Medicaid expansion programs: effects on Medicaid enrollment and healthcare employment Public Deposited

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  • March 19, 2019
  • Morrison, Marisa
    • Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
  • This dissertation examines the effects of Section 1115 coverage expansions on health insurance coverage and healthcare employment. Although Section 1115 expansions had smaller enrollments than the Patient Protection and Affordable Care Act’s (ACA) Medicaid expansion, they—like the ACA’s Medicaid expansion—extended publicly financed health insurance to low-income adults who were previously ineligible for such coverage. Therefore, studying the effects of Section 1115 expansions can provide insights into the longer-term effects of the ACA’s Medicaid expansion. In the dissertation’s first analysis, I construct multinomial probit models in Current Population Survey Annual Social and Economic Supplement data to evaluate Section 1115 expansions’ effects on health insurance coverage for “pre-expansion eligible” parents and children. These pre-expansion eligible individuals were eligible for Medicaid or the Children’s Health Insurance Program (CHIP) under rules in place prior to or in the absence of Section 1115 expansions. I find that the probability of public coverage enrollment increased for pre-expansion eligible children and parents and that the probability of private coverage declined for pre-expansion eligible parents after Section 1115 expansions. Because Section 1115 expansions were associated with an increased probability of Medicaid or CHIP enrollment among pre-expansion eligible individuals, the ACA’s effect on pre-expansion eligible individuals’ enrollment in public coverage is likely to be larger. Second, I use ordinary least squares (OLS) models with county and year fixed effects to estimate Section 1115 expansions’ effects on county-level health care and social assistance employment. This study’s principal data set is County Business Patterns data. I find that Section 1115 expansions were associated with increases in county-level health care and social assistance employment across all states with changes in expansion status during the study period. This finding suggests that healthcare employment could grow in response to public coverage expansions. Finally, I use OLS models with hospital and year fixed effects to examine Section 1115 expansions’ effects on hospital employment. This study’s key data source is the American Hospital Association annual survey. I find that these expansions were not associated with hospital employment growth. Applying these findings to the ACA’s coverage expansion suggests that the ACA could have small effects on hospital employment.
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Rights statement
  • In Copyright
  • Perreira, Krista
  • Oberlander, Jonathan
  • Holmes, George M.
  • Domino, Marisa
  • Silberman, Pam
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2015
Place of publication
  • Chapel Hill, NC
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