Medicaid Expansion

Maria Steenland and Laura Wherry examine postpartum hospitalization rates in eight states and find a "17 percent decrease in the occurrence of sixty-day postpartum hospitalizations among people with Medicaid-financed deliveries" in states that expanded Medicaid under the Affordable Care Act compared with people in states that did not.

They conclude that expansion led to improved postpartum health for low-income populations.

Asako Moriya and Sujoy Chakravarty find that after the 2014 Medicaid expansion, Black-White disparities in preventable hospitalizations decreased in both expansion and nonexpansion states, with the size of the decrease greater in expansion states.

Black-White disparities in emergency department (ED) visits increased in all states. The authors find no significant changes in Hispanic-White disparities in preventable hospitalizations or ED visits.

Behavioral Health

To provide financial assistance during the pandemic, Congress temporarily expanded the Child Tax Credit to reach more families and provide a larger credit per child.

Using survey data, Akansha Batra and coauthors find that this expansion was associated with "reduced anxiety symptoms among low-income adults with children, as well as greater mental health benefits among Black and Hispanic people than among White people."

From 2010 through 2014, Medicare phased in cost-sharing parity for outpatient mental health and substance use disorder (MHSUD) services, thereby reducing cost-sharing levels.

Vicki Fung and coauthors find that among White beneficiaries, the policy change was associated with an increase in relative rates of MHSUD specialty visits and medication use and a decrease in ED visits and hospitalizations related to MHSUD.

However, reductions in cost sharing were "associated with smaller or no gains in MHSUD use for racial and ethnic minority beneficiaries compared with White beneficiaries," yielding wider racial and ethnic disparities.

Hospitals

In 2016 the Centers for Medicare and Medicaid Services began reporting hospital star ratings as a summary measure of hospital quality. Steven Spivack and coauthors explore whether hospitals that serve socially vulnerable populations are disadvantaged in these ratings.

Although overall ratings are lower for hospitals caring for higher proportions of patients who are dually eligible for Medicare and Medicaid, there was inconsistency across elements of quality, such as mortality, safety, and patient experience.

Equity

To better understand barriers to diversity in the physician workforce, Louisa Holaday and coauthors investigate debt among medical residents by race and ethnicity.

They determine that disparities in debt among postgraduate medical resident trainees mirror broader national trends in wealth disparity. Black trainees were mostly likely to have debt, and "all trainees from populations that are underrepresented in medicine were generally more likely to have debt compared with Asian and White trainees."

J. Michael McWilliams and coauthors examine spending among community-dwelling, fee-for-service Medicare beneficiaries with an eye to risk-adjustment methods, which, they argue, "should encourage the desired level and distribution of spending, not entrench the status quo."

They find "that adding social factors, particularly race and ethnicity, to the [Hierarchical Condition Categories] model can entrench health disparities instead of reducing them, by lowering population-based payments to more accurately predicted levels of spending."

COVID-19

Using health plan data from twelve states during the first year of the COVID-19 pandemic, H. Stephen Kaye and Joseph Caldwell examine excess mortality among recipients of Medicaid home and community-based services who are younger than age sixty-five.

Excess mortality rates for this group of people with disabilities were 7.4 times those of community-dwelling Medicaid beneficiaries of the same age not receiving home and community-based services and 26.6 times those of the general population.

M. Kate Bundorf and coauthors draw on data from the second year of the pandemic to report that rates of employer-sponsored health insurance coverage stayed relatively flat in 2021, despite rising employment. About eight million people gained coverage in 2021 and early 2022, they estimate, driven primarily by increases in Medicaid and other public coverage.

This month, we'll feature authors from the January issue discussing topics like food insecurity, employer-sponsored insurance coverage and more.

Recently, Health Affairs Editor-in-Chief Alan Weil interviewed Jennifer Ng’andu, managing director at the Robert Wood Johnson Foundation of the Healthy Children and Families Program, to discuss how key federal income support policies relate to positive health outcomes.

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About Health Affairs

Health Affairs is the leading peer-reviewed journal at the intersection of health, health care, and policy. Published monthly by Project HOPE, the journal is available in print and online. Late-breaking content is also found through healthaffairs.org, Health Affairs Today, and Health Affairs Sunday Update.

Project HOPE is a global health and humanitarian relief organization that places power in the hands of local health care workers to save lives across the globe. Project HOPE has published Health Affairs since 1981.

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