Health Insurance and Access to Care After Unemployment in Medicaid Expansion Versus Nonexpansion States During COVID-19.

BACKGROUND

Prior work has shown that Medicaid coverage offset reductions in employer-sponsored insurance after COVID-19-related job loss in Medicaid expansion states. However, the effect of Medicaid expansion on health care access is not fully understood.

OBJECTIVE

To estimate the association of unemployment during COVID-19 with health insurance coverage and health care access in Medicaid expansion versus nonexpansion states.

STUDY

DESIGN

We used restricted, longitudinal National Health Interview Survey (NHIS) data from 2019 to 2020, focusing on working-age adults (N=5156). Using triple-difference models, we estimated changes in outcomes for respondents becoming unemployed between 2019 and 2020 (after COVID-19) relative to continuously employed respondents, in Medicaid expansion versus nonexpansion states.

PRINCIPAL FINDINGS: Compared with continuously employed respondents, there was a statistically significant increase in Medicaid coverage among the newly unemployed in expansion states (6.1 percentage points (pp), 95% CI: 1.0 to 11.3, P=0.019) but not in nonexpansion states (3.9 pp, 95% CI: -3.9 to 11.8, P=0.324); however, the triple difference was nonsignificant. Uninsurance increased among the newly unemployed in expansion states by only 4.9 pp (95% CI: 0.9 to 8.9, P=0.016) versus 12.4 pp in nonexpansion states (95% CI: 0.2 to 24.6, P=0.047), but the triple difference was statistically nonsignificant. There was a significant increase in delaying or skipping medical care among newly unemployed respondents in nonexpansion states, but not in expansion states and the triple difference was statistically significant (-15.5 pp, 95% CI: -26.9 to -4.0, P=0.008).

CONCLUSION

Our results suggest that Medicaid expansion prevented disruptions in health care access for the newly unemployed during COVID-19.