Insurance Churn and the COVID-19 Pandemic.

IF 9.5 Q1 HEALTH CARE SCIENCES & SERVICES
Sarah P Shubeck, Emily Crawford, Matthew J Notowidigdo
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引用次数: 0

Abstract

Importance: Many individuals in the US face a high risk of losing their health insurance coverage and experiencing insurance churn, especially those enrolled in Medicaid. Prior research has found that the risk of losing insurance coverage remains high in the US even after the Patient Protection and Affordable Care Act significantly reduced the number of uninsured individuals.

Objective: To estimate whether the Families First Coronavirus Response Act (FFCRA) decreased insurance churn.

Design, setting, and participants: This study used 2 quasi-experimental approaches: an interrupted time series approach and a difference-in-difference approach. Both approaches use individual-level data from the Medical Expenditure Panel Survey from January 2015 to December 2022. In the difference-in-difference analysis comparing individuals with Medicaid to individuals with private health insurance coverage, the probability that insured individuals aged 2 to 64 years lose insurance over the next 12 months before and after the FFCRA was estimated. Data were analyzed from January to November 2024.

Main outcomes and measures: Primary outcome was the share of insured individuals who lost insurance coverage over the next 12 months. This measure was defined for all insured individuals and defined separately for individuals with Medicaid and for individuals with private insurance coverage.

Results: The sample included 96 473 individuals. Of these, 46 779 (49.7%) were male, and the mean (SD) age was 31.9 (18.1) years. In the interrupted time series analysis, the FFCRA was associated with a reduction in insurance churn by 2.06 percentage points (β = -0.021; 95% CI, -0.024 to -0.018; P < .001). In the difference-in-difference analysis, the FFRCA reduced Medicaid churn by 5.51 percentage points (β = -0.055; 95% CI, -0.060 to -0.050; P < .001). Combining these estimates, 65.0% (95% CI, 54.8-75.3) of the reduction in insurance churn came from the reduction in Medicaid churn.

Conclusions and relevance: In this study, the FFCRA was associated with a significantly decreased risk of losing health insurance. Without the FFCRA, an estimated 2.94 million individuals with Medicaid would have lost insurance coverage each year during the COVID-19 public health emergency.

保险动荡与COVID-19大流行。
重要性:在美国,许多人面临着失去医疗保险和经历保险变动的高风险,尤其是那些参加医疗补助计划的人。先前的研究发现,即使在《患者保护和平价医疗法案》大大减少了未参保人数之后,美国失去保险的风险仍然很高。目的:评估《家庭第一冠状病毒应对法案》(FFCRA)是否减少了保险流失。设计、环境和参与者:本研究采用两种准实验方法:中断时间序列方法和差中差方法。这两种方法都使用了2015年1月至2022年12月医疗支出小组调查的个人层面数据。在比较医疗补助个人与私人医疗保险个人的差异分析中,估计了在FFCRA前后的未来12个月内,2至64岁的投保人失去保险的可能性。数据分析时间为2024年1月至11月。主要结果和措施:主要结果是在未来12个月内失去保险覆盖的参保个人的比例。这项措施是为所有参保的个人定义的,并分别为有医疗补助计划的个人和有私人保险的个人定义。结果:样本包括96 473人。其中46例 779例(49.7%)为男性,平均(SD)年龄为31.9(18.1)岁。在中断时间序列分析中,FFCRA与保险流失率降低2.06个百分点相关(β = -0.021;95% CI, -0.024 ~ -0.018;P < 0.001)。在差异分析中,FFRCA减少了5.51个百分点的医疗补助流失率(β = -0.055;95% CI, -0.060 ~ -0.050;P < 0.001)。综合这些估计,65.0% (95% CI, 54.8-75.3)的保险流失率减少来自于医疗补助流失率的减少。结论和相关性:在本研究中,FFCRA与失去健康保险的风险显著降低相关。如果没有FFCRA,在2019冠状病毒病突发公共卫生事件期间,估计每年有294万医疗补助计划的人将失去保险。
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
CiteScore
4.00
自引率
7.80%
发文量
0
期刊介绍: JAMA Health Forum is an international, peer-reviewed, online, open access journal that addresses health policy and strategies affecting medicine, health, and health care. The journal publishes original research, evidence-based reports, and opinion about national and global health policy. It covers innovative approaches to health care delivery and health care economics, access, quality, safety, equity, and reform. In addition to publishing articles, JAMA Health Forum also features commentary from health policy leaders on the JAMA Forum. It covers news briefs on major reports released by government agencies, foundations, health policy think tanks, and other policy-focused organizations. JAMA Health Forum is a member of the JAMA Network, which is a consortium of peer-reviewed, general medical and specialty publications. The journal presents curated health policy content from across the JAMA Network, including journals such as JAMA and JAMA Internal Medicine.
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