The impact of Medicaid expansion on state expenditures through the COVID-19 era

IF 3.1 2区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Jenny Markell BA, Mark Katz Meiselbach PhD
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引用次数: 0

Abstract

Objective

To investigate the impact of Medicaid expansion on state expenditures through the end of 2022.

Data Sources

We used data from the National Association of State Budget Officers (NASBO)'s State Expenditure Report, Kaiser Family Foundation (KFF)'s Medicaid expansion tracker, US Bureau of Labor Statistics data (BLS), US Bureau of Economic Analysis data (BEA), and Pandemic Response Accountability Committee Oversight (PRAC).

Study Design

We investigated spending per capita (by state population) across seven budget categories, including Medicaid spending, and four spending sources. We performed a difference-in-differences (DiD) analysis that compared within-state changes in spending over time in expansion and nonexpansion states to estimate the effect of Medicaid expansion on state budgets. We adjusted for annual state unemployment rate, annual state per capita personal income, and state spending of Coronavirus Relief Funds (CRF) from 2020 to 2022 and included state and year fixed effects.

Data Collection/Extraction Methods

We linked annual state-level data on state-reported fiscal year expenditures from NASBO with state-level characteristics from BLS and BEA data and with CRF state spending from PRAC.

Principal Findings

Medicaid expansion was associated with an average increase of 21% (95% confidence interval [CI]: 16%–25%) in per capita Medicaid spending after Medicaid expansion among states that expanded prior to 2020. After inclusion of an interaction term to separate between the coronavirus disease (COVID) era (2020–2022) and the prior period following expansion (2015–2019), we found that although Medicaid expansion led to an average increase of 33% (95% CI: 21%–45%) in federal funding of state expenditures in the post-COVID years, it was not significantly associated with increased state spending.

Conclusions

There was no evidence of crowding out of other state expenditure categories or a substantial impact on total state spending, even in the COVID-19 era. Increased federal expenditures may have shielded states from substantial budgetary impacts.

在 COVID-19 时代,医疗补助扩展对各州支出的影响。
目标:调查到 2022 年底医疗补助扩展对各州支出的影响:我们使用的数据来自全美州预算官员协会(NASBO)的州支出报告、凯撒家庭基金会(KFF)的医疗补助扩展跟踪器、美国劳工统计局(BLS)数据、美国经济分析局(BEA)数据以及大流行病应对问责委员会监督(PRAC):我们调查了包括医疗补助支出在内的七个预算类别和四个支出来源的人均支出(按州人口计算)。我们进行了差异分析(DiD),比较了扩展州和未扩展州的州内支出随时间的变化,以估计医疗补助扩展对州预算的影响。我们调整了州年度失业率、州年度人均个人收入以及 2020 年至 2022 年各州的冠状病毒救助基金(CRF)支出,并纳入了州和年份固定效应:我们将 NASBO 提供的各州上报财政年度支出的年度州级数据与 BLS 和 BEA 数据中的州级特征以及 PRAC 提供的 CRF 州级支出联系起来:在 2020 年之前扩大医疗补助范围的州中,扩大医疗补助范围后人均医疗补助支出平均增加 21%(95% 置信区间 [CI]:16%-25%)。在加入交互项以区分冠状病毒病(COVID)时代(2020-2022 年)和扩军后的前一时期(2015-2019 年)后,我们发现,虽然医疗补助扩军导致后 COVID 年联邦对各州支出的资助平均增加了 33%(95% 置信区间:21%-45%),但它与各州支出的增加并无显著关联:即使在 COVID-19 时代,也没有证据表明其他州支出类别被挤出或对州支出总额产生重大影响。联邦支出的增加可能使各州免受实质性预算影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Health Services Research
Health Services Research 医学-卫生保健
CiteScore
4.80
自引率
5.90%
发文量
193
审稿时长
4-8 weeks
期刊介绍: Health Services Research (HSR) is a peer-reviewed scholarly journal that provides researchers and public and private policymakers with the latest research findings, methods, and concepts related to the financing, organization, delivery, evaluation, and outcomes of health services. Rated as one of the top journals in the fields of health policy and services and health care administration, HSR publishes outstanding articles reporting the findings of original investigations that expand knowledge and understanding of the wide-ranging field of health care and that will help to improve the health of individuals and communities.
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