Association for Public Policy Analysis & Management

Panel: How Do State Policy Decisions Impact Health Insurance Coverage and Out-of-Pocket Spending: Evidence from Federal Survey Data

(Health Policy)

Policy decisions made at the state level play in important role in determining a variety of health systems outcomes. This role became particularly clear when the Affordable Care Act Medicaid expansion became optional for states, creating a natural experiment among the states according to their respective Medicaid expansion decisions. Under the current administration, it appears that state flexibility in health policy—and policy more generally—will be prioritized so that states may have increasing control over their Medicaid programs and other aspects of their health systems and markets. An exploration of the impacts of current policy permutations across states can inform state decisions as policymakers consider their options moving forward.

The proposed panel includes three analyses that use survey data to consider the impacts of state policy choices on out-of-pocket health care spending and health insurance coverage. The first study uses data from the Medical Expenditure Panel – Insurance Component (MEPS-IC) to investigate how employer insurance offers, workers’ eligibility, and out-of-pocket premiums are changing as a result of the Medicaid expansion decisions.  The second study uses data from the Current Population Survey (CPS) to examine the comparative out-of-pocket spending burdens for adults with incomes between 100 and 138% of the federal poverty level (FPL) in states that have chosen to expand Medicaid—where this group faces little to no cost-sharing in most cases—and in states that have chosen not to expand Medicaid, where this group may face out-of-pocket premiums and cost-sharing for coverage purchased through the marketplace. Finally, the third analysis uses CPS data to examine the impact of recent state minimum wage increases on enrollment in employer-sponsored insurance (ESI) coverage and considers whether the impact of the minimum wage changes varied between Medicaid expansion states and non-expansion states.

The research included in this panel illustrates both the intended and unintended consequences of state policy decisions on a range of health systems outcomes. This panel also highlights the necessity of access to different types of federal survey for the purposes of healthy policy evaluation. Federal survey data is especially critical when analyzing variation between states, as when comparing outcomes by Medicaid expansion status. As policy flexibility for states continues to grow, this ability to compare states to one another will continue to be essential.