Spillover benefit of improved access to healthcare on reducing worry about housing and meal affordability

Background The Affordable Care Act Medicaid expansion improved access to health insurance among low-income populations. We sought to examine the spillover benefits of the ACA Medicaid expansion on ability to afford rent/mortgage and purchase of nutritious meals. Methods Using data from the Behaviora...
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Autor*in:	Kino, Shiho [verfasserIn] Sato, Koryu Kawachi, Ichiro

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2018

Schlagwörter:	Patient protection affordable care act Health insurance House stability Food security Causal inference

Anmerkung:	© The Author(s). 2018

Übergeordnetes Werk:	Enthalten in: International journal for equity in health - London : BioMed Central, 2002, 17(2018), 1 vom: 22. Nov.
Übergeordnetes Werk:	volume:17 ; year:2018 ; number:1 ; day:22 ; month:11

Links:	Volltext

DOI / URN:	10.1186/s12939-018-0877-y

Katalog-ID:	SPR028716248

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520			\|a Background The Affordable Care Act Medicaid expansion improved access to health insurance among low-income populations. We sought to examine the spillover benefits of the ACA Medicaid expansion on ability to afford rent/mortgage and purchase of nutritious meals. Methods Using data from the Behavioral Risk Factor Surveillance System (BRFSS) we analyzed individuals aged 18–64 years residing in 12 U.S. states (including five ACA Medicaid expansion states) in 2015. Our treatment of interest was access to health insurance, instrumented by the ACA Medicaid expansion. Our outcome variables were: worry or stress about having sufficient money to pay the rent or mortgage and to purchase nutritious meals. We conducted a two-stage least squares instrumental variables regression. Results A 10%-point increase in the proportion of those who obtained health insurance following the ACA Medicaid expansion reduced the probability of being worried and stressed related to purchasing nutritious meals by 7.2% points (95% CI: 1.3–13.2) as well as paying the rent or mortgage by 8.6% points (95% CI: 2.5–14.7) among people living below 138% of the federal poverty level (FPL). The ACA Medicaid expansion was not associated with access to health insurance among those living over 138% of FPL, and obtaining health insurance did not influence stress or worry in relation to affording rent/mortgage or meals in this income group. Conclusions Improved access to health insurance contributed to reducing worry and stress associated with paying rent/mortgage or purchasing meals among low-income people. Expanding health insurance access may have contributed to increasing the disposable income of low income groups.
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allfields	10.1186/s12939-018-0877-y doi (DE-627)SPR028716248 (SPR)s12939-018-0877-y-e DE-627 ger DE-627 rakwb eng Kino, Shiho verfasserin (orcid)0000-0002-9349-4980 aut Spillover benefit of improved access to healthcare on reducing worry about housing and meal affordability 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s). 2018 Background The Affordable Care Act Medicaid expansion improved access to health insurance among low-income populations. We sought to examine the spillover benefits of the ACA Medicaid expansion on ability to afford rent/mortgage and purchase of nutritious meals. Methods Using data from the Behavioral Risk Factor Surveillance System (BRFSS) we analyzed individuals aged 18–64 years residing in 12 U.S. states (including five ACA Medicaid expansion states) in 2015. Our treatment of interest was access to health insurance, instrumented by the ACA Medicaid expansion. Our outcome variables were: worry or stress about having sufficient money to pay the rent or mortgage and to purchase nutritious meals. We conducted a two-stage least squares instrumental variables regression. Results A 10%-point increase in the proportion of those who obtained health insurance following the ACA Medicaid expansion reduced the probability of being worried and stressed related to purchasing nutritious meals by 7.2% points (95% CI: 1.3–13.2) as well as paying the rent or mortgage by 8.6% points (95% CI: 2.5–14.7) among people living below 138% of the federal poverty level (FPL). The ACA Medicaid expansion was not associated with access to health insurance among those living over 138% of FPL, and obtaining health insurance did not influence stress or worry in relation to affording rent/mortgage or meals in this income group. Conclusions Improved access to health insurance contributed to reducing worry and stress associated with paying rent/mortgage or purchasing meals among low-income people. Expanding health insurance access may have contributed to increasing the disposable income of low income groups. Patient protection affordable care act (dpeaa)DE-He213 Health insurance (dpeaa)DE-He213 House stability (dpeaa)DE-He213 Food security (dpeaa)DE-He213 Causal inference (dpeaa)DE-He213 Sato, Koryu aut Kawachi, Ichiro aut Enthalten in International journal for equity in health London : BioMed Central, 2002 17(2018), 1 vom: 22. Nov. (DE-627)356253716 (DE-600)2092056-8 1475-9276 nnns volume:17 year:2018 number:1 day:22 month:11 https://dx.doi.org/10.1186/s12939-018-0877-y kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_375 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4367 GBV_ILN_4700 AR 17 2018 1 22 11
spelling	10.1186/s12939-018-0877-y doi (DE-627)SPR028716248 (SPR)s12939-018-0877-y-e DE-627 ger DE-627 rakwb eng Kino, Shiho verfasserin (orcid)0000-0002-9349-4980 aut Spillover benefit of improved access to healthcare on reducing worry about housing and meal affordability 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s). 2018 Background The Affordable Care Act Medicaid expansion improved access to health insurance among low-income populations. We sought to examine the spillover benefits of the ACA Medicaid expansion on ability to afford rent/mortgage and purchase of nutritious meals. Methods Using data from the Behavioral Risk Factor Surveillance System (BRFSS) we analyzed individuals aged 18–64 years residing in 12 U.S. states (including five ACA Medicaid expansion states) in 2015. Our treatment of interest was access to health insurance, instrumented by the ACA Medicaid expansion. Our outcome variables were: worry or stress about having sufficient money to pay the rent or mortgage and to purchase nutritious meals. We conducted a two-stage least squares instrumental variables regression. Results A 10%-point increase in the proportion of those who obtained health insurance following the ACA Medicaid expansion reduced the probability of being worried and stressed related to purchasing nutritious meals by 7.2% points (95% CI: 1.3–13.2) as well as paying the rent or mortgage by 8.6% points (95% CI: 2.5–14.7) among people living below 138% of the federal poverty level (FPL). The ACA Medicaid expansion was not associated with access to health insurance among those living over 138% of FPL, and obtaining health insurance did not influence stress or worry in relation to affording rent/mortgage or meals in this income group. Conclusions Improved access to health insurance contributed to reducing worry and stress associated with paying rent/mortgage or purchasing meals among low-income people. Expanding health insurance access may have contributed to increasing the disposable income of low income groups. Patient protection affordable care act (dpeaa)DE-He213 Health insurance (dpeaa)DE-He213 House stability (dpeaa)DE-He213 Food security (dpeaa)DE-He213 Causal inference (dpeaa)DE-He213 Sato, Koryu aut Kawachi, Ichiro aut Enthalten in International journal for equity in health London : BioMed Central, 2002 17(2018), 1 vom: 22. Nov. (DE-627)356253716 (DE-600)2092056-8 1475-9276 nnns volume:17 year:2018 number:1 day:22 month:11 https://dx.doi.org/10.1186/s12939-018-0877-y kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_375 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4367 GBV_ILN_4700 AR 17 2018 1 22 11
allfields_unstemmed	10.1186/s12939-018-0877-y doi (DE-627)SPR028716248 (SPR)s12939-018-0877-y-e DE-627 ger DE-627 rakwb eng Kino, Shiho verfasserin (orcid)0000-0002-9349-4980 aut Spillover benefit of improved access to healthcare on reducing worry about housing and meal affordability 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s). 2018 Background The Affordable Care Act Medicaid expansion improved access to health insurance among low-income populations. We sought to examine the spillover benefits of the ACA Medicaid expansion on ability to afford rent/mortgage and purchase of nutritious meals. Methods Using data from the Behavioral Risk Factor Surveillance System (BRFSS) we analyzed individuals aged 18–64 years residing in 12 U.S. states (including five ACA Medicaid expansion states) in 2015. Our treatment of interest was access to health insurance, instrumented by the ACA Medicaid expansion. Our outcome variables were: worry or stress about having sufficient money to pay the rent or mortgage and to purchase nutritious meals. We conducted a two-stage least squares instrumental variables regression. Results A 10%-point increase in the proportion of those who obtained health insurance following the ACA Medicaid expansion reduced the probability of being worried and stressed related to purchasing nutritious meals by 7.2% points (95% CI: 1.3–13.2) as well as paying the rent or mortgage by 8.6% points (95% CI: 2.5–14.7) among people living below 138% of the federal poverty level (FPL). The ACA Medicaid expansion was not associated with access to health insurance among those living over 138% of FPL, and obtaining health insurance did not influence stress or worry in relation to affording rent/mortgage or meals in this income group. Conclusions Improved access to health insurance contributed to reducing worry and stress associated with paying rent/mortgage or purchasing meals among low-income people. Expanding health insurance access may have contributed to increasing the disposable income of low income groups. Patient protection affordable care act (dpeaa)DE-He213 Health insurance (dpeaa)DE-He213 House stability (dpeaa)DE-He213 Food security (dpeaa)DE-He213 Causal inference (dpeaa)DE-He213 Sato, Koryu aut Kawachi, Ichiro aut Enthalten in International journal for equity in health London : BioMed Central, 2002 17(2018), 1 vom: 22. Nov. (DE-627)356253716 (DE-600)2092056-8 1475-9276 nnns volume:17 year:2018 number:1 day:22 month:11 https://dx.doi.org/10.1186/s12939-018-0877-y kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_375 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4367 GBV_ILN_4700 AR 17 2018 1 22 11
allfieldsGer	10.1186/s12939-018-0877-y doi (DE-627)SPR028716248 (SPR)s12939-018-0877-y-e DE-627 ger DE-627 rakwb eng Kino, Shiho verfasserin (orcid)0000-0002-9349-4980 aut Spillover benefit of improved access to healthcare on reducing worry about housing and meal affordability 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s). 2018 Background The Affordable Care Act Medicaid expansion improved access to health insurance among low-income populations. We sought to examine the spillover benefits of the ACA Medicaid expansion on ability to afford rent/mortgage and purchase of nutritious meals. Methods Using data from the Behavioral Risk Factor Surveillance System (BRFSS) we analyzed individuals aged 18–64 years residing in 12 U.S. states (including five ACA Medicaid expansion states) in 2015. Our treatment of interest was access to health insurance, instrumented by the ACA Medicaid expansion. Our outcome variables were: worry or stress about having sufficient money to pay the rent or mortgage and to purchase nutritious meals. We conducted a two-stage least squares instrumental variables regression. Results A 10%-point increase in the proportion of those who obtained health insurance following the ACA Medicaid expansion reduced the probability of being worried and stressed related to purchasing nutritious meals by 7.2% points (95% CI: 1.3–13.2) as well as paying the rent or mortgage by 8.6% points (95% CI: 2.5–14.7) among people living below 138% of the federal poverty level (FPL). The ACA Medicaid expansion was not associated with access to health insurance among those living over 138% of FPL, and obtaining health insurance did not influence stress or worry in relation to affording rent/mortgage or meals in this income group. Conclusions Improved access to health insurance contributed to reducing worry and stress associated with paying rent/mortgage or purchasing meals among low-income people. Expanding health insurance access may have contributed to increasing the disposable income of low income groups. Patient protection affordable care act (dpeaa)DE-He213 Health insurance (dpeaa)DE-He213 House stability (dpeaa)DE-He213 Food security (dpeaa)DE-He213 Causal inference (dpeaa)DE-He213 Sato, Koryu aut Kawachi, Ichiro aut Enthalten in International journal for equity in health London : BioMed Central, 2002 17(2018), 1 vom: 22. Nov. (DE-627)356253716 (DE-600)2092056-8 1475-9276 nnns volume:17 year:2018 number:1 day:22 month:11 https://dx.doi.org/10.1186/s12939-018-0877-y kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_375 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4367 GBV_ILN_4700 AR 17 2018 1 22 11
allfieldsSound	10.1186/s12939-018-0877-y doi (DE-627)SPR028716248 (SPR)s12939-018-0877-y-e DE-627 ger DE-627 rakwb eng Kino, Shiho verfasserin (orcid)0000-0002-9349-4980 aut Spillover benefit of improved access to healthcare on reducing worry about housing and meal affordability 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s). 2018 Background The Affordable Care Act Medicaid expansion improved access to health insurance among low-income populations. We sought to examine the spillover benefits of the ACA Medicaid expansion on ability to afford rent/mortgage and purchase of nutritious meals. Methods Using data from the Behavioral Risk Factor Surveillance System (BRFSS) we analyzed individuals aged 18–64 years residing in 12 U.S. states (including five ACA Medicaid expansion states) in 2015. Our treatment of interest was access to health insurance, instrumented by the ACA Medicaid expansion. Our outcome variables were: worry or stress about having sufficient money to pay the rent or mortgage and to purchase nutritious meals. We conducted a two-stage least squares instrumental variables regression. Results A 10%-point increase in the proportion of those who obtained health insurance following the ACA Medicaid expansion reduced the probability of being worried and stressed related to purchasing nutritious meals by 7.2% points (95% CI: 1.3–13.2) as well as paying the rent or mortgage by 8.6% points (95% CI: 2.5–14.7) among people living below 138% of the federal poverty level (FPL). The ACA Medicaid expansion was not associated with access to health insurance among those living over 138% of FPL, and obtaining health insurance did not influence stress or worry in relation to affording rent/mortgage or meals in this income group. Conclusions Improved access to health insurance contributed to reducing worry and stress associated with paying rent/mortgage or purchasing meals among low-income people. Expanding health insurance access may have contributed to increasing the disposable income of low income groups. Patient protection affordable care act (dpeaa)DE-He213 Health insurance (dpeaa)DE-He213 House stability (dpeaa)DE-He213 Food security (dpeaa)DE-He213 Causal inference (dpeaa)DE-He213 Sato, Koryu aut Kawachi, Ichiro aut Enthalten in International journal for equity in health London : BioMed Central, 2002 17(2018), 1 vom: 22. Nov. (DE-627)356253716 (DE-600)2092056-8 1475-9276 nnns volume:17 year:2018 number:1 day:22 month:11 https://dx.doi.org/10.1186/s12939-018-0877-y kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_375 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4367 GBV_ILN_4700 AR 17 2018 1 22 11
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Results A 10%-point increase in the proportion of those who obtained health insurance following the ACA Medicaid expansion reduced the probability of being worried and stressed related to purchasing nutritious meals by 7.2% points (95% CI: 1.3–13.2) as well as paying the rent or mortgage by 8.6% points (95% CI: 2.5–14.7) among people living below 138% of the federal poverty level (FPL). The ACA Medicaid expansion was not associated with access to health insurance among those living over 138% of FPL, and obtaining health insurance did not influence stress or worry in relation to affording rent/mortgage or meals in this income group. Conclusions Improved access to health insurance contributed to reducing worry and stress associated with paying rent/mortgage or purchasing meals among low-income people. 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author	Kino, Shiho
spellingShingle	Kino, Shiho misc Patient protection affordable care act misc Health insurance misc House stability misc Food security misc Causal inference Spillover benefit of improved access to healthcare on reducing worry about housing and meal affordability
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topic_title	Spillover benefit of improved access to healthcare on reducing worry about housing and meal affordability Patient protection affordable care act (dpeaa)DE-He213 Health insurance (dpeaa)DE-He213 House stability (dpeaa)DE-He213 Food security (dpeaa)DE-He213 Causal inference (dpeaa)DE-He213
topic	misc Patient protection affordable care act misc Health insurance misc House stability misc Food security misc Causal inference
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title	Spillover benefit of improved access to healthcare on reducing worry about housing and meal affordability
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title_full	Spillover benefit of improved access to healthcare on reducing worry about housing and meal affordability
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title_sort	spillover benefit of improved access to healthcare on reducing worry about housing and meal affordability
title_auth	Spillover benefit of improved access to healthcare on reducing worry about housing and meal affordability
abstract	Background The Affordable Care Act Medicaid expansion improved access to health insurance among low-income populations. We sought to examine the spillover benefits of the ACA Medicaid expansion on ability to afford rent/mortgage and purchase of nutritious meals. Methods Using data from the Behavioral Risk Factor Surveillance System (BRFSS) we analyzed individuals aged 18–64 years residing in 12 U.S. states (including five ACA Medicaid expansion states) in 2015. Our treatment of interest was access to health insurance, instrumented by the ACA Medicaid expansion. Our outcome variables were: worry or stress about having sufficient money to pay the rent or mortgage and to purchase nutritious meals. We conducted a two-stage least squares instrumental variables regression. Results A 10%-point increase in the proportion of those who obtained health insurance following the ACA Medicaid expansion reduced the probability of being worried and stressed related to purchasing nutritious meals by 7.2% points (95% CI: 1.3–13.2) as well as paying the rent or mortgage by 8.6% points (95% CI: 2.5–14.7) among people living below 138% of the federal poverty level (FPL). The ACA Medicaid expansion was not associated with access to health insurance among those living over 138% of FPL, and obtaining health insurance did not influence stress or worry in relation to affording rent/mortgage or meals in this income group. Conclusions Improved access to health insurance contributed to reducing worry and stress associated with paying rent/mortgage or purchasing meals among low-income people. Expanding health insurance access may have contributed to increasing the disposable income of low income groups. © The Author(s). 2018
abstractGer	Background The Affordable Care Act Medicaid expansion improved access to health insurance among low-income populations. We sought to examine the spillover benefits of the ACA Medicaid expansion on ability to afford rent/mortgage and purchase of nutritious meals. Methods Using data from the Behavioral Risk Factor Surveillance System (BRFSS) we analyzed individuals aged 18–64 years residing in 12 U.S. states (including five ACA Medicaid expansion states) in 2015. Our treatment of interest was access to health insurance, instrumented by the ACA Medicaid expansion. Our outcome variables were: worry or stress about having sufficient money to pay the rent or mortgage and to purchase nutritious meals. We conducted a two-stage least squares instrumental variables regression. Results A 10%-point increase in the proportion of those who obtained health insurance following the ACA Medicaid expansion reduced the probability of being worried and stressed related to purchasing nutritious meals by 7.2% points (95% CI: 1.3–13.2) as well as paying the rent or mortgage by 8.6% points (95% CI: 2.5–14.7) among people living below 138% of the federal poverty level (FPL). The ACA Medicaid expansion was not associated with access to health insurance among those living over 138% of FPL, and obtaining health insurance did not influence stress or worry in relation to affording rent/mortgage or meals in this income group. Conclusions Improved access to health insurance contributed to reducing worry and stress associated with paying rent/mortgage or purchasing meals among low-income people. Expanding health insurance access may have contributed to increasing the disposable income of low income groups. © The Author(s). 2018
abstract_unstemmed	Background The Affordable Care Act Medicaid expansion improved access to health insurance among low-income populations. We sought to examine the spillover benefits of the ACA Medicaid expansion on ability to afford rent/mortgage and purchase of nutritious meals. Methods Using data from the Behavioral Risk Factor Surveillance System (BRFSS) we analyzed individuals aged 18–64 years residing in 12 U.S. states (including five ACA Medicaid expansion states) in 2015. Our treatment of interest was access to health insurance, instrumented by the ACA Medicaid expansion. Our outcome variables were: worry or stress about having sufficient money to pay the rent or mortgage and to purchase nutritious meals. We conducted a two-stage least squares instrumental variables regression. Results A 10%-point increase in the proportion of those who obtained health insurance following the ACA Medicaid expansion reduced the probability of being worried and stressed related to purchasing nutritious meals by 7.2% points (95% CI: 1.3–13.2) as well as paying the rent or mortgage by 8.6% points (95% CI: 2.5–14.7) among people living below 138% of the federal poverty level (FPL). The ACA Medicaid expansion was not associated with access to health insurance among those living over 138% of FPL, and obtaining health insurance did not influence stress or worry in relation to affording rent/mortgage or meals in this income group. Conclusions Improved access to health insurance contributed to reducing worry and stress associated with paying rent/mortgage or purchasing meals among low-income people. Expanding health insurance access may have contributed to increasing the disposable income of low income groups. © The Author(s). 2018
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title_short	Spillover benefit of improved access to healthcare on reducing worry about housing and meal affordability
url	https://dx.doi.org/10.1186/s12939-018-0877-y
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up_date	2024-07-03T21:16:06.291Z
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Results A 10%-point increase in the proportion of those who obtained health insurance following the ACA Medicaid expansion reduced the probability of being worried and stressed related to purchasing nutritious meals by 7.2% points (95% CI: 1.3–13.2) as well as paying the rent or mortgage by 8.6% points (95% CI: 2.5–14.7) among people living below 138% of the federal poverty level (FPL). The ACA Medicaid expansion was not associated with access to health insurance among those living over 138% of FPL, and obtaining health insurance did not influence stress or worry in relation to affording rent/mortgage or meals in this income group. Conclusions Improved access to health insurance contributed to reducing worry and stress associated with paying rent/mortgage or purchasing meals among low-income people. 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Spillover benefit of improved access to healthcare on reducing worry about housing and meal affordability

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