The 2014 Medicaid expansion excluded Americans who were 65 years old and older, but they could still be affected via spillover effects. Using Medicare administrative data, we test for spillovers in Medicare spending and Medicaid coverage among low‐income Medicare beneficiaries. We analyze two cohorts: those under 65 in 2014, who could have been induced by the expansion to take up Medicaid before joining Medicare; and those 65 or older in 2014, whose Medicaid eligibility was never affected by the expansion. We only find spillovers for the under‐65 cohort, where Medicare spending fell and Medicaid coverage increased, with no measurable adverse effect on mortality. Combined with a null effect for the over‐65 cohort, these facts suggest Medicare beneficiaries were not crowded out of health care by the expansion. Instead, those under‐65 cohort satisfied “pent‐up” demand via Medicaid, consuming care they would have otherwise obtained later under Medicare.

中文翻译：

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医疗补助扩大对医疗保险的溢出效应：来自行政数据的证据


2014 年医疗补助的扩大排除了 65 岁及以上的美国人，但他们仍可能受到溢出效应的影响。使用 Medicare 管理数据，我们测试了低收入 Medicare 受益人的 Medicare 支出和 Medicaid 覆盖率的溢出效应。我们分析了两个群体：2014 年 65 岁以下的人，他们可能在加入 Medicare 之前受到扩张的诱导而参加 Medicaid;以及 2014 年 65 岁或以上的人，他们的 Medicaid 资格从未受到扩展的影响。我们只发现了 65 岁以下人群的溢出效应，其中医疗保险支出下降，医疗补助覆盖率增加，对死亡率没有可衡量的不利影响。再加上对 65 岁以上人群的零效应，这些事实表明 Medicare 受益人并没有因扩张而被挤出医疗保健。相反，那些 65 岁以下的群体通过 Medicaid 满足了“被压抑”的需求，消耗了他们以后在 Medicare 下本可以获得的护理。