How Much Better is Medicaid than Marketplace Coverage at Easing the Burden of Out-of-Pocket Spending for Near-Poor Adults? (December 2016)

Principal Investigator: Frederic Blavin, PhD, The Urban Institute

The goal of this study is to inform expansion and non-expansion states of the effect of Medicaid expansion on out-of-pocket spending and the overall resources available to families. Using data from the 2014-2016 Current Population Survey Annual Social and Economic Supplement, the applicants will conduct a difference-in-differences analysis, using the 2014 Medicaid expansion as a natural experiment, to address the following research questions:

1. Compared to marketplace coverage, what is the impact of the Medicaid expansion on reducing premium and non-premium out-of-pocket health spending among low-income adults with incomes between 100 and 138% FPL? In other words, among those in this income group, how much would out-of-pocket health spending in nonexpansion states change if states either expanded Medicaid or made Marketplace benefits and cost-sharing comparable with Medicaid?
2. What is the impact of the Medicaid expansion on out-of-pocket health spending among adults with incomes below 100% FPL in expansion states, relative to similar adults in nonexpansion states without access to Medicaid or Marketplace subsidies? 
3. How do these changes in out-of-pocket spending affect the overall resources available to families? 

Publications

Medicaid vs. Marketplace Coverage for Near-Poor Adults: Effects on Out-of-Pocket Spending and Coverage
(June 2018, Presentation)

"Medicaid Versus Marketplace Coverage for Near-Poor Adults: Effects On Out-Of-Pocket Spending"
(February 2018, Health Affairs)

Impact of Medicaid vs. Marketplace Coverage on Out-of-Pocket Spending for Near-Poor Adults
(December 2017, SHARE Webinar)

Medicaid vs. Marketplace Coverage for Near-Poor Adults: Impact on Out-of-Pocket Spending Burdens
(November 2017, Presentation)