Graduate Thesis Or Dissertation

 

The Effect of Medicaid Expansion under the Patient Protection and Affordable Care Act on Health Insurance and Health Care Utilization Among Near- Elderly Individuals Transitioning into Medicare Public Deposited

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https://ir.library.oregonstate.edu/concern/graduate_thesis_or_dissertations/g445cm94r

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  • The enactment of the Patient Protection and Affordable Care Act (ACA) can be considered an important policy intervention in the context of the U.S. health care. The ACA supported non-elderly adults to obtain health insurance coverage. While Medicare provided health insurance to almost all elderly-adults (persons over 65), the ACA provisions supported the health insurance coverage for a large number of non-elderly adults, since 2014. Therefore, the magnitude of the gap between Medicare beneficiaries and nearly-elderly adults in the probability of being insured, the probability of having at least one personal health care provider and the utilization of health care services for asthma and diabetes could be expected to narrow in the post-ACA period. This dissertation, consisting of two studies, evaluated this narrowing effect for different race/ethnic groups and for genders. Study 1 evaluated the effect of the ACA on the race/ethnicity-based disparities in the status of insurance coverage, status of having at least one health care provider, and diabetes and asthma-related health care utilization among persons transitioning into Medicare at the age of 65. Data were retrieved from the Behavior Risk Factor Surveillance System Data for years 2010 to 2017 (n=3,767,441). The sample included persons aged from 60 to 70 from states that expanded Medicaid prior to 2017 (n=672,067). This study found that the ACA increased access to health insurance and access to personalized health care provision for pre-Medicaid near-elderly persons while not having a significant influence on the use of diabetes and asthma care utilization. This could be a result of improved access to insurance and health care provision that led to improved health condition of the pre-Medicare near-elderly persons that the need for asthma and diabetes care did not increase in the post-ACA period. The minority race/ethnic groups’ status of being insured still need to be improved to approach the status for males and require more policy attention while status of having personal health care among minorities continue to need significant improvement. Study 2 evaluated the effect of the Patient Protection and Affordable Care Act (ACA) on the gender-based disparities in the status of insurance coverage, status of having at least one health care provider, and diabetes and asthma related health care utilization among persons transitioning into Medicare at the age of 65. Data were retrieved from the Behavior Risk Factor Surveillance System Data for years 2010 to 2017 (n=3,767,441). The sample included persons aged from 60 to 70 from states that expanded Medicaid prior to 2017 (n=672,067). This study found that the ACA increased access to health insurance and access to personalized health care provision for pre-Medicaid near-elderly persons while not having a significant influence on the use of diabetes and asthma related care utilization. This could be a result of improved access to insurance and health care provision led to improved health condition of the pre-Medicare near-elderly persons that the need for asthma and diabetes care did not increase in the post-ACA period. The females’ status of being insured still need to be improved to approach the status for males and require more policy attention. The female’s status of having personal health care providers surpassed that of males in the post-ACA period even though the difference was not statistically significant.
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