The Mortality Effects of Reduced Medicaid Coverage Among International Migrants in Hawaii: 2012–2018

Tim Halliday, Health, Publications

Objectives: To study the impact on mortality in Hawaii from the revoked state Medicaid program coverage in March 2015 for most Compact of Free Association (COFA) migrants who were nonblind, nondisabled, and nonpregnant.

Methods: We computed quarterly crude mortality rates for COFA migrants, Whites, and Japanese Americans from March 2012 to November 2018. We employed a difference-in-difference research design to estimate the impact of the Medicaid expiration on log mortality rates.

Results: We saw larger increases in COFA migrant mortality rates than White mortality rates after March 2015. By 2018, the increase was 43% larger for COFA migrants (P = .003). Mortality trends over this period were similar for Whites and Japanese Americans, who were not affected by the policy.

Conclusions: Mortality rates of COFA migrants increased after Medicaid benefits expired despite the availability of state-funded premium coverage for private insurance and significant outreach efforts to reduce the impact of this coverage change.

Leave a Comment

Your email address will not be published. Required fields are marked *

The University of Hawaii Economic Research Organization (UHERO) welcomes online comments to stories that are posted on our website or social media pages. Comments are intended to be a forum for open, respectful, and family-friendly discussion. UHERO reserves the right to remove anything posted on our website or social media pages that is deemed inappropriate. All comments are moderated and will therefore have a delayed post time.
Some guidelines (not an exhaustive list) we use when moderating/approving comments include:

  • Do not bully, intimidate, or harass any user.
  • Do not post content that is hateful, threatening or wildly off-topic; or do anything unlawful, malicious, discriminatory or defamatory.
  • Observe confidentiality laws at all times.
  • Do not post spam or advertisements.
  • Observe fair use, copyright and disclosure laws.
  • Do not use vulgar language or profanity.

UHERO may amend this policy from time to time.