| Evaluating the benefits of health reform has not included prospective measures of economic security, nor has it examined spillover effects to non-health related dimensions of economic well-being. This three-paper dissertation addresses these gaps in the literature and expands the study of economic well-being as it relates to health care. The three dissertation aims were to: 1) identify different prospective measures of economic insecurity, focusing on insecurity with respect to health and medical care, 2) evaluate how health care reform, as implemented by Massachusetts in 2006, reduced the risk of health related economic insecurity, and 3) determine if a state's decision to expand Medicaid was associated with reductions in county-level rates of food insecurity.;This dissertation's overall findings suggest that expanded insurance options under the Affordable Care Act (ACA) have the potential to improve the risk of health-related economic insecurity and that Medicaid expansions will likely have spillover effects on non-health economic hardships faced by families and communities. Results of our analyses in Aim 1 indicated that poor health, hospitalization, unmet medical needs, and unemployment are strong predictors of economic insecurity, as expected, but the effects vary for the different measures used to indicate economic insecurity. Aim 2 found that the odds of spending a high percentage of income on out-of-pocket medical spending reduced by 35% in post-reform Massachusetts (OR=0.65, CI [0.47-0.89), p-value <0.01). These findings support the hypothesis that the risk of insecurity will be reduced in a health care reform environment where health insurance is more affordable and accessible.;Results from Aim 3 demonstrated how health care reform, specifically the decision to expand Medicaid at the state-level, will likely have spillover effects on domains that are targeted by other safety net programs, e.g., food insecurity. Controlling for baseline characteristics, the preferred random intercept, random coefficient model found that the interaction term between early expansion and an indicator for a high Medicaid rate county was associated with significant declines in food insecurity rates (-2.62%, p=0.01). To the best of our knowledge, Aim 3 is the first to empirically evaluate the potential spillover effects of the ACA on food insecurity. |
