{"id":"https://openalex.org/W4417153241","doi":"https://doi.org/10.1097/mlr.0000000000002254","title":"Health Insurance and Access to Care After Unemployment in Medicaid Expansion Versus Nonexpansion States During COVID-19","display_name":"Health Insurance and Access to Care After Unemployment in Medicaid Expansion Versus Nonexpansion States During COVID-19","publication_year":2025,"publication_date":"2025-11-18","ids":{"openalex":"https://openalex.org/W4417153241","doi":"https://doi.org/10.1097/mlr.0000000000002254","pmid":"https://pubmed.ncbi.nlm.nih.gov/41359010"},"language":"en","primary_location":{"id":"doi:10.1097/mlr.0000000000002254","doi":"https://doi.org/10.1097/mlr.0000000000002254","is_oa":false,"landing_page_url":"https://doi.org/10.1097/mlr.0000000000002254","pdf_url":null,"source":{"id":"https://openalex.org/S79233773","display_name":"Medical Care","issn_l":"0025-7079","issn":["0025-7079","1537-1948"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","doyens","jufo-2","ki-jl-2","medline","norway-2"],"host_organization":"https://openalex.org/P4310315671","host_organization_name":"Lippincott Williams & Wilkins","host_organization_lineage":["https://openalex.org/P4310315671","https://openalex.org/P4310318547"],"host_organization_lineage_names":["Lippincott Williams & Wilkins","Wolters Kluwer"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Medical Care","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref","pubmed"],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5036782734","display_name":"James Matthew Campbell","orcid":"https://orcid.org/0000-0002-4789-3825","observed_orcids":["https://orcid.org/0000-0002-4789-3825"]},"institutions":[{"id":"https://openalex.org/I130238516","display_name":"University of Minnesota","ror":"https://ror.org/017zqws13","country_code":"US","type":"education","lineage":["https://openalex.org/I130238516"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"James M. Campbell","raw_affiliation_strings":["Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN","institution_ids":["https://openalex.org/I130238516"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5112031827","display_name":"Jos\u00e9 J. Escarce","orcid":"https://orcid.org/0000-0001-9371-0068","observed_orcids":["https://orcid.org/0000-0001-9371-0068"]},"institutions":[{"id":"https://openalex.org/I161318765","display_name":"University of California, Los Angeles","ror":"https://ror.org/046rm7j60","country_code":"US","type":"education","lineage":["https://openalex.org/I161318765"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Jos\u00e9 J. Escarce","raw_affiliation_strings":["Department of Health Policy and Management, Fielding School of Public Health, University of California, UCLA, Los Angeles, CA","Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Health Policy and Management, Fielding School of Public Health, University of California, UCLA, Los Angeles, CA","institution_ids":["https://openalex.org/I161318765"]},{"raw_affiliation_string":"Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA","institution_ids":["https://openalex.org/I161318765"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5054947920","display_name":"Dennis R\u00fcnger","orcid":"https://orcid.org/0000-0002-0358-1483","observed_orcids":["https://orcid.org/0000-0002-0358-1483"]},"institutions":[{"id":"https://openalex.org/I161318765","display_name":"University of California, Los Angeles","ror":"https://ror.org/046rm7j60","country_code":"US","type":"education","lineage":["https://openalex.org/I161318765"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Dennis R\u00fcnger","raw_affiliation_strings":["Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA","institution_ids":["https://openalex.org/I161318765"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5014822677","display_name":"David Paul Eisenman","orcid":"https://orcid.org/0000-0003-4320-1331","observed_orcids":["https://orcid.org/0000-0003-4320-1331"]},"institutions":[{"id":"https://openalex.org/I161318765","display_name":"University of California, Los Angeles","ror":"https://ror.org/046rm7j60","country_code":"US","type":"education","lineage":["https://openalex.org/I161318765"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"David P. Eisenman","raw_affiliation_strings":["Community Health Sciences, Fielding School of Public Health, University of California, UCLA, Los Angeles, CA","Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Community Health Sciences, Fielding School of Public Health, University of California, UCLA, Los Angeles, CA","institution_ids":["https://openalex.org/I161318765"]},{"raw_affiliation_string":"Department of Medicine, Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA","institution_ids":["https://openalex.org/I161318765"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5030580706","display_name":"Peter J. Huckfeldt","orcid":"https://orcid.org/0000-0003-1593-4167","observed_orcids":["https://orcid.org/0000-0003-1593-4167"]},"institutions":[{"id":"https://openalex.org/I130238516","display_name":"University of Minnesota","ror":"https://ror.org/017zqws13","country_code":"US","type":"education","lineage":["https://openalex.org/I130238516"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"Peter J. Huckfeldt","raw_affiliation_strings":["Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN","institution_ids":["https://openalex.org/I130238516"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":2,"corresponding_author_ids":["https://openalex.org/A5030580706","https://openalex.org/A5036782734"],"corresponding_institution_ids":["https://openalex.org/I130238516"],"apc_list":null,"apc_paid":null,"fwci":0.0,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":{"value":0.32965884,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"64","issue":"1","first_page":"19","last_page":"28"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10391","display_name":"Healthcare Policy and Management","score":0.9984999895095825,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},"topics":[{"id":"https://openalex.org/T10391","display_name":"Healthcare Policy and Management","score":0.9984999895095825,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T11959","display_name":"Employment and Welfare Studies","score":0.0010999999940395355,"subfield":{"id":"https://openalex.org/subfields/3600","display_name":"General Health Professions"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11610","display_name":"Food Security and Health in Diverse Populations","score":9.999999747378752e-05,"subfield":{"id":"https://openalex.org/subfields/3600","display_name":"General Health Professions"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/medicaid-expansion","display_name":"Medicaid expansion","score":0.9990000128746033},{"id":"https://openalex.org/keywords/unemployment","display_name":"unemployment","score":0.7360000014305115},{"id":"https://openalex.org/keywords/health-insurance-coverage","display_name":"health insurance coverage","score":0.9819999933242798},{"id":"https://openalex.org/keywords/uninsurance","display_name":"uninsurance","score":0.6809999942779541},{"id":"https://openalex.org/keywords/health-care-access","display_name":"health care access","score":0.8569999933242798},{"id":"https://openalex.org/keywords/delayed-medical-care","display_name":"delayed care","score":0.6140000224113464},{"id":"https://openalex.org/keywords/employer-sponsored-health-insurance","display_name":"employer-sponsored health insurance","score":0.8230000138282776},{"id":"https://openalex.org/keywords/working-age-adults","display_name":"working-age adults","score":0.7630000114440918},{"id":"https://openalex.org/keywords/state-medicaid-policy","display_name":"state Medicaid policy","score":0.41600000858306885}],"concepts":[{"id":"https://openalex.org/C2776534028","wikidata":"https://www.wikidata.org/wiki/Q1141363","display_name":"Medicaid","level":3,"score":0.9059000015258789},{"id":"https://openalex.org/C2778126366","wikidata":"https://www.wikidata.org/wiki/Q41171","display_name":"Unemployment","level":2,"score":0.8203999996185303},{"id":"https://openalex.org/C2983635472","wikidata":"https://www.wikidata.org/wiki/Q334911","display_name":"Health insurance","level":3,"score":0.6829000115394592},{"id":"https://openalex.org/C144133560","wikidata":"https://www.wikidata.org/wiki/Q4830453","display_name":"Business","level":0,"score":0.48820000886917114},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.47269999980926514},{"id":"https://openalex.org/C162118730","wikidata":"https://www.wikidata.org/wiki/Q1128453","display_name":"Actuarial science","level":1,"score":0.37880000472068787},{"id":"https://openalex.org/C4249254","wikidata":"https://www.wikidata.org/wiki/Q3044431","display_name":"Demographic economics","level":1,"score":0.3443000018596649},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.3127000033855438},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.30070000886917114},{"id":"https://openalex.org/C99454951","wikidata":"https://www.wikidata.org/wiki/Q932068","display_name":"Environmental health","level":1,"score":0.28060001134872437},{"id":"https://openalex.org/C2993080335","wikidata":"https://www.wikidata.org/wiki/Q294308","display_name":"Public health insurance","level":4,"score":0.26510000228881836},{"id":"https://openalex.org/C2780877353","wikidata":"https://www.wikidata.org/wiki/Q2518253","display_name":"Health services research","level":3,"score":0.26489999890327454}],"mesh":[],"locations_count":3,"locations":[{"id":"doi:10.1097/mlr.0000000000002254","doi":"https://doi.org/10.1097/mlr.0000000000002254","is_oa":false,"landing_page_url":"https://doi.org/10.1097/mlr.0000000000002254","pdf_url":null,"source":{"id":"https://openalex.org/S79233773","display_name":"Medical Care","issn_l":"0025-7079","issn":["0025-7079","1537-1948"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","doyens","jufo-2","ki-jl-2","medline","norway-2"],"host_organization":"https://openalex.org/P4310315671","host_organization_name":"Lippincott Williams & Wilkins","host_organization_lineage":["https://openalex.org/P4310315671","https://openalex.org/P4310318547"],"host_organization_lineage_names":["Lippincott Williams & Wilkins","Wolters Kluwer"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Medical Care","raw_type":"journal-article"},{"id":"pmid:41359010","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/41359010","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Medical care","raw_type":"Journal Article"},{"id":"pmid:41359418","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/41359418","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Medical care","raw_type":"Journal Article"}],"best_oa_location":null,"sustainable_development_goals":[{"display_name":"Decent work and economic growth","score":0.9211000204086304,"id":"https://metadata.un.org/sdg/8"},{"display_name":"Good health and well-being","score":0.8371999859809875,"id":"https://metadata.un.org/sdg/3"},{"display_name":"Reduced inequalities","score":0.7578999996185303,"id":"https://metadata.un.org/sdg/10"},{"display_name":"No poverty","score":0.41670000553131104,"id":"https://metadata.un.org/sdg/1"}],"sustainable_development_goals_aurora":[],"study_designs":[{"display_name":"Observational Study","id":"https://openalex.org/study-designs/observational-study"}],"awards":[],"funders":[],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":18,"referenced_works":["https://openalex.org/W1606675402","https://openalex.org/W1830759370","https://openalex.org/W1972991952","https://openalex.org/W2102905683","https://openalex.org/W2113212232","https://openalex.org/W2654438086","https://openalex.org/W3122925988","https://openalex.org/W3157986539","https://openalex.org/W3160809923","https://openalex.org/W3194582427","https://openalex.org/W3198469010","https://openalex.org/W4200272573","https://openalex.org/W4281700030","https://openalex.org/W4283075254","https://openalex.org/W4362473643","https://openalex.org/W4367597202","https://openalex.org/W4385511773","https://openalex.org/W4387397019"],"related_works":[],"abstract_inverted_index":{"BACKGROUND:":[0],"Prior":[1],"work":[2],"has":[3],"shown":[4],"that":[5,240],"Medicaid":[6,18,25,53,103,122,241],"coverage":[7,47,123],"offset":[8],"reductions":[9],"in":[10,17,52,85,102,121,128,143,166,182,203,213,218,245],"employer-sponsored":[11],"insurance":[12,46],"after":[13],"COVID-19-related":[14],"job":[15],"loss":[16],"expansion":[19,26,54,104,129,167,219,242],"states.":[20,57,107],"However,":[21],"the":[22,38,125,155,163,192,222,250],"effect":[23],"of":[24,40],"on":[27,75],"health":[28,45,49,246],"care":[29,50,208,247],"access":[30,51,248],"is":[31],"not":[32,142,217],"fully":[33],"understood.":[34],"OBJECTIVE:":[35],"To":[36],"estimate":[37],"association":[39],"unemployment":[41],"during":[42,253],"COVID-19":[43],"with":[44,111],"and":[48,93,221],"versus":[55,105,179],"nonexpansion":[56,106,144,183,214],"STUDY":[58],"DESIGN:":[59],"We":[60],"used":[61],"restricted,":[62],"longitudinal":[63],"National":[64],"Health":[65],"Interview":[66],"Survey":[67],"(NHIS)":[68],"data":[69],"from":[70],"2019":[71,92],"to":[72,98,138,151,176,188,233],"2020,":[73],"focusing":[74],"working-age":[76],"adults":[77],"(N=5156).":[78],"Using":[79],"triple-difference":[80],"models,":[81],"we":[82],"estimated":[83],"changes":[84],"outcomes":[86],"for":[87,249],"respondents":[88,212],"becoming":[89],"unemployed":[90,127,165,211,252],"between":[91],"2020":[94],"(after":[95],"COVID-19)":[96],"relative":[97],"continuously":[99,112],"employed":[100,113],"respondents,":[101,114],"PRINCIPAL":[108],"FINDINGS:":[109],"Compared":[110],"there":[115],"was":[116,158,195,199,225],"a":[117,200],"statistically":[118,196,226],"significant":[119,201,227],"increase":[120,202],"among":[124,162,209],"newly":[126,164,210,251],"states":[130,145,168,184,220],"(6.1":[131],"percentage":[132],"points":[133],"(pp),":[134],"95%":[135,148,230],"CI:":[136,149,174,186,231],"1.0":[137],"11.3,":[139],"P=0.019)":[140],"but":[141,191,216],"(3.9":[146],"pp,":[147,229],"-3.9":[150],"11.8,":[152],"P=0.324);":[153],"however,":[154],"triple":[156,193,223],"difference":[157,194,224],"nonsignificant.":[159,197],"Uninsurance":[160],"increased":[161],"by":[169],"only":[170],"4.9":[171],"pp":[172,181],"(95%":[173,185],"0.9":[175],"8.9,":[177],"P=0.016)":[178],"12.4":[180],"0.2":[187],"24.6,":[189],"P=0.047),":[190],"There":[198],"delaying":[204],"or":[205],"skipping":[206],"medical":[207],"states,":[215],"(-15.5":[228],"-26.9":[232],"-4.0,":[234],"P=0.008).":[235],"CONCLUSION:":[236],"Our":[237],"results":[238],"suggest":[239],"prevented":[243],"disruptions":[244],"COVID-19.":[254]},"counts_by_year":[],"updated_date":"2026-09-26T08:19:03.415552","created_date":"2025-12-08T00:00:00"}
