IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0272497.html
   My bibliography  Save this article

Association between median household income, state Medicaid expansion status, and COVID-19 outcomes across US counties

Author

Listed:
  • Tsikata Apenyo
  • Antonio Elias Vera-Urbina
  • Khansa Ahmad
  • Tracey H Taveira
  • Wen-Chih Wu

Abstract

Objective: To study the relationship between county-level COVID-19 outcomes (incidence and mortality) and county-level median household income and status of Medicaid expansion of US counties. Methods: Retrospective analysis of 3142 US counties was conducted to study the relationship between County-level median-household-income and COVID-19 incidence and mortality per 100,000 people in US counties, January-20th-2021 through December-6th-2021. County median-household-income was log-transformed and stratified by quartiles. Multilevel-mixed-effects-generalized-linear-modeling adjusted for county socio-demographic and comorbidities and tested for Medicaid-expansion-times-income-quartile interaction on COVID-19 outcomes. Results: There was no significant difference in COVID-19 incidence-rate across counties by income quartiles or by Medicaid expansion status. Conversely, for non-Medicaid-expansion states, counties in the lowest income quartile had a 41% increase in COVID-19 mortality-rate compared to counties in the highest income quartile. Mortality-rate was not related to income in counties from Medicaid-expansion states. Conclusions: Median-household-income was not related to COVID-19 incidence-rate but negatively related to COVID-19 mortality-rate in US counties of states without Medicaid-expansion.

Suggested Citation

  • Tsikata Apenyo & Antonio Elias Vera-Urbina & Khansa Ahmad & Tracey H Taveira & Wen-Chih Wu, 2022. "Association between median household income, state Medicaid expansion status, and COVID-19 outcomes across US counties," PLOS ONE, Public Library of Science, vol. 17(8), pages 1-12, August.
    • Handle: RePEc:plo:pone00:0272497
    DOI: 10.1371/journal.pone.0272497
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0272497
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0272497&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0272497?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Colleen M. Carey & Sarah Miller & Laura R. Wherry, 2020. "The Impact of Insurance Expansions on the Already Insured: The Affordable Care Act and Medicare," American Economic Journal: Applied Economics, American Economic Association, vol. 12(4), pages 288-318, October.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Shyam Raman & Johanna Catherine Maclean & W. David Bradford & Coleman Drake, 2023. "Recreational cannabis and opioid distribution," Health Economics, John Wiley & Sons, Ltd., vol. 32(4), pages 747-754, April.
    2. Scott Barkowski & Dajung Jun & Yuting Zhang, 2025. "Spillover effects of Medicaid expansion on Medicare: Evidence from administrative data," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 44(2), pages 579-611, March.
    3. Dillender, Marcus & Jinks, Lu & Lo Sasso, Anthony T., 2023. "When (and why) providers do not respond to changes in reimbursement rates," Journal of Public Economics, Elsevier, vol. 217(C).
    4. Sarah Miller & Norman Johnson & Laura R Wherry, 2021. "Medicaid and Mortality: New Evidence From Linked Survey and Administrative Data," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 136(3), pages 1783-1829.
    5. Conor Lennon, 2025. "Did the Affordable Care Act's Medicaid eligibility expansions crowd out private health insurance coverage?," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 44(1), pages 208-235, January.
    6. Bjoerkheim, Markus & Sigaud, Liam & Ampaabeng, Kofi, 2023. "The Effect of the Affordable Care Act's Medicaid Expansion on the Mental Health Of Already-Enrolled Medicaid Beneficiaries," Working Papers 12430, George Mason University, Mercatus Center.
    7. Geruso, Michael & Richards, Michael R., 2022. "Trading spaces: Medicare's regulatory spillovers on treatment setting for non-Medicare patients," Journal of Health Economics, Elsevier, vol. 84(C).
    8. Denis Agniel & Jonathan H. Cantor & Johanna Catherine Maclean & Kosali I. Simon & Erin Taylor, 2023. "Insurance Coverage and Provision of Opioid Treatment: Evidence from Medicare," NBER Working Papers 31884, National Bureau of Economic Research, Inc.
    9. Borgschulte, Mark & Vogler, Jacob, 2020. "Did the ACA Medicaid expansion save lives?," Journal of Health Economics, Elsevier, vol. 72(C).
    10. Guihua Wang, 2022. "The Effect of Medicaid Expansion on Wait Time in the Emergency Department," Management Science, INFORMS, vol. 68(9), pages 6648-6665, September.
    11. Dillender, Marcus & Friedson, Andrew & Gian, Cong & Simon, Kosali, 2019. "Does the healthcare educational market respond to short-run local demand?," Economics of Education Review, Elsevier, vol. 73(C).
    12. Barkowski, Scott & Jun, Dajung & Zhang, Yuting, 2022. "Medicaid Expansion Spillover Effects on Health Care Consumption and Coverage: Evidence from Medicare Administrative Data," MPRA Paper 112178, University Library of Munich, Germany.
    13. Liam Sigaud & Markus Bjoerkheim & Vitor Melo, 2024. "The Hidden Subsidy of the Affordable Care Act," Papers 2407.07217, arXiv.org.
    14. Kole Reddig, 2024. "Spillover between Medicare and Medicaid: Evidence from decreasing physician reimbursements," Contemporary Economic Policy, Western Economic Association International, vol. 42(2), pages 223-236, April.
    15. Dunn, Abe & Knepper, Matthew & Dauda, Seidu, 2021. "Insurance expansions and hospital utilization: Relabeling and reabling?," Journal of Health Economics, Elsevier, vol. 78(C).
    16. Neprash, Hannah T. & Zink, Anna & Sheridan, Bethany & Hempstead, Katherine, 2021. "The effect of Medicaid expansion on Medicaid participation, payer mix, and labor supply in primary care," Journal of Health Economics, Elsevier, vol. 80(C).
    17. Moiz Bhai & Danny Hughes, 2024. "Estimating Self-Selection in Medicare Advantage," Working Papers 2024-009, Human Capital and Economic Opportunity Working Group.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0272497. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.