Sound policy trumps politics: states should expand Medicaid

The effect of Medicaid expansions on demand for care from the Veterans Health Administration

BACKGROUND

Adequate access to care at Veterans Health Administration (VA) medical centers has become a high-profile policy issue. The Affordable Care Act (ACA) could improve access to care for veterans, particularly if its Medicaid expansion is implemented in all states. The relationship between Medicaid expansion on the one hand and VA enrollment and utilization on the other has not previously been explored for all states.

METHODS

Using VA and other public data from 2002 to 2008, we calculated a measure of Medicaid eligibility sensitive to state-year varying policy change but not changes in demographics or economic conditions. Next, controlling for potential confounding factors, we estimated fixed effects Poisson models of VA enrollment and inpatient and outpatient utilization. We then used these estimates to simulate the effect of the ACA׳s Medicaid expansion on demand for VA care.

RESULTS

If the ACA׳s Medicaid expansion had been implemented in all states, enrollment for VA health coverage, acute inpatient care (days), and outpatient visits would have been 9%, 6%, and 12% lower, respectively. In states that did not expand Medicaid in 2014, VA enrollment, inpatient days, and outpatient visits were, respectively, 10, 6, and 13 percentage points higher than they would have been otherwise.

CONCLUSION

VA medical centers in states that did not expand Medicaid in 2014 are likely to have experienced a higher demand, and commensurately longer wait times. As policymakers continue to address VA capacity issues, they should be mindful of the potential role of Medicaid, and that it will change over time as more states adopt the expansion.

Employment hardships and single mothers' self-rated health: evidence from the panel study of income dynamics

Using a national sample of single mothers from the 2007 and 2009 waves of the Panel Study of Income Dynamics, this study examined the effects of multiple employment statuses on the selfrated health of single mothers during the recent economic recession. Unlike other studies, the current study minimized selection bias by controlling for prior self-rated health, in addition to other predisposing factors, enabling factors, and need factors. We found that underemployment, but not unemployment, is associated with lower levels of self-rated health of single mothers. Results further indicate that the 25-39 age range (compared to the 18-24 age range), lower family income, prior lower self-rated health, more chronic diseases, and binge drinking place single mothers at an increased risk of lower levels of self-rated health. In contrast, strength-building physical activity is significantly associated with higher levels of self-rated health. Implications for health care policy and social work practice are drawn from the results.