Unwinding pandemic-era social programs: Effects on healthcare outcomes and disparities

项目总结/摘要 该项目将研究家庭第一冠状病毒应对法案（FFCRA）到期的影响 增加补充营养援助计划（SNAP）对医疗保健结果的福利水平， 残疾、种族和民族的差异。这些群体在疾病预防方面存在差距， 管理，不利的临床事件和护理费用，其中每一个都与食物有关 不安全感现有的研究发现SNAP可以减少粮食不安全，并建议SNAP可以减少 不利的医疗保健结果，特别是对弱势群体，但这些研究遭受了关键的因果关系， 推断的局限性，并已集中在SNAP的变化实质上不同于FFCRA解旋。 同时，在解开FFCRA SNAP的方法中的状态级变化增加（例如，定时 从2021年4月到2023年3月），福利损失规模的个人水平变化（从95美元 每月超过1,000美元），以及马萨诸塞州（MA）的政策，打破了该州的SNAP回滚 分为两个不平衡的步骤，所有这些都创造了自然实验，我们可以用来确定SNAP的因果影响。 此外，我们将使用强大的政策跟踪来识别和调整非SNAP政策平仓模式， 我们将利用国家T-MSIS Medicaid数据和MA提供的独特详细的关联数据。最终 MA和US分析将相互补充，并提供较高的内部和外部有效性。 具体来说，我们将建立一个与食品、住房和医疗补助相关的政策登记册 获取并开发一套简约的政策解除模式，以确定调整因素，供以后分析 (we将同样关注其他医疗保健、公共卫生和经济状况）（目标1）。然后我们将 估计SNAP解除对医疗补助事件率（预防性使用、不良事件率和 支出;目标2），我们将最终估计SNAP解除对这些事件中差异的影响 按残疾、种族和族裔分列的死亡率（目标3）。对于目标2和3（2020-2026年），我们将衡量以下方面的差异： 医疗保健结果的水平和趋势，以及使用解旋相关变化前后的差异 一种多层次的增长曲线建模方法，对许多有效性威胁具有灵活性和鲁棒性（同时还 利用具有过去SNAP应用程序的合格非参与者作为比较者，没有未平仓风险）。 目前的政策建议将减少SNAP接入，但几乎没有数据可以说明这种情况是如何发生的。 减少可能会影响保健结果和差距。我们的研究将缩小这一关键的知识差距。 研究正在进行的SNAP解旋将扩展过去的工作，重点是SNAP增加和/或 改变统一的大小和时间，从这个项目中学习也将推动国家卫生研究院少数 健康和健康差距战略计划的目标3是评估“减少健康差距的干预措施”。

Project Summary/Abstract This project will study the effects of the expiration of Families First Coronavirus Response Act (FFCRA) increases to Supplemental Nutrition Assistance Program (SNAP) benefit levels on healthcare outcomes and disparities by disability, race, and ethnicity. These groups experience disparities in disease prevention and management, unfavorable clinical events, and care expenditures, each of which are associated with food insecurity. Existing studies have found SNAP to reduce food insecurity and suggest SNAP may reduce unfavorable healthcare outcomes, especially for vulnerable groups, but these studies suffered key causal inference limitations and have focused on SNAP changes substantially different from the FFCRA unwinding. Meanwhile, state-level variation in approaches to unwinding the FFCRA SNAP increases (e.g., timing ranging from April 2021 to March 2023), individual-level variation in the size of benefit losses (ranging from $95 per month to over $1,000 per month), and a Massachusetts (MA) policy that broke the state’s SNAP rollbacks into two uneven steps all create natural experiments we can use to identify the causal impacts of SNAP. Further, we will use robust policy tracking to identify and adjust for non-SNAP policy unwinding patterns, and we will leverage both national T-MSIS Medicaid data and uniquely detailed linked data from MA. Ultimately, the MA and US analyses will complement each other and provide high internal and external validity. Specifically, we will create a registry of policies related to the unwinding of food, housing, and Medicaid access and then develop parsimonious sets of policy unwinding patterns to identify adjusters for later analyses (we will similarly attend to other healthcare, public health, and economic conditions) (Aim 1). We will then estimate the effects of SNAP unwinding on Medicaid event rates (preventive use, unfavorable event rates, and expenditures; Aim 2), and we will finally estimate the effects of SNAP unwinding on disparities in these event rates by disability, race, and ethnicity (Aim 3). For Aims 2 and 3 (2020-2026), we will measure differences in the levels and trends of healthcare outcomes and disparities before and after unwinding-related changes using a multilevel approach to growth curve modeling that is flexible and robust to many validity threats (while also utilizing eligible non-participants with past SNAP applications as a comparator with no unwinding exposure). Current policy proposals would reduce SNAP access, but there is little data to shed light on how such reductions may affect healthcare outcomes and disparities. Our study will reduce this critical knowledge gap. Studying the ongoing SNAP unwinding will extend past work that has focused on SNAP increases and/or changes uniform in their size and timing, and learnings from this project will also advance the NIH Minority Health and Health Disparities Strategic Plan’s Goal 3 to assess “interventions to reduce health disparities.”