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

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

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

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.

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

2018 ◽  
Vol 14 (2) ◽  
pp. e92-e102 ◽  
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.

scholarly journals MP71-05 THE IMPACT OF THE AFFORDABLE CARE ACT AND MEDICAID EXPANSION ON INSURANCE STATUS AND CANCER STAGING FOR BLADDER CANCER PATIENTS

2018 ◽  
Vol 199 (4S) ◽  
Author(s):  
Kyle Plante ◽  
Natasha Ginzburg ◽  
Joseph Jacob ◽  
Oleg Shapiro ◽  
Gennady Bratslavsky ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Cancer Patients ◽  
Affordable Care Act ◽  
Cancer Staging ◽  
Insurance Status ◽  
Medicaid Expansion ◽  
The Affordable Care Act ◽  
The Impact

Association of Medicaid expansion under the Affordable Care Act with access to elective spine surgical care

2021 ◽  
pp. 1-9
Author(s):  
Jacob K. Greenberg ◽  
Derek S. Brown ◽  
Margaret A. Olsen ◽  
Wilson Z. Ray
Keyword(s):  
United States ◽  
Spine Surgery ◽  
Surgical Procedures ◽  
Affordable Care Act ◽  
Surgical Care ◽  
The United States ◽  
Medicaid Expansion ◽  
Percentage Points ◽  
The Affordable Care Act ◽  
The Impact

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.

scholarly journals Patterns of Coverage Gains Among Young Adult Cancer Patients Following the Affordable Care Act

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Leticia M Nogueira ◽  
Neetu Chawla ◽  
Xuesong Han ◽  
Ahmedin Jemal ◽  
K Robin Yabroff
Keyword(s):  
Young Adult ◽  
Cancer Patients ◽  
Affordable Care Act ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Temporal Patterns ◽  
Patients Âgés ◽  
The Affordable Care Act ◽  
Young Adult Cancer ◽  
The Impact

Abstract The dependent coverage expansion (DCE) and Medicaid expansions (ME) under the Affordable Care Act (ACA) may differentially affect eligibility for health insurance coverage in young adult cancer patients. Studies examining temporal patterns of coverage changes in young adults following these policies are lacking. We used data from the National Cancer Database 2003–2015 to conduct a quasi-experimental study of cancer patients ages 19–34 years, grouped as DCE-eligible (19- to 25-year-olds) and DCE-ineligible (27- to 34-year-olds). Although private insurance coverage in DCE-eligible cancer patients increased incrementally following DCE implementation (0.5 per quarter; P < .001), an immediate effect on Medicaid coverage gains was observed after ME in all young adult cancer patients (3.01 for DCE-eligible and 1.62 for DCE-ineligible, both P < .001). Therefore, DCE and ME each had statistically significant and distinct effects on insurance coverage gains. Distinct temporal patterns of ACA policies’ impact on insurance coverage gains likely affect patterns of receipt of cancer care. Temporal patterns should be considered when evaluating the impact of health policies.

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

2018 ◽  
Vol 31 (6) ◽  
pp. 905-916 ◽  
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

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

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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