Indiana University SPEA Edward J. Bloustein School of Planning and Public Policy University of Pennsylvania AIR American University

Panel Paper: Early Changes in Insurance Coverage and Related Outcomes for Parents and Children Under the Affordable Care Act

Saturday, November 14, 2015 : 8:30 AM
Tequesta (Hyatt Regency Miami)

*Names in bold indicate Presenter

Stacey McMorrow, Urban Institute and Genevieve Kenney, The Urban Institute
Research Objective: With the expansion of Medicaid eligibility to low-income individuals in 28 states and eligibility for federal subsidies to purchase marketplace coverage for those with moderate incomes, the Affordable Care Act has the potential to improve insurance coverage and related outcomes for all Americans. In this study, we examine early changes in insurance coverage, access to care and health outcomes for parents and children under the ACA.

Study Design: Using early release data from the National Health Interview Survey, we examine changes in insurance coverage, presence of a usual source of care, and self-reported general and mental health status for parents and children between early 2013 (calendar quarters 1 and 2) and early 2014. This period captures the early effects of the 2014 Medicaid expansion and the first marketplace open enrollment period. We examine differences by family income and between states that did and did not expand Medicaid as of October 31, 2013. Mental health status is measured using the Kessler scale of psychological distress. Additional outcomes, including difficulty finding providers, use of various services, and financial burdens related to medical bills will be available with the release of the full 2014 NHIS file in June 2015 which will also include data from the third and fourth quarter of 2014.

Population Studied: Parents (18-64) are defined as those living with a dependent child in their household. Children are ages 0-17.

Principal Findings: Between early 2013 and early 2014, the uninsurance rate for parents in states that expanded Medicaid fell from 20.4% to 14.6%, with no significant change in nonexpansion states. Those with incomes below 138 percent of poverty reported improvements in self-reported health status over the same period, and those with moderate incomes (138-399 percent of poverty) were more likely to have a usual source of care in early 2014 compared to early 2013. Parents in expansion states also saw a drop in reporting of moderate psychological distress over the same period.

Children with incomes below 138 percent of poverty saw a significant decline in uninsurance overall, from 9.5% to 7.4%, and a very large drop in the share with an uninsured family member in Medicaid expansion states, from 46.8% to 35.3% between early 2013 and early 2014. There were few significant changes in usual source of care or self-reported health status for children.

Conclusions: Uninsurance declined for parents and for low-income children in early 2014 suggesting that the ACA is improving access to health insurance coverage, particularly in Medicaid expansion states. Some early evidence also suggests improvements in access to care and health outcomes for parents under the ACA.

Implications: As ACA implementation continues, additional coverage gains are likely, and associated increases in access to care and service use and health status improvements may grow stronger. The extent to which coverage and health status improvements for parents result in spillover effects for children’s health and well-being remains to be seen.