Medicaid Medicaid/Medicare

Medicaid Expansions and Crowd Out

Most previous research into Medicaid expansions focus on extending coverage to pregnant women or children. However, a recent Section 1115 waiver allows for researcher to examine what happens when Medicaid coverage is extended to a larger share of adults. This is exactly what a paper by Atherly et al. (2015) examines:

…prior to ACA adults generally have not been eligible for Medicaid. One exception is the Health Insurance Flexibility and Accountability (HIFA) initiative, which extended Medicaid coverage to a variety of typically ineligible populations and explicitly allowed the inclusion of childless adults, offering new opportunities to explore crowd-out…HIFA targeted individuals with incomes below 200 percent of the federal poverty level

Did HIFA give insurance to the uninsured or were people switching from commercial plans to HIFA? Based on a survey of almost 800 individuals, the authors find that:

Most HIFA enrollees (91 percent) reported being uninsured prior to participation
in HIFA. Of those who were uninsured, most reported having been
uninsured for an extended time…Prior to joining HIFA programs, a large share of enrollees had been without health insurance for more than a year (59 percent in NM and 69 percent in OR) or had never had health insurance (16 percent in NM and 9 percent in OR).


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