Access to Employer-Health Insurance, or Not, Among the Medicaid Eligible Workforce

• In Event: Revisiting Medicaid Expansion and Work: Labor Supply, Coverage, and Economic Adjustment Across Populations

Abstract

One of the major changes to US healthcare under the One Big Beautiful Bill Act (OBBBA) is the federally-mandated work requirements as a condition for Medicaid eligibility beginning in January 2027 for able-bodied adults without dependents (e.g., working-aged childless adults). Prior studies from a small number of states found little evidence that Medicaid work requirements lead to improvements in labor market participation and are associated with reductions in Medicaid enrollment and net coverage rates. Several studies highlight virtually all of the Medicaid population whom work requirements would apply to are either working or would qualify for an exemption (e.g., caretaker responsibility, schooling, qualifying disability), less attention is given to their alternative sources of coverage if their states were to scale back eligibility in response to reductions in the Federal contributions to Medicaid financing. After states apply their strategies to comply with the OBBBA’s work requirements, we anticipate reductions in enrollment for many who gained eligibility under the Affordable Care Act (ACA), but we know little about their access to alternative sources of health insurance–employer-sponsored health insurance (ESI) coverage.Revisiting the impacts of the ACA’s Medicaid expansions, our study explores the impacts of the ACA with respect to pre-ACA industry and occupational ESI offer rates–the share of workers receiving ESI. Our analytical data set uses the Current Population Survey’s Annual Social and Economic (ASEC) covering calendar years 2010-2019, and we constructed state and a) occupational- and b) industry-specific ESI offer rates using the American Community Survey (ACS). We apply a difference-in-difference-in-differences (i.e., triple-difference or DDD) regression framework exploiting the timing of state Medicaid expansion decisions interacted with pre-ACA ESI offer rate for the sample person in the CPS. Our preliminary findings suggest coverage gains stemming from the ACA Medicaid expansions were generally larger among workers in occupations and industries with limited access to ESI before the ACA.We recognize that uncoupling health insurance benefits from work can make participation and attachment endogenous. To that end, we observed that Medicaid expansion was associated with increases in a) the number of unique occupations and industries, and b) the number of occupations and industries with historically low ESI offer rates represented among the Medicaid-covered workforce. We believe our descriptive results hold important implications for the workforce using Medicaid as their primary source of health insurance coverage. Even though most Medicaid-covered workers will be considered compliant with the new eligibility guidelines, many at risk of losing coverage because of additional changes in Medicaid financing may not have access to ESI and would have difficulty affording nongroup (e.g., marketplace) coverage without subsidies.

Author

• Joseph Benitez, University of Kentucky
  Presenting Author