Association of Medicaid expansion with health insurance coverage by marital status and sex

Jim P. Stimpson, Jessie Kemmick Pintor, Fernando A. Wilson

Research output: Contribution to journalArticle

Abstract

Objective To determine the association of Medicaid expansion with health insurance coverage by marital status and sex. Methods A population-based, quasi-experimental policy analysis was undertaken of the implementation of the Patient Protection and Affordable Care Act’s (ACA) Medicaid expansion provision on or after January 1, 2014. The 2010–16 American Community Survey provided data on 3,874,432 Medicaid-eligible adults aged 19–64 with incomes up to 138% of the federal poverty level. The outcome measures were no health insurance coverage and Medicaid coverage. The predictor variables were marital status and sex, with controls for family size, poverty status, race/ethnicity, education, employment status, immigration status, and metropolitan residence. Results In 2016, the uninsured rate for married men and women in a Medicaid expansion state was 21.2% and 17.1%, respectively, compared to 37.4% for married men and 35.8% for married women in a non-expansion state. The Medicaid coverage rate grew between 14.8% to 19.3% in Medicaid expansion states, which contrasts with less than a 5% growth in non-expansion states. Triple differences analysis suggests that, for women of all age groups, Medicaid expansion resulted in a 1.6 percentage point lower uninsured rate for married women compared to unmarried women. For men, there was not a statistically significant difference in the uninsured rate for married compared to unmarried men. For women of all age groups, there was a 2.6 percentage point higher Medicaid coverage rate for married compared to unmarried women. For men, there was a 1.8 percentage point higher Medicaid coverage rate for married compared to unmarried men. Conclusion Medicaid expansion under the ACA differentially lowered uninsurance and improved Medicaid coverage for married persons, especially married women, more than unmarried persons.

Original languageEnglish (US)
Article numbere0223556
JournalPloS one
Volume14
Issue number10
DOIs
StatePublished - Jan 1 2019

Fingerprint

Health insurance
health insurance
marital status
Insurance Coverage
Medicaid
Marital Status
Health Insurance
gender
poverty
Patient Protection and Affordable Care Act
Poverty
policy analysis
family size
Age Groups
nationalities and ethnic groups
Education
immigration
education
income
Policy Making

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

Cite this

Association of Medicaid expansion with health insurance coverage by marital status and sex. / Stimpson, Jim P.; Pintor, Jessie Kemmick; Wilson, Fernando A.

In: PloS one, Vol. 14, No. 10, e0223556, 01.01.2019.

Research output: Contribution to journalArticle

@article{393dfe2206834f6b8962588fccfc5ba0,
title = "Association of Medicaid expansion with health insurance coverage by marital status and sex",
abstract = "Objective To determine the association of Medicaid expansion with health insurance coverage by marital status and sex. Methods A population-based, quasi-experimental policy analysis was undertaken of the implementation of the Patient Protection and Affordable Care Act’s (ACA) Medicaid expansion provision on or after January 1, 2014. The 2010–16 American Community Survey provided data on 3,874,432 Medicaid-eligible adults aged 19–64 with incomes up to 138{\%} of the federal poverty level. The outcome measures were no health insurance coverage and Medicaid coverage. The predictor variables were marital status and sex, with controls for family size, poverty status, race/ethnicity, education, employment status, immigration status, and metropolitan residence. Results In 2016, the uninsured rate for married men and women in a Medicaid expansion state was 21.2{\%} and 17.1{\%}, respectively, compared to 37.4{\%} for married men and 35.8{\%} for married women in a non-expansion state. The Medicaid coverage rate grew between 14.8{\%} to 19.3{\%} in Medicaid expansion states, which contrasts with less than a 5{\%} growth in non-expansion states. Triple differences analysis suggests that, for women of all age groups, Medicaid expansion resulted in a 1.6 percentage point lower uninsured rate for married women compared to unmarried women. For men, there was not a statistically significant difference in the uninsured rate for married compared to unmarried men. For women of all age groups, there was a 2.6 percentage point higher Medicaid coverage rate for married compared to unmarried women. For men, there was a 1.8 percentage point higher Medicaid coverage rate for married compared to unmarried men. Conclusion Medicaid expansion under the ACA differentially lowered uninsurance and improved Medicaid coverage for married persons, especially married women, more than unmarried persons.",
author = "Stimpson, {Jim P.} and Pintor, {Jessie Kemmick} and Wilson, {Fernando A.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1371/journal.pone.0223556",
language = "English (US)",
volume = "14",
journal = "PLoS One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "10",

}

TY - JOUR

T1 - Association of Medicaid expansion with health insurance coverage by marital status and sex

AU - Stimpson, Jim P.

AU - Pintor, Jessie Kemmick

AU - Wilson, Fernando A.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective To determine the association of Medicaid expansion with health insurance coverage by marital status and sex. Methods A population-based, quasi-experimental policy analysis was undertaken of the implementation of the Patient Protection and Affordable Care Act’s (ACA) Medicaid expansion provision on or after January 1, 2014. The 2010–16 American Community Survey provided data on 3,874,432 Medicaid-eligible adults aged 19–64 with incomes up to 138% of the federal poverty level. The outcome measures were no health insurance coverage and Medicaid coverage. The predictor variables were marital status and sex, with controls for family size, poverty status, race/ethnicity, education, employment status, immigration status, and metropolitan residence. Results In 2016, the uninsured rate for married men and women in a Medicaid expansion state was 21.2% and 17.1%, respectively, compared to 37.4% for married men and 35.8% for married women in a non-expansion state. The Medicaid coverage rate grew between 14.8% to 19.3% in Medicaid expansion states, which contrasts with less than a 5% growth in non-expansion states. Triple differences analysis suggests that, for women of all age groups, Medicaid expansion resulted in a 1.6 percentage point lower uninsured rate for married women compared to unmarried women. For men, there was not a statistically significant difference in the uninsured rate for married compared to unmarried men. For women of all age groups, there was a 2.6 percentage point higher Medicaid coverage rate for married compared to unmarried women. For men, there was a 1.8 percentage point higher Medicaid coverage rate for married compared to unmarried men. Conclusion Medicaid expansion under the ACA differentially lowered uninsurance and improved Medicaid coverage for married persons, especially married women, more than unmarried persons.

AB - Objective To determine the association of Medicaid expansion with health insurance coverage by marital status and sex. Methods A population-based, quasi-experimental policy analysis was undertaken of the implementation of the Patient Protection and Affordable Care Act’s (ACA) Medicaid expansion provision on or after January 1, 2014. The 2010–16 American Community Survey provided data on 3,874,432 Medicaid-eligible adults aged 19–64 with incomes up to 138% of the federal poverty level. The outcome measures were no health insurance coverage and Medicaid coverage. The predictor variables were marital status and sex, with controls for family size, poverty status, race/ethnicity, education, employment status, immigration status, and metropolitan residence. Results In 2016, the uninsured rate for married men and women in a Medicaid expansion state was 21.2% and 17.1%, respectively, compared to 37.4% for married men and 35.8% for married women in a non-expansion state. The Medicaid coverage rate grew between 14.8% to 19.3% in Medicaid expansion states, which contrasts with less than a 5% growth in non-expansion states. Triple differences analysis suggests that, for women of all age groups, Medicaid expansion resulted in a 1.6 percentage point lower uninsured rate for married women compared to unmarried women. For men, there was not a statistically significant difference in the uninsured rate for married compared to unmarried men. For women of all age groups, there was a 2.6 percentage point higher Medicaid coverage rate for married compared to unmarried women. For men, there was a 1.8 percentage point higher Medicaid coverage rate for married compared to unmarried men. Conclusion Medicaid expansion under the ACA differentially lowered uninsurance and improved Medicaid coverage for married persons, especially married women, more than unmarried persons.

UR - http://www.scopus.com/inward/record.url?scp=85074079809&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85074079809&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0223556

DO - 10.1371/journal.pone.0223556

M3 - Article

C2 - 31644546

AN - SCOPUS:85074079809

VL - 14

JO - PLoS One

JF - PLoS One

SN - 1932-6203

IS - 10

M1 - e0223556

ER -