Examination of Elective Bariatric Surgery Rates Before and After US Affordable Care Act Medicaid Expansion

Patients presenting with localized breast cancer have a five-year survival of 99 per cent, whereas survival falls to 27 per cent in advanced disease. This obviates the importance of early diagnosis and treatment. Our study evaluates the impact of Ohio's Medicaid expansion and the passage of the Affordable Care Act (ACA) on the stage at which Ohioans were diagnosed with breast cancer. Data were collected for 3056 patients presenting with breast cancer between 2006 and 2016 in the Dayton area. Patients were divided into groups based on cancer stage. The percentage of patients presenting with advanced disease (stage 3 or 4) was compared both before and after ACA implementation and Ohio Medicaid expansion. These results were also compared with statewide data maintained by the Ohio Department of Health. Compared with pre-ACA, the number of uninsured patients post-ACA was noted to fall 83 per cent, the number of patients presenting with Medicaid increased by five times, and the proportion of patients younger than 65 years presenting with breast cancer increased by approximately 7 per cent. These changes notwithstanding, no difference was identified in the percentage of patients presenting with advanced breast cancer before and after ACA implementation or Ohio Medicaid expansion ( P = 0.56). Statewide data similarly demonstrated no change ( P = 0.88). Improved insurance access had a smaller-than-anticipated impact on the stage at which Ohioans presented with breast cancer. As significant morbidity and mortality can be avoided by earlier presentation, additional research is appropriate to identify factors affecting patients’ decision to seek breast cancer screening and care.

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National and Regional Variation in Local Primary Care Physician Density Relative to the Uninsured and the Affordable Care Act

INQUIRY The Journal of Health Care Organization Provision and Financing ◽

10.1177/0046958019873807 ◽

2019 ◽

Vol 56 ◽

pp. 004695801987380

Author(s):

Barry C. Hill ◽

Daniel Coster ◽

David R. Black

Keyword(s):

Primary Care ◽

Primary Care Physician ◽

Affordable Care Act ◽

Local Level ◽

Care Physician ◽

Medicaid Expansion ◽

Physician Density ◽

Before And After ◽

The Affordable Care Act ◽

Access To Primary Care

This study is the first to examine primary care physician (PCP) density relative to the uninsured at the local level prior to and after insurance expansion under the Affordable Care Act. Primary care physician density is associated with access to care, lower inpatient and emergency care, and primary care services. However, access to primary care among the uninsured may be limited due to inadequate availability of PCPs. Core-Based Statistical Area (CBSA) data from the Area Health Resource File were retrospectively examined before and after Medicaid expansion. Multiple logistic regressions were modeled for PCP density with predictor interaction effects for percentage uninsured, Medicaid expansion status, and US Census regions. Medicaid expansion CBSAs had significantly lower proportions of uninsured and higher PCP density compared with their nonexpansion counterparts. Nationally, increasing proportions of the uninsured were significantly associated with decreasing PCP density. Most notably, there is an expected 32% lower PCP density in Western Medicaid expansion areas with many uninsured (90th percentile) compared with those with few uninsured (10th percentile). Areas expanding Medicaid with greater proportions of people becoming insured postexpansion had significantly fewer PCPs. Areas with greater proportions of the uninsured may have reduced access to primary care due to the paucity of PCPs in these areas. Efforts to improve access should consider a lack of local PCPs as a limitation for ensuring accessible and timely care. Health care and policy leaders should focus on answers to improve the local availability of primary care clinicians in underserved communities.

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Trends in Insurance Status Among Patients Diagnosed With Cancer Before and After Implementation of the Affordable Care Act

Journal of Oncology Practice ◽

10.1200/jop.2017.027102 ◽

2018 ◽

Vol 14 (2) ◽

pp. e92-e102 ◽

Cited By ~ 14

Author(s):

Haley A. Moss ◽

Laura J. Havrilesky ◽

S. Yousuf Zafar ◽

Gita Suneja ◽

Junzo Chino

Keyword(s):

Breast Cancer ◽

Affordable Care Act ◽

Insurance Coverage ◽

Insurance Status ◽

Medicaid Expansion ◽

Before And After ◽

Medicaid Eligibility ◽

The Affordable Care Act ◽

Insurance Rates ◽

The Impact

Purpose: The Affordable Care Act (ACA) aimed to increase insurance coverage through key provisions such as expansion of Medicaid eligibility and enforcement of an individual mandate. The objective of this study is to examine the impact of the ACA on insurance rates among patients newly diagnosed with colon, lung, or breast cancer. Methods: Using the SEER database, patients younger than age 65 years diagnosed with colon, lung, or breast cancer between 2008 and 2014 were identified. Insurance rates were examined before versus after passage of the ACA (2011) and before (2011 to 2013) versus after (2014) Medicaid expansion in nine expansion states and five nonexpansion states. Difference-in-differences models were used to estimate the differential impact of ACA in expansion compared with nonexpansion states. Results: A total of 414,085 patients with known insurance status were diagnosed with colon, lung, or breast cancer between 2008 and 2014. For all cancer types, there was a significant increase in patients enrolled in Medicaid after 2011 in expansion states. Between 2011 to 2013 and 2014, in patients living in states with Medicaid expansion, the uninsured rates decreased by ≥ 50% among patients with a new diagnosis of lung and colon cancer (6.5% in 2011 to 2013 to 3.1% in 2014 and 6.8% in 2011 to 2013 to 3.4% in 2014, respectively; P < .001); the uninsured rate decreased to a lesser degree for patients with breast cancer (2.7% in 2011 to 2013 to 1.6% in 2014; P < .001). This decrease in the rate of uninsured patients was absent in patients living in nonexpansion states. Conclusion: The ACA resulted in expanded insurance coverage for patients diagnosed with colon, lung, and breast cancer. However, the impact was only observed in states that increased their Medicaid eligibility.

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Postpartum Medicaid Coverage and Contraceptive Use Before and After Ohio's Medicaid Expansion Under the Affordable Care Act

Women s Health Issues ◽

10.1016/j.whi.2020.08.006 ◽

2020 ◽

Vol 30 (6) ◽

pp. 426-435

Author(s):

Anne L. Dunlop ◽

Peter Joski ◽

Andrea E. Strahan ◽

Erica Sierra ◽

E. Kathleen Adams

Keyword(s):

Affordable Care Act ◽

Contraceptive Use ◽

Medicaid Expansion ◽

Medicaid Coverage ◽

Before And After ◽

The Affordable Care Act

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Early Impact of the Patient Protection and Affordable Care Act on Delivery of Children’s Surgical Care

Clinical Pediatrics ◽

10.1177/0009922818825156 ◽

2019 ◽

Vol 58 (4) ◽

pp. 453-460 ◽

Cited By ~ 2

Author(s):

Jonathan C. Routh ◽

Steven Wolf ◽

Rohit Tejwani ◽

Ruiyang Jiang ◽

Gina-Maria Pomann ◽

...

Keyword(s):

Affordable Care Act ◽

Inpatient Care ◽

Surgical Care ◽

Control Group ◽

Medicaid Expansion ◽

Inclusion Criteria ◽

Patient Protection ◽

Care Facilities ◽

Before And After ◽

The Impact

The impact of the Patient Protection and Affordable Care Act (PPACA) on children’s access to surgical care is not well-defined. Our objective was to describe the early impact of PPACA on children’s surgical care before and after Medicaid expansion in 2014. We compared pediatric and young adult surgical outcomes in 2013 and 2014 in Medicaid expansion and nonexpansion states; young adults were included as a control group. From 4 states, 1 597 708 encounters met all inclusion criteria. Comparing expansion to nonexpansion states, modest increases were noted in elective instead of urgent/emergent admissions; in ambulatory instead of inpatient surgeries; in inpatient length of stays; in discharges to home instead of other inpatient care facilities; and in charges for inpatient admissions. A modest decrease of −1.1% was noted in ambulatory admission charges. Overall, we conclude that Medicaid expansion likely increased children’s access to surgical care, resulting in improved delivery and slightly reduced charges.

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POSTOPERATIVE COMPLIANCE OF BARIATRIC SURGERY PATIENTS REGARDING THE ASSESSMENT OF SERUM LEPTIN LEVELS AND INSULIN RESISTANCE

Medical Connections ◽

10.33311/medcon.2019.49.1.1 ◽

2019 ◽

Vol 49 (1/2019) ◽

Keyword(s):

Insulin Resistance ◽

Bariatric Surgery ◽

Serum Levels ◽

Medical Laboratory ◽

Leptin Resistance ◽

Obese Patients ◽

Laboratory Assessment ◽

Serum Leptin ◽

Before And After ◽

Bariatric Patients

Background and aims: Overweight and obese patients who undergo bariatric surgery require a rigorous clinical and paraclinical assessment both before and after the surgery at 3, 6, and 12 months.The present study aims the assessment of serum leptin levels and insulin resistance status in compliant bariatric patients to scheduled medical laboratory assessment at 6 months after surgery. Material and Method: The study included 109 eligible patients selected for bariatric surgery, 48 of whom attended the scheduled visit at 6 months after the surgery. Laboratory assessing regarded the insulin resistance by determining before meal the serum levels of leptin, glucose and insulin, as well as HOMA 1 and HOMA 2 indexes. Results: Patients who underwent bariatric treatment experienced a significant decrease in insulin resistance status. A higher percentage in the preoperative group was recorded in women, feature which was also recorded in the postoperative group that attended the scheduled visit at 6 months after surgery. Age is also an important factor that significantly influences the behavioral adherence to postoperative visits. Conclusions: Insulin resistance status improved significantly in 6 months after bariatric surgery among the fully compliant patients. The percentage of attendance at scheduled visits is higher among women, and decreases with age. Keywords: obesity surgery, leptin resistance, insulin resistance, HOMA index, compliance

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