The impact of the affordable care act (ACA) Medicaid Expansion on access to minimally invasive surgical care

OBJECTIVE The Affordable Care Act expanded Medicaid eligibility in many states, improving access to some forms of elective healthcare in the United States. Whether this effort increased access to elective spine surgical care is unknown. This study’s objective was to evaluate the impact of Medicaid expansion under the Affordable Care Act on the volume and payer mix of elective spine surgery in the United States. METHODS This study evaluated elective spine surgical procedures performed from 2011 to 2016 and included in the all-payer State Inpatient Databases of 10 states that expanded Medicaid access in 2014, as well as 4 states that did not expand Medicaid access. Adult patients aged 18–64 years who underwent elective spine surgery were included. The authors used a quasi-experimental difference-in-difference design to evaluate the impact of Medicaid expansion on hospital procedure volume and payer mix, independent of time-dependent trends. Subgroup analysis was conducted that stratified results according to cervical fusion, thoracolumbar fusion, and noninstrumented surgery. RESULTS The authors identified 218,648 surgical procedures performed in 10 Medicaid expansion states and 118,693 procedures performed in 4 nonexpansion states. Medicaid expansion was associated with a 17% (95% CI 2%–35%, p = 0.03) increase in mean hospital spine surgical volume and a 23% (95% CI −0.3% to 52%, p = 0.054) increase in Medicaid volume. Privately insured surgical volumes did not change significantly (incidence rate ratio 1.13, 95% CI −5% to 34%, p = 0.18). The increase in Medicaid volume led to a shift in payer mix, with the proportion of Medicaid patients increasing by 6.0 percentage points (95% CI 4.1–7.0, p < 0.001) and the proportion of private payers decreasing by 6.7 percentage points (95% CI 4.5–8.8, p < 0.001). Although the magnitude of effects varied, these trends were similar across procedure subgroups. CONCLUSIONS Medicaid expansion under the Affordable Care Act was associated with an economically and statistically significant increase in spine surgery volume and the proportion of surgical patients with Medicaid insurance, indicating improved access to care.

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Changes in Receipt of Adjuvant Radiation for Endometrial Cancer Patients Before and After the Affordable Care Act: The Impact of Medicaid Expansion

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2020.07.2476 ◽

2020 ◽

Vol 108 (3) ◽

pp. e414

Author(s):

A. Dursteler ◽

H.N. Burney ◽

J.A. Holmes

Keyword(s):

Endometrial Cancer ◽

Cancer Patients ◽

Affordable Care Act ◽

Adjuvant Radiation ◽

Medicaid Expansion ◽

Before And After ◽

The Affordable Care Act ◽

The Impact

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Breast Cancer Stage at Presentation in Ohio: The Effect of Medicaid Expansion and the Affordable Care Act

The American Surgeon ◽

10.1177/000313482008600327 ◽

2020 ◽

Vol 86 (3) ◽

pp. 195-199

Author(s):

Dan Kirkpatrick ◽

Margaret Dunn ◽

Rebecca Tuttle

Keyword(s):

Breast Cancer ◽

Affordable Care Act ◽

Advanced Disease ◽

Disease Stage ◽

Cancer Stage ◽

Medicaid Expansion ◽

Cancer Data ◽

Before And After ◽

The Affordable Care Act ◽

The Impact

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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The Impact of the Affordable Care Act (ACA) Medicaid Expansion on Visit Rates for Diabetes in Safety Net Health Centers

The Journal of the American Board of Family Medicine ◽

10.3122/jabfm.2018.06.180075 ◽

2018 ◽

Vol 31 (6) ◽

pp. 905-916 ◽

Cited By ~ 11

Author(s):

Nathalie Huguet ◽

Rachel Springer ◽

Miguel Marino ◽

Heather Angier ◽

Megan Hoopes ◽

...

Keyword(s):

Affordable Care Act ◽

Safety Net ◽

Health Centers ◽

Medicaid Expansion ◽

The Affordable Care Act ◽

The Impact

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Examining the Impact of the Affordable Care Act on Access to Surgical Care and Outcomes: A Systematic Review

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2020.08.400 ◽

2020 ◽

Vol 231 (4) ◽

pp. e151

Author(s):

Cody Lendon Mullens ◽

J. Andres Hernandez ◽

Kathleen Fox ◽

David C. Borgstrom

Keyword(s):

Systematic Review ◽

Affordable Care Act ◽

Surgical Care ◽

The Affordable Care Act ◽

The Impact

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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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