Saturday, April 1, 2023
4/1/2023
Medicaid expansion under the Affordable Care Act, wherein states have the option to expand Medicaid coverage to adults with household incomes up to 138 percent of the federal poverty level, has been shown to reduce mortality rates nationwide. From 2014 to 2018, mortality rates dropped 3.6% more in states that expanded Medicaid than those that did not. Although the impact of Medicaid expansion on mortality is well-documented, its impact on mortality disparities remains underexamined. The overarching goal of this study is to identify the relationship between Medicaid expansion and rural-urban ethnoracial disparities, while also estimating the mediating role of poverty alleviation in this relationship. This study is significant because it: 1) focuses on mortality disparity reduction instead of the simple reduction of mortality, 2) analyzes the impact of Medicaid expansion on intersectional mortality disparities, meaning disparities found at the intersection of multiple health disparity populations (e.g. black and rural), and 3) identifies the indirect effect of Medicaid expansion on intersectional mortality disparities through poverty alleviation. The innovations of this project center on three contributions. First, it will provide an explicit analysis of mortality disparity reduction as opposed to just aggregate impacts on different groups; Second, the study will generate an updated and improved cost-of-living adjustment for the Supplemental Poverty Measure, as well as county-level estimates of the Supplemental Poverty Measure. Third, the study will provide a robust analysis of the mediating role of poverty in the relationship between Medicaid expansion and intersectional mortality disparity reduction. The project will be completed through three specifics aims. In Aim 1, we will estimate the effect of Medicaid expansion on ethnoracial mortality disparities by rural-urban status from 2011 to 2019. We will do so using time- varying difference-in-difference design with marginal prediction analysis via census data and restricted data from the National Vital Statistics System. In Aim 2, we will improve the cost-of- living adjustment in the existing Supplemental Poverty Measure and estimate the improved measure at the county level from 2011 to 2019. We will do so using restricted American Community Survey and Current Population Survey data housed in the Federal Statistical Research Data Centers to create a county-specific cost-of-living adjustment and corresponding county-specific poverty thresholds. In Aim 3, we will estimate the mediating role of poverty reduction in the relationship between Medicaid expansion and rural-urban ethnoracial mortality disparities from 2011 to 2019. We will do so by integrating our estimates of the supplemental poverty measure with our difference-in-difference models from Aim 1.
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).
