Early childhood Medicaid exposure linked to adult health outcomes

Expanding publicly funded health insurance to low-income children could have long-term benefits for adult health, according to new research from the University of Maryland School of Public Health. Published in the Journal of Health Economics, the study found that exposure to Medicaid in early childhood, from conception through age 5, is associated with significant improvements in adult health (age 25 to 54). The research suggests that the improvement in health may be linked to greater access to and use of health services by children whose families received Medicaid, and a decreased economic burden on families from medical expenses and debt.

"There's growing recognition that what happens to you as a child is carried with you throughout life," said Dr. Michel H. Boudreaux, lead researcher and assistant professor in the Department of Health Services Administration at the University of Maryland School of Public Health. "Investing in young children could have important payoffs and our study suggests that the benefits of Medicaid may persist for decades into the future."

Considerable research has shown short-term benefits from health programs for low-income children, but little research has examined the long-term effects of Medicaid and similar programs on health and economic status. Medicaid is a major federal program that provides coverage to 35 percent (28 million) of children under age 19 (according to a 2013 study) and accounts for 8 percent of all federal spending (according to a 2012 study). As the Affordable Care Act has led to expansion of Medicaid in some states, while others states have opted out, understanding the long-term effects of investments in children's health is of increasing importance. "Dr. Boudreaux's groundbreaking study provides critical new information that has important implications for federal and state Medicaid policy," says Genevieve Kenney, co-director of the Urban Institute's Health Policy Center.

Capitalizing on the staggered roll-out of Medicaid across US states, largely in the late 1960s Dr. Boudreaux and his colleagues were able to isolate Medicaid's impact during early childhood on the midlife health and economic status of low-income children. Rather than examine individual families' use of Medicaid services, researchers compared the period of time from conception to sixth birthday that low-income children were eligible for Medicaid. Using data on adults from the Panel Study of Income Dynamics, researchers compared cohorts who had no opportunity to receive Medicaid in early childhood, some exposure, and full exposure from conception through age five.

Greater exposure to Medicaid during early childhood was associated with a significant and meaningful improvement in midlife health using a composite index that combines information on high blood pressure, diabetes, heart disease/heart attack, and obesity. Low-income children's exposure to Medicaid throughout early childhood relative to no exposure is associated with a 22 percent decrease in the prevalence of high blood pressure among adults. Researchers also examined the economic impact of exposure to Medicaid in early childhood on adult economic status, but were unable to show a significant association.

Dr. Boudreaux points to two mechanisms that link early childhood Medicaid exposure to adult health outcomes: childhood health service use and family medical debt. Researchers found that Medicaid exposure increased hospital usage by low-income children four percent during early childhood and that Medicaid's introduction is associated with a decrease in medical debt in households that have children, freeing up resources that could be invested in kids in other ways.