The Deep Divide: State Borders Create Medicaid Haves And Have-Nots | Kaiser Health News

October 3, 2019

A recent University of Michigan study found Medicaid expansion substantially reduced mortality rates from 2014 to 2017. The researchers said Illinois averted 345 deaths annually while Missouri had 194 additional deaths each year. The same trends held for other side-by-side states such as Kentucky (did expand) and Tennessee (did not), New Mexico (did) and Texas (did not).

Source: The Deep Divide: State Borders Create Medicaid Haves And Have-Nots | Kaiser Health News


Since Obamacare, Waiting Lists For Disabled Care Grew 40 Percent

October 1, 2019

Since Obamacare, Waiting Lists For Care For Disabled People Have Grown 40 Percent

Source: Since Obamacare, Waiting Lists For Disabled Care Grew 40 Percent


Tool Informs Medicaid’s Business Case for Investing in Prevention – RWJF

June 24, 2019

This is why Nemours Children’s Health System developed the Prevention Business Case Financial Simulation Tool and accompanying user guide. While exploring strategies for Medicaid investment in preventative health services, Nemours discovered that there was a lack of tools and resources available to state Medicaid agencies and MCOs to make a business case for investing in prevention. To help these organizations fill this need, Nemours developed the Financial Simulation tool using existing research literature and partnering with the Maryland Department of Health to test and validate the tool with Maryland Medicaid data. The Financial Simulation tool provides key “return on investment” (ROI) information to any state interested in exploring and implementing childhood obesity prevention interventions.The tool allows states’ Medicaid agencies and MCOs to estimate the cost of investing in various childhood obesity treatment and prevention services; health care cost savings resulting from intervention; expected short and medium-term health benefits; and a timeline of savings in order to provide evidence of the business case for Medicaid obesity prevention interventions.

Source: Tool Informs Medicaid’s Business Case for Investing in Prevention – RWJF


The Effects of Medicaid Expansion on Labor Market Outcomes: Evidence from Border Counties by Lizhong Peng, Xiaohui Guo, Chad D. Meyerhoefer :: SSRN

October 19, 2018

This paper provides new empirical evidence on the employment and earning effects of the recent Medicaid expansion. Unlike most existing studies that use a conventional state and year fixed effects approach, our main identification strategy is based on the comparison of employment and wages in contiguous county-pairs in neighboring states (i.e. border counties) with different Medicaid expansion status. Using the 2008-2016 Quarterly Census of Employment and Wages, we estimate a set of distributed lag models in order to examine the dynamic effects of Medicaid expansion. Results from our preferred specification suggest a small but statistically significant decrease in employment of 1.3 percent one year after the Medicaid expansion. This disemployment effect is transitory and appears to primarily occur in low-wage sectors. In particular, employment returns to pre-expansion levels within two years. We also do not find any statistically significant effect of the Medicaid expansion on wages at any point.

via The Effects of Medicaid Expansion on Labor Market Outcomes: Evidence from Border Counties by Lizhong Peng, Xiaohui Guo, Chad D. Meyerhoefer :: SSRN


Medicaid Expansion and Intensity of Treatment: Increased Cost in the Emergency Department by Shooshan Danagoulian, Allen C. Goodman, Alexander Janke, Phillip Levy :: SSRN

October 18, 2018

We estimate the impact of the ACA Medicaid expansion on the intensity of treatment in the emergency department. We conduct a visit level analysis with a difference-in-differences specification for the number of procedures, number of diagnoses, and visit characterization according to the NYU Algorithm using the State Emergency Department Databases (SEDD) for six states in 2013-2014. Our results show that in expanding states the number of procedures increased by up to 0.27 per visits (3.9%), and the number of diagnoses declined by up to 0.10 diagnoses per visit. While we remain agnostic about the mechanism for the increase in procedures, we believe increasing reimbursements motivates providers to perform more procedures, or bill more carefully, or both. We also find evidence of changing composition of visit type, with an increase in non-preventable emergency visits and primary care treatable visits. This increase is particularly strong among patients who were uninsured in 2013. We estimate that the additional procedures cost $248 million, constituting at least 3.1% of the total medical expenditure associated with the expansion in the four expanding states in our study. We conclude that the provider side response in treatment presents a substantial additional cost to expanding insurance coverage with fee-for-service payment structure, and should be accordingly included in projected costs of future insurance expansions.

via Medicaid Expansion and Intensity of Treatment: Increased Cost in the Emergency Department by Shooshan Danagoulian, Allen C. Goodman, Alexander Janke, Phillip Levy :: SSRN


Medicaid, Marijuana and Opioids: Identifying Shocks to Opioid Mortality by John Anders :: SSRN

October 17, 2018

Is the opioid epidemic attributable to prescription painkillers being more accessible or to opioid substitutes being less accessible ? I find that the state-level decision to increase access to prescription painkillers by expanding Medicaid under the Affordable Care Act increased both opioid prescriptions and in opioid-related deaths. These results vary strongly by demography, being driven largely by deaths of white men without college degrees. A back of the envelope calculation suggests that, for an average county, Medicaid expansion caused approximately 2,800 more people to be insured per year, 175,000 more opioid units to be prescribed per year, and 4 additional opioid-related deaths per year. Overall, opioid accessibility shocks explain about 12,000 opioid deaths per year, or nearly a third of the overall death toll. I also find that the state-level decision to legalize recreational Marijuana (a substitute painkiller) reduced opioid- related deaths. Overall, these opioid-substitute accessibility shocks also explain about 12,000 opioid deaths per year. I conclude that policy-makers can achieve reductions in opioid mortality without restricting access to opioids.

via Medicaid, Marijuana and Opioids: Identifying Shocks to Opioid Mortality by John Anders :: SSRN


Medicaid and the Labor Supply of Single Mothers: Implications for Health Care Reform by R. Vincent Pohl :: SSRN

September 16, 2018

The Medicaid expansions and health insurance subsidies of the Affordable Care Act (ACA) change work incentives for single mothers. To evaluate the employment effects of these policies ex ante, I estimate a model of labor supply and health insurance choice exploiting variation in pre‐ACA Medicaid policies. Simulations show that single mothers increase their labor supply at the extensive and intensive margin by 12% and 7%, respectively, uninsurance rates decline by up to 40%, and an average family’s welfare improves by 1,600 dollars per year. Health insurance subsidies and not Medicaid expansions mostly drive these effects.

via Medicaid and the Labor Supply of Single Mothers: Implications for Health Care Reform by R. Vincent Pohl :: SSRN