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The Impact of Medicaid on Medical Utilization in a Vulnerable Population: Evidence from COFA Migrants

Author

Listed:
  • Timothy J. Halliday
  • Randall Q. Akee
  • Tetine Sentell
  • Megan Inada
  • Jill Miyamura
Abstract
In March 2015, the State of Hawaii stopped covering the vast majority of migrants from countries belonging to the Compact of Free Association (COFA) in the state Medicaid program. COFA migrants were instead required to obtain private insurance in the exchanges established under the Affordable Care Act. Using statewide administrative hospital discharge data, we show that Medicaid-funded hospitalizations and emergency room visits declined in this population by 69% and 42% after the expiration of Medicaid eligibility. This decrease occurred despite the fact that low-income COFA households were eligible for state-funded premium coverage for private insurance. Utilization funded by private insurance did increase, but not enough to offset the declines in Medicaid-funded utilization. Uninsured ER visits increased as a consequence of the expiration of Medicaid benefits. Paradoxically, we also find a substantial increase in Medicaid-funded ER visits by infants after the expiration of benefits.

Suggested Citation

  • Timothy J. Halliday & Randall Q. Akee & Tetine Sentell & Megan Inada & Jill Miyamura, 2019. "The Impact of Medicaid on Medical Utilization in a Vulnerable Population: Evidence from COFA Migrants," NBER Working Papers 26030, National Bureau of Economic Research, Inc.
    • Handle: RePEc:nbr:nberwo:26030
    Note: CH EH LS PE
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    References listed on IDEAS

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    1. Timothy J. Halliday & Randall Q. Akee, 2020. "The impact of Medicaid on medical utilization in a vulnerable population: Evidence from COFA migrants," Health Economics, John Wiley & Sons, Ltd., vol. 29(10), pages 1231-1250, October.
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    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Chris Sampson’s journal round-up for 12th October 2020
      by Chris Sampson in The Academic Health Economists' Blog on 2020-10-12 11:00:03

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    Cited by:

    1. Jonathan Gruber & Benjamin D. Sommers, 2019. "The Affordable Care Act’s Effects on Patients, Providers and the Economy: What We’ve Learned So Far," NBER Working Papers 25932, National Bureau of Economic Research, Inc.
    2. Daniel Sebastian Tello‐Trillo, 2021. "Effects of losing public health insurance on preventative care, health, and emergency department use: Evidence from the TennCare disenrollment," Southern Economic Journal, John Wiley & Sons, vol. 88(1), pages 322-366, July.
    3. Timothy J. Halliday & Randall Q. Akee, 2020. "The impact of Medicaid on medical utilization in a vulnerable population: Evidence from COFA migrants," Health Economics, John Wiley & Sons, Ltd., vol. 29(10), pages 1231-1250, October.

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    More about this item

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • J61 - Labor and Demographic Economics - - Mobility, Unemployment, Vacancies, and Immigrant Workers - - - Geographic Labor Mobility; Immigrant Workers

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