Examining the effects of the Medicaid expansion on: Social welfare, healthcare utilization, and uncompensated care

This dissertation includes three chapters examining various effects of the Medicaid expansion through the Affordable Care Act (ACA). I explore the topic of implementation and how it can lead to reformulation of policies, to other outcomes not expected, or even to outright failure. I then apply the theory of implementation to three topics the Medicaid expansion is affecting. The first paper explorers how the enhanced matching rates affect the overall spending and cost-sharing between the federal government and state government. Specifically, I explorer the behavior of state spending and how states allocate intergovernmental grants. Previous research has shown that states respond to large increases in the federal Medicaid subsidy in a stimulative manner by increasing spending towards other programs. A logistic regression was performed to predict the Medicaid expansion’s impact on state spending on social welfare between the years 2011, 2013, and 2015. Overall, the results are consistent with my hypothesis that expansion states use intergovernmental matching grants towards social welfare. The second paper explores the increased access of health insurance through the Medicaid Expansion. A difference-in-difference regression (state-in state-out methodology) is utilized to observe the differences in outcomes. I utilize a natural quasi-experimental approach to assess the impact of a large nationwide public health insurance expansion on access to health care services, health care utilization, and health outcomes between expansion states and non-expansion states. I found that Medicaid expansion’s impact on utilization was positive as blood pressure medication and cholesterol checks increased and a decrease decreased percentage of individuals in the state who needed to see a doctor in the last 12 months, but did not because of cost relative to non-expansion states. I found a 1.1 percent increase in healthcare access in expansion states. The Third paper explorers the Medicaid expansion’s effect on uncompensated care and Medicaid DSH payment. Safety net hospitals are the last line of opportunity for the poor, uninsured, elderly, and disabled seeking healthcare. Safety net hospitals take an enormous amount of uncompensated care due to the lack of insurance. The Federal Government provides funding to hospitals to treat indignant populations through disproportionate funding programs, under which facilities are able to receive partial compensation through Medicaid DSH payment. The Affordable Care Act will reduce the amount of funding towards Medicaid DSH programs, and congressional action has delayed the cuts until the fiscal year 2018. I utilize a difference-in-difference regression (state-in state-out methodology) and logistic regression to observe if there was a decrease in uncompensated care and DSH payments in expansion states and non-expansion states (control). The results are mixed. There is a reduction in uncompensated care in expansion states versus non-expansion states, however, there is no statistical significance. There is statistical significance in the reduction of DSH payment in expansion states versus non-expansion states. The results from the chapters give insight into the implementation status of the Medicaid expansion. The final chapter summarizes the findings from the three dissertation papers and makes several policy perspectives related to the Medicaid expansion in the Patient Protection and Affordable Care Act.U of I OnlyAuthor submitted a U of I access extension request