Prior research has found that gaining Medicaid eligibility improves physical and emotional health and household financial outcomes. For low-income parents, improvements in these domains could translate into changes in parenting patterns, which in turn could influence child development. Financial stress and parents’ emotional problems have both been linked to difficulties in parenting, conceptually under the family stress model, and in empirical research. Previous studies have established that positive parenting patterns contribute to an array of beneficial outcomes for children and can mitigate the harmful impact of other hardships. Heretofore, no studies have assessed the direct association between Medicaid eligibility expansion and child development outcomes.
The expansion of Medicaid under the Affordable Care Act (ACA) raised eligibility levels for parents in 19 states in 2014, and in additional states in subsequent years. While not as extensive as the expansion of Medicaid to childless adults under the ACA, this was nevertheless a substantial change. This study assessed whether this shift in policy impacted parents’ self-rated health and symptoms of depression, parenting patterns, and children’s social skills and behaviors.
I used data from the Early Childhood Longitudinal Survey, Kindergarten class of 2010-2011, a cohort study that followed a nationally representative sample of 18,000 students from their entrance into kindergarten in 2010 through 2016, when most were in 5th grade. This dataset collected information from multiple respondents each year. I limited the sample to households with incomes at 150% FPL or below. I used parental surveys to assess parents’ self-rated health and depressive symptoms. Parental surveys were also used to assess measures of parental-child communication and warmth, both measured with multi-item scales. Children’s social skills, externalizing behaviors, and internalizing behaviors were assessed by teachers. Children’s relational abilities were assessed by parents.
I estimated two-way fixed effects models with individual and year fixed effects to assess the impact of Medicaid expansion on the outcomes. I used linear regression models for continuous outcomes and linear probability models for dichotomous outcomes. Generally, models showed limited impacts of expanded Medicaid eligibility. I found some evidence for improvements in self-rated health for parents and parent-child warmth, but I interpret these results with caution given multiple hypothesis testing and inconsistency across some sensitivity tests. In the baseline specification, expanding Medicaid eligibility for parents from 0 to 100% of the FPL is marginally associated with a 5.7 percentage point reduction in the chance of a parent reporting fair or poor health (p < .1). The same level expansion is associated with an improvement in parent-child warmth of .33 points on a 9-point scale (p< .05).
A full understanding of the impacts of parental Medicaid on these outcomes would require additional research. The limited results in this study may be due to the modest magnitude of the expansion for parents that occurred in 2014. Research on larger expansions or on different populations, such as families with younger children, might find stronger effects.
|Advisor:||Markus, Anne R., Cordes, Joseph J.|
|Commitee:||Ku, Leighton, Rosenbaum, Sara|
|School:||The George Washington University|
|Department:||Public Policy & Administration|
|School Location:||United States -- District of Columbia|
|Source:||DAI 81/11(E), Dissertation Abstracts International|
|Subjects:||Public policy, Public health|
|Keywords:||Child development, Health insurance, Medicaid|
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