Did Medicaid slow declines in access to health care during the great recession?

Joseph A. Benitez, Victoria E. Perez, Jie Chen

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Objective: We examine whether broadened access to Medicaid helped insulate households from declines in health coverage and health care access linked to the 2007-2009 Great Recession. Data Source: 2004-2010 Behavioral Risk Factor Surveillance System (BRFSS). Study Design: Flexible difference-in-difference regressions were used to compare the impact of county-level unemployment on health care access in states with generous Medicaid eligibility guidelines versus states with restrictive guidelines. Data Collection/Extraction Methods: Nonelderly adults (aged 19-64) in the BRFSS were linked to county unemployment rates from the Bureau of Labor Statistics’ Local Area Unemployment Statistics Program. We created a Medicaid generosity index by simulating the share of a nationally representative sample of adults that would be eligible for Medicaid under each state's 2007 Medicaid guidelines using data from the 2007 Current Population Survey's Annual Social and Economic Supplement. Principal Findings: A percentage point (PPT) increase in the county unemployment rate was associated with a 1.3 PPT (95% CI: 0.9-1.6, P <.01) increase in the likelihood of being uninsured and a 0.86 PPT (95% CI: 0.6-1.1, P <.01) increase in unmet medical needs due to cost in states with restrictive Medicaid eligibility guidelines. Conversely, a one PPT increase in unemployment was associated with only a 0.64 PPT (P <.01) increase in uninsurance among states with the most generous eligibility guidelines. Among states in the fourth quartile of generosity (ie, most generous), rises in county-level unemployment were associated with a 0.68 PPT (P <.10) increase in unmet medical needs due to cost—a 21% smaller decrease relative to states with the most restrictive Medicaid eligibility guidelines. Conclusions: Increased access to Medicaid during the Great Recession mitigated the effects of increased unemployment on the rate of unmet medical need, particularly for adults with limited income.

Original languageEnglish
Pages (from-to)655-667
Number of pages13
JournalHealth Services Research
Volume56
Issue number4
DOIs
StatePublished - Aug 2021

Bibliographical note

Funding Information:
The authors would like to thank attendees at the 2020 Western Economics Association International (WEAI) Virtual Conference for helpful comments on an earlier version of this manuscript. The authors would also like to thank Matthew Naveen for helpful comments. The authors are also grateful for helpful comments received from seminar attendees at the University of Kentucky, University of Maryland, and the University of Colorado at Denver. Joseph Benitez received support for this research provided by the Robert Wood Johnson Foundation's (RWJF) Policies for Action program (Grant #77341) and the Disparities Researchers Equalizing Access for Minorities (DREAM) Scholars Program in the University of Kentucky's Center for Health Equity Transformation and Center for Clinical and Translational Science (#UL1TR001998). The views expressed here do not necessarily reflect the views of RWJF, the University of Kentucky, Indiana University, or the University of Maryland. The authors would also like to thank Steve Claas for editing prior versions of this manuscript. Joint Acknowledgment/Disclosure Statement:

Funding Information:
Joint Acknowledgment/Disclosure Statement: The authors would like to thank attendees at the 2020 Western Economics Association International (WEAI) Virtual Conference for helpful comments on an earlier version of this manuscript. The authors would also like to thank Matthew Naveen for helpful comments. The authors are also grateful for helpful comments received from seminar attendees at the University of Kentucky, University of Maryland, and the University of Colorado at Denver. Joseph Benitez received support for this research provided by the Robert Wood Johnson Foundation's (RWJF) Policies for Action program (Grant #77341) and the Disparities Researchers Equalizing Access for Minorities (DREAM) Scholars Program in the University of Kentucky's Center for Health Equity Transformation and Center for Clinical and Translational Science (#UL1TR001998). The views expressed here do not necessarily reflect the views of RWJF, the University of Kentucky, Indiana University, or the University of Maryland. The authors would also like to thank Steve Claas for editing prior versions of this manuscript.

Publisher Copyright:
© 2021 The Authors. Health Services Research published by Wiley Periodicals LLC on behalf of Health Research and Educational Trust.

Keywords

  • Great Recession
  • Medicaid
  • determinants of health
  • health care access
  • state health policy
  • unemployment

ASJC Scopus subject areas

  • Health Policy

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