The Effect of Medicaid Expansion on Mortality Disparities and Poverty

根据《平价医疗法案》扩大医疗补助，各州可以选择扩大 医疗补助覆盖家庭收入高达联邦贫困人口138%的成年人 这一水平已被证明可以降低全国的死亡率。从2014年到2018年，死亡率 在扩大医疗补助的州中，下降的幅度比没有扩大的州多3.6%。尽管它的影响 医疗补助计划的扩大对死亡率的影响是有据可查的，但它对死亡率差距的影响仍然存在 被低估了。这项研究的首要目标是确定医疗补助与 扩展和城乡民族差距，同时也估计了 在这一关系中脱贫。这项研究具有重要意义，因为它：1)关注死亡率 减少差距而不是简单地降低死亡率，2)分析了医疗补助的影响 扩大了跨部门死亡率差异，这意味着在 多个健康差距人群(例如黑人和农村人口)，以及3)确定 通过扶贫扩大医疗补助对跨部门死亡率差距的影响。这个 该项目的创新主要集中在三个方面。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综合影响；第二， 这项研究将为补充方案产生最新和改进的生活费调整 贫困衡量标准，以及县一级对补充贫困衡量标准的估计。第三, 该研究将对贫困在两国关系中的中介作用进行有力的分析 医疗补助的扩大和跨部门死亡率差距的缩小。该项目将竣工 通过三个具体目标。在目标1中，我们将评估医疗补助扩大对 2011至2019年按城乡地位分列的民族死亡率差异。我们将用时间来做到这一点- 基于人口普查数据和边际预测分析的变差分设计 来自国家生命统计系统的受限数据。在目标2中，我们将提高- 生活适应在现有补充贫困测算中的应用 2011年至2019年在县级测量。我们将使用受限制的美国航空公司 社区调查和当前人口调查数据保存在联邦统计局 研究数据中心创建特定县的生活费调整和对应 特定县的贫困门槛。在目标3中，我们将评估贫困的中介作用 扩大医疗补助与城乡人口死亡率之间关系的降低 2011年至2019年的差距。我们将通过整合我们对补充资金的估计来实现这一点 使用我们的目标1中的差异模型来衡量贫困。

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.