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The effect of Medicaid expansion on Medicaid participation, payer mix, and labor supply in primary care

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  • Neprash, Hannah T.
  • Zink, Anna
  • Sheridan, Bethany
  • Hempstead, Katherine
Abstract
Evidence of increased health care utilization associated with the Medicaid expansion suggests that clinicians increased capacity to meet demand. However, little is known about the mechanism underlying this response. Using a novel source of all-payer data, we quantified clinicians’ response to the Medicaid expansion – examining whether and how they changed their Medicaid participation decisions, payer mix, and overall labor supply. Primary care clinicians in expansion states provided an average of 49 additional appointments per year (a 21% relative increase) for patients insured by Medicaid, compared to clinicians in non-expansion states - with new-patient visits representing half (25 appointments) of this overall increase. Clinicians did not increase their labor supply to accommodate these additional appointments. They instead offset the 1.7 percentage point average increase in Medicaid payer mix with an equivalent reduction in commercial payer mix. However, this reduction in commercial patient share represented only a 2.8% relative decrease, with commercially insured patients still comprising the majority of the average clinician's patient panel. Subsample analyses revealed a larger increase in care for Medicaid patients among clinicians with high Medicaid participation preceding the eligibility expansion.

Suggested Citation

  • Neprash, Hannah T. & Zink, Anna & Sheridan, Bethany & Hempstead, Katherine, 2021. "The effect of Medicaid expansion on Medicaid participation, payer mix, and labor supply in primary care," Journal of Health Economics, Elsevier, vol. 80(C).
    • Handle: RePEc:eee:jhecon:v:80:y:2021:i:c:s0167629621001260
    DOI: 10.1016/j.jhealeco.2021.102541
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    References listed on IDEAS

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    Cited by:

    1. Kole Reddig, 2024. "Spillover between Medicare and Medicaid: Evidence from decreasing physician reimbursements," Contemporary Economic Policy, Western Economic Association International, vol. 42(2), pages 223-236, April.
    2. Erkmen G. Aslim & Murat C. Mungan & Han Yu, 2024. "A welfare analysis of Medicaid and recidivism," Health Economics, John Wiley & Sons, Ltd., vol. 33(11), pages 2463-2507, November.
    3. Nicole Black & Anthony Harris & David W. Johnston & Trong-Anh Trinh, 2024. "Workforce Impacts of Subsidised Mental Healthcare: Evidence on Supply, Earnings, and Geographic Distribution," Papers 2024-17, Centre for Health Economics, Monash University.
    4. Liam Sigaud & Markus Bjoerkheim & Vitor Melo, 2024. "The Hidden Subsidy of the Affordable Care Act," Papers 2407.07217, arXiv.org.
    5. Gangopadhyaya, Anuj & Schiman, Jeffrey C., 2023. "Does subsidized public health insurance for parents improve children's human capital and close achievement gaps?," Economics of Education Review, Elsevier, vol. 93(C).

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    More about this item

    Keywords

    Medicaid; Primary care; Payer mix; Labor supply;
    All these keywords.

    JEL classification:

    • H53 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Welfare Programs
    • H75 - Public Economics - - State and Local Government; Intergovernmental Relations - - - State and Local Government: Health, Education, and Welfare
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • I38 - Health, Education, and Welfare - - Welfare, Well-Being, and Poverty - - - Government Programs; Provision and Effects of Welfare Programs

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