MEDICAID EXPANSION DURING THE COVID-19 PANDEMIC: An analysis of preventive screening rates following Medicaid expansion

Abstract

Preventive medicine is a widely accepted means to improving health outcomes among populations and access to healthcare coverage is a critical step to increasing preventive screening rates. As states have continued to expand Medicaid eligibility under the Affordable Care Act (ACA), previous studies identified significant changes in preventive screening rates following expansion. However, none of these studies occurred during the COVID-19 pandemic. This study focuses on how expansion of Medicaid during the COVID-19 pandemic by Utah and Idaho may have influenced preventive healthcare, including cancer screening, diabetes screening, cholesterol screening, HIV screening, and influenza vaccination status, among low-income, non-elderly adults. Using the CDC Behavioral Risk Factor Surveillance System (BRFSS) survey dataset to perform a difference-in-difference (DiD) analysis of preventive care rates in expansion vs. non-expansion states during between two time points, 2018-2019 (pre-period) and 2020-2021 (post-period). This study identifies statistically significant increases in healthcare coverage DiD estimate 6.1%, p = <0.001), routine check-ups (DiD estimate 3.2%, p = 0.003), influenza vaccination (DiD estimate 2.8%, p = 0.008), and HIV screening (DiD estimate 6.5%, p = <0.001) among expansion states. This study did not identify statistically significant differences in trends (change from pre- to post- period) in cancer, diabetes, and cholesterol screening rates when comparing expansion and non-expansion states. This study indicates that Medicaid expansion during the COVID-19 pandemic resulted in preventive screening rate changes which differ from similar studies conducted prior to the pandemic. Future studies are needed to determine (i) why increases in healthcare coverage and routine check-ups are not indicative of increases in preventive screening, and (ii) how factors related to the COVID-19 pandemic influenced these deviations. If consistent increases in physician visits yet low preventive care rates continue to be observed following the COVID-19 pandemic, additional considerations toward implementing patient education and support services, and/or value-based prevention incentives among physicians concurrent with expansion of coverage mechanisms may be needed.