The impact of Medicaid expansion on asthma-related health care services utilization and expenditure

Abstract

Objective

The purpose of this study was to examine the effect of Medicaid expansion on asthma-related health care services utilization and expenditures among low-income adult patients with asthma aged 26–64.

Methods

Using a pooled dataset from 2007 to 2018 Medical Expenditures Panel Surveys (MEPS), we implemented a multivariate difference-in-differences analysis, which compared changes in utilization and expenditures for asthma-related health care services among adult patients with asthma with income below 133% Federal Poverty Level (FPL) vs. above 133%–400% FPL, before and after Medicaid expansion in 2014. We used negative binomial models to analyze utilization outcomes. Expenditures were estimated using two-part models with logit as the first part and generalized linear models as the second part. Estimates were weighted for the complex multi-stage sampling design of MEPS.

Results

Medicaid expansion was associated with increases in both utilization and expenditures for asthma-related prescription drugs among low-income patients with asthma, by 1.8 prescription fills (p < 0.05) and $233 (p < 0.05) per year, respectively. No statistically significant association was detected for other asthma-related health care services.

Conclusion

Medicaid expansion led to an increase in accessibility of prescription drugs among low-income asthma patients, but had no effect on other asthma-related health care services.

Keywords:

• Health care utilization and expenditures
• medicaid expansion
• difference-in-differences
• prescription drugs

Disclosure statement

The authors declare that they have no conflict of interest.

Appendix 1. Effects of Medicaid expansion on asthma-related healthcare services utilization by patients with asthma aged 26–64.

Appendix 2. Effect of Medicaid expansion on asthma-related prescription drug expenditures by patients with asthma aged 26–64.

Appendix 3. Effect of Medicaid expansion on asthma-related emergency department visits expenditures by patients with asthma aged 26–64.

Appendix 4. Effect of Medicaid expansion on asthma-related hospital inpatient visits expenditures by patients with asthma aged 26–64.

Appendix 5. Effect of Medicaid expansion on asthma-related outpatient department visits expenditures by patients with asthma aged 26–64.

Appendix 6. Effect of Medicaid expansion on asthma-related office-based medical provider visits expenditures by patients with asthma aged 26–64.

Appendix 7. Effect of Medicaid expansion on asthma-related home health visits expenditures by patients with asthma aged 26–64.

Appendix 8. Medicaid adoption statutes.

Funding

The author(s) reported there is no funding associated with the work featured in this article.