Medicaid Expansion Under the Affordable Care Act and Insurance Coverage in Rural and Urban Areas

Background and objectives: One of the main goals of the health system is the fair contribution of people to healthcare financing. Therefore, the current study not only evaluated the status of fair financial contribution, but also investigated the impacts of the health reform plan on the financial pillars of the Iranian healthcare system. Method: To conduct this retrospective descriptive study, the data of Income and Expenditure Survey (2011-2015) commissioned by Statistical Center of Iran were used. To measure fairness of financing, four indices were used. Data were analyzed using the Excel and SPSS software. Findings: The results show that although the health reform plan has increased insurance coverage of both rural and urban households, out of pocket, and even its proportion to household capacity to pay continues to rise. Prevalence of catastrophic health expenditures in the baseline year in rural and urban areas was 2.19% and 1.04%, reaching 3.69% and 2.39% at the end of the study, respectively. Accordingly, fair financial contribution in rural and urban areas was obtained 0.830% and 0.850% in the baseline year, reaching 0.823% and 0.850% in the last year of the study, respectively. Conclusion: Although indices of fair financial contribution during the 5-year period varied, they ultimately showed a worse situation compared to the baseline year. Thus, it is assumed that the health reform plan has not yet been successful in meeting the goal of improving fair financial contribution to the health system.

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Effects of the Medicaid expansion under the Affordable Care Act on health insurance coverage, health care access, and use for people with disabilities

Disability and Health Journal ◽

10.1016/j.dhjo.2021.101180 ◽

2021 ◽

pp. 101180

Author(s):

Xiaobei Dong ◽

Tim Gindling ◽

Nancy A. Miller

Keyword(s):

Health Care ◽

Health Insurance ◽

Affordable Care Act ◽

Health Care Access ◽

Insurance Coverage ◽

People With Disabilities ◽

Health Insurance Coverage ◽

Medicaid Expansion ◽

Care Access ◽

The Affordable Care Act

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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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Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non-Expansion States

10.3386/w22182 ◽

2016 ◽

Cited By ~ 19

Author(s):

Charles Courtemanche ◽

James Marton ◽

Benjamin Ukert ◽

Aaron Yelowitz ◽

Daniela Zapata

Keyword(s):

Health Insurance ◽

Affordable Care Act ◽

Insurance Coverage ◽

Health Insurance Coverage ◽

Medicaid Expansion ◽

The Affordable Care Act

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

Journal of Clinical Oncology ◽

10.1200/jco.2020.39.28_suppl.76 ◽

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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