，限制了他们提供的能力， 在乎根据《患者保护和平价医疗法案》（ACA-ME）， 已被证明大大增加了医疗保险覆盖面和医疗保健利用率， 参与者的身心健康和经济安全，并影响他们的劳动力市场的结果。所有 这些影响可能是ACA-ME影响非正式护理的潜在机制。然而，在这方面， 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。 成年人了我们建议研究社区照顾援助计划对非正式照顾的影响， 被老年人接受。具体来说，我们将使用差异中的差异方法， 在扩大医疗补助计划之前和之后， 在扩张后，相对于可比的非正式护理提供和接受的变化， 同一时期生活在非扩张州的个人。我们将使用美国时间使用调查， 衡量18至64岁的低收入成年人提供的非正式护理，这些人最有可能受到 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对非正式护理的溢出效应，拟议项目将对以下方面具有重要意义： 有兴趣设计更有效政策以维持甚至增加非正规教育供应的决策者 关心，以满足不断上升的需求，并为那些有兴趣在ACA的更全面的评估- 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.