One common argument from opponents of the Affordable Care Act is that an expansion of government into health care will result in "crowd out", where private influences and coverage go down as public ones go up.
But that's not always the case, as seen in a study just released by the NEJM (Full disclosure, I'm one of the authors of this work). "Dependent Coverage under the ACA and Medicaid Coverage for Childbirth."
In the United States, rates of uninsurance have been historically high among young adults (19 to 26 years of age). One of the first implemented provisions of the Affordable Care Act (ACA) was a mandate that all private-insurance family policies cover dependents until 26 years of age. Estimates suggest that this provision has reduced the rate of uninsurance among young adults by approximately 10%. Childbirth, the major reason for hospitalization of young adults, has received little attention in prior literature on the mandate.
As I've written many times, Medicaid is a huge source of coverage for babies born in the United States. Even before the ACA, Medicaid covered all pregnant mothers who were earning less than 133% of the federal poverty level. In 2010, Medicaid financed 45% of all births in the United States. This means, of course, that relatively few births are uninsured. In 2009, only about 5% of deliveries to young adults were uninsured, more than 60% were Medicaid covered.
One of the provisions of the ACA was that young adults (YA) could stay on their insurance until they were 26 years of age. It's possible, therefore, that this would mean that some of them would no longer need to rely on Medicaid for coverage of giving birth. We wanted to test that hypothesis. We used two different data sources. The first was the natality files from the CDC and the second was the Nationwide Inpatient Sample from AHRQ. For both, we compared mothers age 19-25 years to mothers age 27-29 years, before and after the YA provision went into effect, before 2010 and after 2011.
We found that the rates of Medicaid covered births for YA, while increasing before 2010, decreased after 2011. They were also increasing before 2010 for 27-29 year-olds, but continued to increase after 2011:
Private coverage, on the other hand, while decreasing before 2010, showed an increase in YA after 2011. The reduction in private coverage for those age 27-29 years old seen before 2010 seemed to continue after 2011 as well:
The results were similar in both data sources. In other words, the YA provision of the ACA seems to be associated with a significant increase in private coverage of childbirth among YA, and a significant decrease in Medicaid coverage. Granted, it's a specific expenditure, but it's not an uncommon one.
As people take sides over the added expense of the ACA to the nation's public health care spending, getting YA off of Medicaid's rolls and onto private insurance for childbirth is an interesting step in a good direction.
Read the whole article here.