ACA Medicaid Expansion Associated With Higher Spend Among Low Income, Older Adult Enrollees
Medicaid expansion under the Affordable Care Act (ACA) led to low-income older adults experiencing both increased coverage and spending on outpatient services, according to a study published in Health Services Research.
Researchers set out to “…examine indirect spillover effects of ACA Medicaid expansions to working-age adults on health care coverage, spending, and utilization by older low-income Medicare beneficiaries.”
Authors of the study note this the first analysis on this subject to not rely on self-reported measures of utilization and area-level measures of eligibility. Instead, researchers examined administrative data from 2010–2018 Health and Retirement Study surveys linked to annual Medicare beneficiary summary files.
The study sample consisted of low-income respondents with linked Medicare data aged greater than 69 years who had year-round traditional Medicare coverage and resided in the community. Total spending on inpatient and outpatient services, physician visits, Medicaid, and Medicare Part A and B coverage was measured in states that participated in Medicaid expansion and states that did not. The changes from before to after expansion were calculated using individual-level difference-in-differences models.
Expansion caused Medicaid coverage to increase 9.8% points (95% CI: 0.020-0.176), and institutional outpatient spending points to increase 4.4% (95% CI: 0.005-0.083). Part B enrollment also had a positive but statistically insignificant 2.4% point increase (95% CI: -0.003 to 0.050, P = .079).
“ACA Medicaid expansion was associated with more institutional outpatient spending among older low-income Medicare beneficiaries,” concluded researchers. “Increased care costs should be weighed against potential benefits from increased realized access to care.”
Reference:
Mellor J, McInerney M, Garrow R, Sabik, L. The impact of Medicaid expansion on spending and utilization by older low-income Medicare beneficiaries. Health Serv Res. Published online April 3, 2023. doi:10.1111/1475-6773.14155
