Research Update: Evidence Continues to Build on Medicaid’s Role Promoting Economic Security

I previously wrote about the primary role of health insurance, which is to protect against economic insecurity, medical debt, and bankruptcy. Recently, I have been reading new studies that continues to build on this body of work.

NBER’s Medicaid and Financial Health

Using consumer credit data, the authors examine the financial distress of non-elderly adults in expansion and non-expansion states. And, if you are wondering which parts of the country families are more likely to have medical debt, check out The Urban Institute’s map presenting medical debt by county.

What it finds

  • The Medicaid expansion was associated with a reduction of unpaid medical bills sent to collection by $3.4 billion.
  • It was also associated with improved credit scores and a reduction in new delinquencies.

Why it matters

  • The authors report that more than half of the uninsured have difficulties paying their medical bills. Many medical bills will end up in collection, which generally has a negative impact on an individual’s credit. However, the study finds evidence that the Medicaid expansion helped individuals avoid collection and even improve their credit scores. 
  • The time period for the consumer credit data in the analysis went through the first two years of the expansion. As more data become available, there will be further research on how the expansion may be impacting consumer credit.

Medical Care Research and Review’s The Effect of ACA State Medicaid Expansions on Medical Out-of-Pocket Expenditures

Using data from the 2011-2016 Current Population Survey, this study examines the effect of the Medicaid expansion on out-of-pocket costs for insurance and health care.

What it finds

  • Among individuals with incomes below 138 percent of the federal poverty level (FPL), the Medicaid expansion was associated with a higher probability of not having premiums.
  • Individuals with incomes between 100-138 percent FPL in expansion states were significantly more likely to have no non-premium, out-of-pocket costs than those in non-expansion states.

Why it matters

  • The findings for individuals with incomes between 100 – 138 percent FPL builds on the research suggesting Medicaid better shields families from financial risk than Marketplace coverage.
  • The results of study suggest that the first two years of the Medicaid expansion increased economic security for families.