Affordable Care Act State-Specific Medicaid Expansion Increased Insurance Coverage and Breast Reconstruction Rates: A Difference-in-Difference Model

2019 ◽  
Vol 229 (4) ◽  
pp. S219
Author(s):  
Yoshiko Toyoda ◽  
Eun Jeong Oh ◽  
Codruta Chiuzan ◽  
Christine H. Rohde
Keyword(s):  
Breast Reconstruction ◽  
Affordable Care Act ◽  
Insurance Coverage ◽  
Medicaid Expansion ◽  
Difference In Difference ◽  
Difference Model

scholarly journals The Affordable Care Act’s Coverage Impacts in the Trump Era

2021 ◽  
Vol 58 ◽  
pp. 004695802110429
Author(s):  
Charles Courtemanche ◽  
Ishtiaque Fazlul ◽  
James Marton ◽  
Benjamin Ukert ◽  
Aaron Yelowitz ◽  
...  
Keyword(s):  
Affordable Care Act ◽  
Insurance Coverage ◽  
Community Survey ◽  
Medicaid Expansion ◽  
Percentage Points ◽  
Individual Mandate ◽  
Us Presidential Election ◽  
Causal Impact ◽  
The Individual ◽  
Trump Administration

The 2016 US presidential election created uncertainty about the future of the Affordable Care Act (ACA) and led to postponed implementation of certain provisions, reduced funding for outreach, and the removal of the individual mandate tax penalty. In this article, we estimate how the causal impact of the ACA on insurance coverage changed during 2017 through 2019, the first 3 years of the Trump administration, compared to 2016. Data come from the 2011–2019 waves of the American Community Survey (ACS), with the sample restricted to non-elderly adults. Our model leverages variation in treatment intensity from state Medicaid expansion decisions and pre-ACA uninsured rates. We find that the coverage gains from the components of the law that took effect nationally—such as the individual mandate and regulations and subsidies in the private non-group market—fell from 5 percentage points in 2016 to 3.6 percentage points in 2019. In contrast, the coverage gains from the Medicaid expansion increased in 2017 (7.0 percentage points) before returning to the 2016 level of coverage gains in 2019 (5.9 percentage points). The net effect of the ACA in expansion states is a combination of these trends, with coverage gains falling from 10.8 percentage points in 2016 to 9.6 percentage points in 2019.

scholarly journals Empirical Analyses of Associations between State Political Attitudes and Gains in Health Insurance Coverage after the Affordable Care Act (ACA)

2019 ◽  
Author(s):  
Bisakha Sen ◽  
Reena Joseph
Keyword(s):  
Young Adults ◽  
Affordable Care Act ◽  
Insurance Coverage ◽  
Baseline Period ◽  
Behavioral Risk ◽  
Surveillance Systems ◽  
Medicaid Expansion ◽  
Probability Models ◽  
Percentage Points ◽  
Linear Probability

AbstractObjectivesTo explore whether state-level political-sentiment is associated with gains in insurance post Affordable Care Act (ACA). This is especially relevant given the lawsuit brought by several Republican-leaning states against the ACA, and the ruling of one Texas federal judge that the ACA is unconstitutional, which potentially jeopardizes ACA’s future.MethodsMultivariate linear-probability models are estimated using data from the Behavioral Risk Factor Surveillance Systems for 2011-2017. The outcome is self-reported insurance status. States are placed in quartiles based on votes for President Obama in 2008 and 2012 elections. Starting 2014, ACA health exchanges became active and several states expanded Medicaid, so 2014 onwards is considered as the ‘post-ACA’ period. Models are estimated for all adults under 65-years and for young adults under 35-years. All models control extensively for respondent socio-economic-demographic characteristics and state characteristics.ResultsIn the pre-ACA baseline period, respondents in states with higher Anti-Obama-voting (AOV) were less likely to have insurance. For example, residents in highest AOV-quartile states were 8.0-percentage-points less likely (p<0.001) to have insurance than those in the lowest AOV-quartile states. Post-ACA, fewer high AOV-quartile states expanded Medicaid, and overall insurance gains inclusive of Medicaid-expansion are similar across states. However, net of Medicaid-expansion, residents in higher AOV states saw higher insurance gains. For example, all adults had 2.8-percentage points higher likelihood (p<0.01) and young adults had 4.9-percentage point higher likelihood (p<0.01) of getting insurance in the highest AOV-quartile states compared to the lowest AOV quartile states. Minorities and those with chronic-conditions had larger insurance gains across the country post-ACA, but the extent of these gains did not differ by state AOV levels.ConclusionsState AOV and insurance gains from ACA appear to be incongruent. Policymakers and stakeholders should be aware that non-Medicaid residents of higher-AOV states might potentially lose the most if ACA is revoked.

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 Four Years Later: Insurance Coverage and Access to Care Continue to Diverge between ACA Medicaid Expansion and Non-Expansion States

2019 ◽  
Vol 109 ◽  
pp. 327-333 ◽  
Author(s):  
Sarah Miller ◽  
Laura R. Wherry
Keyword(s):  
Affordable Care Act ◽  
Low Income ◽  
Access To Health Care ◽  
Insurance Coverage ◽  
Medicaid Expansion ◽  
Access To Health ◽  
Interview Survey ◽  
Using Data ◽  
The Impact ◽  
Medicaid Expansions

This paper evaluates the impact of the Affordable Care Act Medicaid expansions four years after implementation using data from the 2010-2017 National Health Interview Survey. We find that low-income adults in states that implemented the Medicaid expansions experienced increases in insurance and Medicaid coverage and improvements in access to health care across several measures.

scholarly journals The Affordable Care Act – Effects of Insurance on Diabetes Biomarkers

2020 ◽  
Author(s):  
Miguel Marino ◽  
Heather Angier ◽  
Rachel Springer ◽  
Steele Valenzuela ◽  
Megan Hoopes ◽  
...  
Keyword(s):  
Affordable Care Act ◽  
Community Health Centers ◽  
Glycosylated Hemoglobin ◽  
Insurance Coverage ◽  
Density Lipoprotein ◽  
Medicaid Expansion ◽  
Uninsured Patients ◽  
Electronic Health Record Data ◽  
Insured Patients ◽  
Hba1c Levels

<b>Objective</b>: We sought to understand how Affordable Care Act (ACA) Medicaid expansion insurance coverage gains are associated with changes in diabetes-related biomarkers. <p> </p> <p><b>Research Design and Methods</b>: Retrospective observational cohort study using electronic health record data from 178 community health centers (CHCs) in the ADVANCE network. We assessed changes in diabetes-related biomarkers among adult patients with diabetes in 10 Medicaid expansion states (n=25,279), comparing newly insured with continuously insured, discontinuously insured, and continuously uninsured patients pre- to post-ACA expansion. Primary outcomes included 24 months pre- to 24 months post-ACA changes in glycosylated hemoglobin (HbA1c), systolic (SBP) and diastolic (DBP) blood pressure, and low-density lipoprotein (LDL) cholesterol levels. </p> <p> </p> <p><b>Results</b>: Newly insured patients exhibited a reduction in adjusted mean HbA1c levels [8.24% (67 mmol/mol) to 8.17% (66 mmol/mol)], which was significantly different from continuously uninsured patients, whose HbA1c levels increased [8.12% (65 mmol/mol) to 8.29% (67 mmol/mol); difference-in-difference (DID)=-0.24%; p<0.001]. Newly insured patients showed greater reductions in adjusted mean SBP than continuously uninsured patients (DID=-1.8 mmHg; p<0.001), DBP (DID=-1.0 mmHg; p<0.001), and LDL (DID=-3.3 mg/dL; p<0.001). Among patients with elevated HbA1c in the 3 months prior to expansion, newly insured patients were more likely than continuously uninsured to have a controlled HbA1c measurement by 24 months post-ACA [Hazard Ratio=1.25; 95% CI=1.02-1.54].</p> <p> </p> <p><b>Conclusions</b>: Post-ACA, newly insured patients had greater improvements in diabetes-related biomarkers than continuously uninsured, discontinuously insured, or continuously insured patients. Findings suggest that health insurance gain via ACA facilitates access to appropriate diabetes care, leading to improvements in diabetes-related biomarkers.</p>

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