We examine whether fees paid by Medicaid for primary care affects the use of health care services among adults with Medicaid coverage who have a high school or less than high school degree. The analysis spans the large changes in Medicaid fees that occurred before and after the ACA-mandated fee increase for primary care services in 2013–2014. We use data from the Behavioral Risk Factors Surveillance System and a difference-in-differences approach to estimate the association between Medicaid fees and whether a person has a personal doctor; a routine check-up or flu shot in the past year; whether a woman had a pap test or a mammogram in the past year; whether a person has ever been diagnosed with asthma, diabetes, cardiovascular diseases, cancer, COPD, arthritis, depression, or kidney diseases; and, whether a person reports good-to-excellent health. Estimates indicate that Medicaid fee increases were associated with small increases in the likelihood of having a personal doctor, or receiving a flu shot, although only having a personal doctor remained significant when accounting for multiple hypothesis testing. We conclude that Medicaid fees did not have a major impact on the use of primary care or on the consequences of that care.

我们研究了医疗补助支付的初级保健费用是否影响具有高中或高中以下学历的医疗补助覆盖范围的成年人对医疗保健服务的使用。该分析涵盖了 2013 年至 2014 年 ACA 规定初级保健服务费用上涨之前和之后发生的医疗补助费用的巨大变化。我们使用来自行为风险因素监测系统的数据和双重差分法来估计医疗补助费用与一个人是否拥有私人医生之间的关联；去年的例行检查或流感疫苗注射；女性在过去一年是否进行过子宫颈抹片检查或乳房X光检查；一个人是否曾被诊断患有哮喘、糖尿病、心血管疾病、癌症、慢性阻塞性肺病、关节炎、抑郁症或肾脏疾病；以及一个人的健康状况是否良好至优秀。估计表明，医疗补助费用的增加与拥有私人医生或接受流感疫苗的可能性小幅增加有关，尽管在考虑多重假设检验时，只有拥有私人医生仍然很重要。我们的结论是，医疗补助费用对初级保健的使用或该保健的后果没有产生重大影响。