The Impact of Medicaid Expansion for Adults Under the Affordable Care Act on Preventive Care for Children

Medical Care ◽  
2020 ◽  
Vol 58 (11) ◽  
pp. 945-951 ◽  
Author(s):  
Shreya Roy ◽  
Fernando A. Wilson ◽  
Li-Wu Chen ◽  
Jungyoon Kim ◽  
Fang Yu
Keyword(s):  
Preventive Care ◽  
Affordable Care Act ◽  
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.

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 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 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.

The Impact of the Affordable Care Act Medicaid Expansion on Vascular Surgery

2020 ◽  
Vol 66 ◽  
pp. 454-461.e1
Author(s):  
Emanuel Eguia ◽  
Marshall S. Baker ◽  
Carlos Bechara ◽  
Murray Shames ◽  
Paul C. Kuo
Keyword(s):  
Vascular Surgery ◽  
Affordable Care Act ◽  
Medicaid Expansion ◽  
The Affordable Care Act ◽  
The Impact

Sa1012 - The Impact of the Affordable Care Act and Medicaid Expansion on Gastrointestinal Surgery Utilization

2018 ◽  
Vol 154 (6) ◽  
pp. S-225
Author(s):  
Allison L. Yang ◽  
David X. Jin ◽  
Tyler R. McClintock ◽  
Alexander Cole ◽  
Ye Wang ◽  
...  
Keyword(s):  
Affordable Care Act ◽  
Gastrointestinal Surgery ◽  
Medicaid Expansion ◽  
The Affordable Care Act ◽  
The Impact

scholarly journals The Impact of the Affordable Care Act Medicaid Expansion on Type 2 Diabetes Diagnosis and Treatment: A National Survey of Physicians

2019 ◽  
Vol 44 (3) ◽  
pp. 463-472 ◽  
Author(s):  
Matthew A. Present ◽  
Aviva G. Nathan ◽  
Sandra A. Ham ◽  
Robert M. Sargis ◽  
Michael T. Quinn ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
National Survey ◽  
Affordable Care Act ◽  
Diagnosis And Treatment ◽  
Diabetes Diagnosis ◽  
Medicaid Expansion ◽  
The Affordable Care Act ◽  
The Impact

Association of Medicaid expansion under the Affordable Care Act and early mortality following lung cancer surgery.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 76-76
Author(s):  
Leticia Nogueira ◽  
Ahmedin Jemal ◽  
Xuesong Han ◽  
K. Robin Yabroff
Keyword(s):  
Lung Cancer ◽  
Access To Care ◽  
Affordable Care Act ◽  
Insurance Coverage ◽  
Lung Cancer Surgery ◽  
Early Mortality ◽  
Major Surgery ◽  
Medicaid Expansion ◽  
The Affordable Care Act ◽  
The Impact

76 Background: Medicaid expansion under the Affordable Care Act is associated with gains in health insurance coverage and a shift towards earlier stage diagnosis among patients with cancer. However, the association between Medicaid expansion and cancer mortality has not been well characterized. The aim of this study was to evaluate the association of Medicaid expansion with changes in early mortality, defined as death within 30 days after major NSCLC surgery, among adults discharged following major surgery for non-small cell lung cancer (NSCLC), a setting where access to care is a major determinant of death. Methods: Of the 11,627 patients selected from the National Cancer Database who were aged 45-64 (more likely to be diagnosed and die from NSCLC and not age-eligible for Medicare coverage) and were discharged from the hospital following major surgery for treatment of NSCLC between 2009 and 2018, 7,294 patients lived in expansion states and 4,333 lived in non-expansion states. Differences-in-differences (DD) analyses were used to evaluate the impact of Medicaid expansion on early mortality pre-(2009- 2013) and post-ACA (2014- 2018). Results: Early mortality among patients discharged from the hospital following NSCLC surgery statistically significantly decreased from 2.4% pre-ACA to 0.8% post-ACA among patients in Medicaid expansion states (1.6 percentage point decrease, p <.0001), but not in patients living in non-expansion states (from 2.1% to 1.6%, p = 0.2), leading to a DD of 1.1 percentage points (95% Confidence Interval = 0.1, 2.1; p = 0.03). Conclusions: This study found a decrease in early mortality following hospital discharge after NSCLC surgery post-ACA among patients living in Medicaid expansion states and no change in patients residing in non-expansion states. Medicaid expansion may be an effective strategy for improving access to care and cancer outcomes among older adults who are not age-eligible for Medicare.

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