The Effect of Medicaid Expansion on Mortality Disparities and Poverty

根据《平价医疗法案》扩大医疗补助，其中各州可以选择扩大 医疗补助覆盖家庭收入达到联邦贫困人口138%的成年人 在全国范围内，这一措施已被证明可以降低死亡率。从2014年到2018年， 在扩大医疗补助计划的州比没有扩大的州下降了3.6%。虽然影响 医疗补助扩大对死亡率的影响是有据可查的，但其对死亡率差异的影响仍然存在。 检查不足。这项研究的首要目标是确定医疗补助之间的关系， 经济增长和城乡民族差异，同时还估计了 在这种关系中扶贫。这项研究意义重大，因为它：1）关注死亡率 减少差距，而不是简单地减少死亡率，2）分析医疗补助的影响 交叉死亡率差距扩大，这意味着 多种健康差异人群（如黑人和农村），以及3）确定的间接影响 通过扶贫扩大医疗补助对交叉死亡率差异的影响。的 本项目的创新之处主要体现在三个方面。首先，它将提供一个明确的分析 减少死亡率差距，而不仅仅是对不同群体的总体影响;第二， 这项研究将产生一个更新和改进的生活费调整， 贫困措施，以及县级估计的补充贫困措施。第三、 这项研究将对贫困在以下关系中的中介作用进行强有力的分析： 医疗补助扩大和跨部门死亡率差距缩小。该项目将完成 通过三个具体目标。在目标1中，我们将评估医疗补助扩张对 2011年至2019年按城乡状况分列的民族死亡率差异。我们会利用时间- 通过普查数据进行边际预测分析的变差中差设计， 国家生命统计系统的有限数据。在目标2中，我们将提高成本- 现有的补充贫困措施中的生活调整，并估计改善后的 从2011年到2019年在县一级采取措施。我们将使用限制性的美国 社区调查和当前人口调查数据存放在联邦统计局。 研究数据中心，以创建一个县的具体生活费调整和相应的 具体的贫困线。在目标3中，我们将评估贫困的中介作用 医疗补助扩大与城乡民族死亡率之间的关系减少 2011年至2019年的差距。我们将通过整合我们的补充估计来做到这一点。 贫困衡量与我们的差异中的差异模型从目标1。

Medicaid expansion under the Affordable Care Act, wherein states have the option to expand Medicaid coverage to adults with household incomes up to 138 percent of the federal poverty level, has been shown to reduce mortality rates nationwide. From 2014 to 2018, mortality rates dropped 3.6% more in states that expanded Medicaid than those that did not. Although the impact of Medicaid expansion on mortality is well-documented, its impact on mortality disparities remains underexamined. The overarching goal of this study is to identify the relationship between Medicaid expansion and rural-urban ethnoracial disparities, while also estimating the mediating role of poverty alleviation in this relationship. This study is significant because it: 1) focuses on mortality disparity reduction instead of the simple reduction of mortality, 2) analyzes the impact of Medicaid expansion on intersectional mortality disparities, meaning disparities found at the intersection of multiple health disparity populations (e.g. black and rural), and 3) identifies the indirect effect of Medicaid expansion on intersectional mortality disparities through poverty alleviation. The innovations of this project center on three contributions. First, it will provide an explicit analysis of mortality disparity reduction as opposed to just aggregate impacts on different groups; Second, the study will generate an updated and improved cost-of-living adjustment for the Supplemental Poverty Measure, as well as county-level estimates of the Supplemental Poverty Measure. Third, the study will provide a robust analysis of the mediating role of poverty in the relationship between Medicaid expansion and intersectional mortality disparity reduction. The project will be completed through three specifics aims. In Aim 1, we will estimate the effect of Medicaid expansion on ethnoracial mortality disparities by rural-urban status from 2011 to 2019. We will do so using time- varying difference-in-difference design with marginal prediction analysis via census data and restricted data from the National Vital Statistics System. In Aim 2, we will improve the cost-of- living adjustment in the existing Supplemental Poverty Measure and estimate the improved measure at the county level from 2011 to 2019. We will do so using restricted American Community Survey and Current Population Survey data housed in the Federal Statistical Research Data Centers to create a county-specific cost-of-living adjustment and corresponding county-specific poverty thresholds. In Aim 3, we will estimate the mediating role of poverty reduction in the relationship between Medicaid expansion and rural-urban ethnoracial mortality disparities from 2011 to 2019. We will do so by integrating our estimates of the supplemental poverty measure with our difference-in-difference models from Aim 1.