Insurance Expansions and Rollbacks and Access to Health Care
Insurance expansions and rollbacks of eligibility for coverage are likely to have contrasting impacts on access to care, and recent legislation provides opportunities to study these connections. The Affordable Care Act (ACA) expanded insurance coverage through Medicaid, the Marketplace, financial incentives, and mandated access to parental employer-sponsored insurance for young adults. The first paper uses interrupted time series methods to go beyond the simple prediction that insurance expansions increase access and finds that, among young adults, the ACA’s expansions reduced racial and ethnic disparities in insurance coverage and access. On the other hand, some observers were concerned that the influx of new patients could reduce access to care for people who had insurance before the ACA. The second paper measures the extent to which the growth in the insured population, especially the ACA’s insurance expansions, had market-level spillovers on access for adults who were insured prior to the expansions. Access may be reduced when insurance eligibility is rolled back. For children families above 138% of poverty, the future of Medicaid and the Children’s Health Insurance Program (CHIP) are uncertain; maintenance-of-effort requirements expire in 2019 and CHIP is funding is only assured through 2017. The third paper in this session uses a detailed program eligibility simulation to identify children who would be affected by this potential rollback and their potential sources of coverage in the event of a rollback, and access and their families’ financial burdens are measured. All three papers use nationally representative surveys.