This simple demonstration will explore the impact of the increase in Medicaid eligibility as a percentage of the federal poverty line.
I will be exploring trends in four separate data sets. First, I will look at the number of emergency room visits per thousand Americans, pear year, as measured by the Kaiser Family Foundation:
## [1] "Emergency Room Visits Per Thousand Americans"
## Min. 1st Qu. Median Mean 3rd Qu. Max.
## 372.0 400.5 415.5 415.4 437.0 445.0
Second, I will explore the percentage of Americans who report foregoing medical care due to cost per year with data from the State Health Data Compare Assistance Center :
## [1] "Percentage of Americans Reporting Foregoing Medical Care Due to Cost"
## Min. 1st Qu. Median Mean 3rd Qu. Max.
## 0.09881 0.13262 0.13523 0.13790 0.14630 0.16928
Third, I will examine the net assets and debts of Americans in the lowest 20th percentile of income earners per year using data from the Federal Reserve’s Consumer Finances Survey:
## [1] "Assets and Debts of Lowest 20% of American Earners"
## Assets Debt
## Min. :12.61 Min. : 7.654
## 1st Qu.:15.88 1st Qu.: 9.670
## Median :17.67 Median :10.739
## Mean :21.49 Mean :10.341
## 3rd Qu.:26.15 3rd Qu.:11.395
## Max. :36.11 Max. :11.860
Finally, I will explore the reported health statuses of Americans per year using data from the Center for Disease Control. This data reports the percentage of Americans claiming “fair” or “poor” health by year.
This dataset separates health statuses by demographics, including gender:
## [1] "Health Status by Gender"
## Male Female
## Min. :0.08700 Min. :0.09100
## 1st Qu.:0.08800 1st Qu.:0.09275
## Median :0.09000 Median :0.09600
## Mean :0.08979 Mean :0.09600
## 3rd Qu.:0.09100 3rd Qu.:0.09875
## Max. :0.09400 Max. :0.10100
Race:
## [1] "Health Status by Race"
## White Black Hispanic
## Min. :0.0820 Min. :0.1340 Min. :0.1200
## 1st Qu.:0.0835 1st Qu.:0.1360 1st Qu.:0.1247
## Median :0.0865 Median :0.1425 Median :0.1290
## Mean :0.0860 Mean :0.1417 Mean :0.1281
## 3rd Qu.:0.0880 3rd Qu.:0.1455 3rd Qu.:0.1318
## Max. :0.0900 Max. :0.1500 Max. :0.1330
And income level. These variables report health statuses for Americans based on their income as a percentage of the federal poverty line (e.g., the variable “100to199pct” is the reported health status of individuals earning between 100% and 199% of the poverty line).
## [1] "Health Status by Income Level"
## Under100pct Btwn100and199pct Btwn200and399pct Over400pct
## Min. :0.1980 Min. :0.1420 Min. :0.07900 Min. :0.03900
## 1st Qu.:0.2067 1st Qu.:0.1440 1st Qu.:0.08225 1st Qu.:0.04025
## Median :0.2110 Median :0.1490 Median :0.08400 Median :0.04250
## Mean :0.2108 Mean :0.1477 Mean :0.08421 Mean :0.04250
## 3rd Qu.:0.2157 3rd Qu.:0.1500 3rd Qu.:0.08675 3rd Qu.:0.04375
## Max. :0.2180 Max. :0.1540 Max. :0.09000 Max. :0.04700
The Center for Disease Control’s health status dataset allows us to demonstrate that changes in health status will affect different communities in different magnitues. As the above summary statistics imply, black and hispanic Americans are much more likely to report “poor” or “fair” health than White americans:
Similarly, women are more likely to report subpar health than men:
This chart shows the median national eligibility limit for Medicaid coverage, measured as a percentage of the federal poverty line (this data was retrieved from the Kaiser Family Foundation). In 2013, the median eligibility leaps up to 138% due to the implementation of the Affordable Care Act.
It is important to note that this is the median value rather than the national eligibility limit.
The following data trends will attempt to identify trends that may have been driven by this leap upwards to 138%, with the blue dashed line signifying the implementation of the increased eligibility limit.
First, let’s look at trend in hospital visits:
The Affordable Care Act appears to have no impact on the number of Americans visiting emergency rooms. There is a noticeable decline in 2020 which is almost certainly due to the Covid-19 public health emergency rather than a delayed response to changes in Medicaid eligibility.
Next let’s exlpore Americans foregoing medical care:
Unlike emergency room visits, the percentage of Americans foregoing care due to cost burdens seems to have been impacted by the Affordable Care Act. The percentage has seen a steady decline since 2013, with only 10% reporting foregoing care in 2021.
Next we’ll look at assets and debts of the poorest Americans:
We would expect Medicaid expansion to have an impact on the personal finances of the poorest Americans given (1) the increased financial security and reduced risk of medical bankruptcy for those with health insurance as opposed to the uninsured, and (2) the presences of state-imposed asset ceilings restricting Medicaid eligibility regardless of one’s income.
Unfortunately, this dataset only contains two data points after 2013 per metric, per year, which does not give us a particularly thorough understanding of the post-ACA trend. However, we can see that after 2013, the trend of declining assets and increasing debt appears to have been disrupted.
Next, we’ll explore the health status of those living under the federal poverty line:
There does not appear to be a cohesive narrative in this data. The pattern is jagged, with the Medicaid expansion not appearing to have an observable impact on the percentage of the impoverished reporting subpar health. While there is a decline between 2013 and 2014, this is not a compelling trend. The decline can be potentially be explained by low-income Americans reporting improved health with the expectation that they will attain health insurance, only to be left uninsured due to National Federation of Independent Business v. Sebelius limiting the expansion of state Medicaid programs or a lack of education or outreach regarding eligibility and enrollment.
The same appears to be true for all income levels:
We can see a clear stratification between reported health status and income level, with higher incomes corresponding with improved health and less variation. However, no income strata appears to have seen a significant change after the implementation of the Affordable Care Act.