Insurance is a financial instrument created to mitigate financial risk. Health insurance in particular aims at covering people from large medical expenditures. In this exercise, we’ll focus on health insurance in the U.S. For context, here is how insurance rates have trended for the past 30 years across racialized groups.
Now, let’s bring this example home. In 2018 the VA general assembly voted to increase eligibility of adults up to 138% of the federal poverty line for childless adults and parents. That’s about $16,754 for an individual and $28,677 for a family of three.
Before this expansion, childless adults were not eligible for Medicaid at any income level (i.e. even if income level was 0% of FPL, they would still not qualify). Parents were only eligible if they made $6,900 or less a year (33 percent of the federal poverty level). Disable adults earning more than $9,700 a year (80% of FPL) were also not eligible.
You can read more about the context in this article for the Virginia Mercury. In this article let me highlight certain quotes:
Advocates have high hopes for expansion and what it could do for Virginia, like improving the rate of uninsured kids, providing much-needed health care for those with mental illness and substance use disorder and increasing access to housing services.
This other article provides another interesting quote:
The most important way to measure good policy is in how many lives are saved, but it’s not the only area where experts are finding evidence that Medicaid expansion made a measurable difference in people’s lives.
Now let’s look at this paper: “Effects of Virginia’s 2019 Medicaid Expansion on Health Insurance Coverage, Access to Care, and Health Status.” You can find the paper attached
Here is the abstract:
Virginia expanded Medicaid under the Affordable Care Act beginning in January 2019, which substantially increased income eligibility up to 138% of the federal poverty level (FPL) for both childless adults and parents. In this study, we examined the effects of Virginia’s Medicaid expansion in 2019 on health insurance coverage, access to care, and health status by employing a difference-in-differences and a synthetic control design. The study included data on health insurance from the 2016–2020 American Community Survey (ACS) and data on access to care and health status come from the 2016–2020 Behavioral Risk Factors Surveillance System (BRFSS). The samples from ACS and BRFSS were limited to non-elderly adults with income below 138% of the FPL. Separate models were estimated for individuals below 100% of FPL, and those within 100–138% of FPL. The Virginia Medicaid expansion was associated with a 9–11 percentage-point increase in Medicaid coverage rate and a 7–8 percentage-point increase in the insured rate among individuals below 100% FPL, in the first two years of expansion. There was a larger increase in Medicaid coverage among individuals within 100 138% of FPL which also led to a larger increase in the insured rate in 2020. Both income groups showed no changes in private coverage after the expansion in Virginia. We also found a decline in delaying necessary medical visits due to cost for individuals below 100% FPL in 2019 and for individuals within 100–138% FPL in 2020. There was overall no discernable change in health status outcomes. Virginia’s 2019 Medicaid expansion substantially increased insurance coverage among poor adults with suggestive early evidence for improved access. The findings highlight the missed opportunity for other states that have not yet decided to expand their Medicaid programs to improve coverage and access among their low-income individuals.
Here are the articles “highlights”: