Poster #77 - Medicaid Expansion and Immigrant Enrollment Coverage 2017-2023

• In Event: Saturday Poster Luncheon

Abstract

Since the passage of the Patient Protection and Affordable Care Act (ACA) in 2010, numerous studies have explored Medicaid expansion, a key component of the ACA. Although existing literature offers valuable insights into the impact of the ACA Medicaid expansion, the enrollment coverage of immigrants under this program remains underexplored. Most current research treats Medicaid beneficiaries as a broad category, with only a handful specifically addressing immigrant enrollees (see Stimpson and Wilson, 2018; KFF/LA Times, 2023; Bustamante et al., 2019). This indicates a significant gap in comparative studies between immigrants in expansion and non-expansion states, a gap that this study covers. This study examines the research question of whether the number of qualified immigrants enrolled in Medicaid differs in states that expanded Medicaid compared to those that did not. Studying the effects of Medicaid coverage on this group provides valuable insights for enhancing healthcare access for immigrants and addressing health insurance disparities. Understanding and overcoming coverage barriers is essential to ensure that all eligible individuals can access and benefit from Medicaid services.

The independent variable of the study is Medicaid expansion, while the dependent variable is immigrant enrollment. The study also considers other confounding variables such as state GDP, population size, and state governing party to examine the systemic factors driving immigrant Medicaid enrollment. It utilizes administrative datasets from the Centers for Medicare and Medicaid Services, the Bureau of Economic Analysis, and the National Governors Association. The datasets include all immigrants officially recorded in each state as enrollees, governors who have served, and states’ GDP between 2017 and 2023. Bivariate and multivariate regressions of the data were performed using Stata, and outputs were analyzed with a difference-in-differences model to compare changes in the intervention and control groups.

The study finds the following:

▪ States with Medicaid expansion see significantly higher immigrant enrollment, underscoring the critical role of expansion policies in enhancing healthcare coverage. 

▪ A pronounced negative impact of Republican governance on enrollment, suggesting that political leadership plays a crucial role in determining Medicaid access. 

▪ An observed positive correlation between state GDP and Medicaid enrollment, implying that as state GDP rises, Medicaid enrollment increases. 

▪ Overall, the study reveals differences in immigrant enrollment influenced by Medicaid expansion and shaped by governance (party ideology and expansion policies) and economic conditions (state GDP), providing valuable, data-driven insights for healthcare policymaking.

The paper concludes that qualified immigrants in expansion states have higher chances of being insured than those in non-expansion states. The discretionary decisions made by non-expansion states, primarily governed by Republicans, that hinder immigrants' access to insurance can result in more severe health issues by the time they seek care. This pronounced negative impact on enrollment provides insights for policymakers to promote ongoing expansion initiatives in states that have yet to adopt them. It can also enable policymakers to predict enrollment shifts tied to leadership changes. Additionally, the observed positive correlation between state GDP and Medicaid enrollment implies that federal policymakers could consider enhancing state matching funds in low-GDP areas. 

Author

• Issa Belmond Thullah, Virginia Commonwealth University
  Presenting Author