Abstract 13155: Differences in Cardiovascular Prescription Drug Utilization Among Medicaid Beneficiaries in Early Expander vs. Non-expander States From 2011 to 2018

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Andrew Sumarsono ◽  
Hussain Lalani ◽  
Matthew W Segar ◽  
Ambarish Pandey
Keyword(s):  
Drug Utilization ◽  
Prescription Drugs ◽  
Low Income ◽  
The United States ◽  
Medicaid Expansion ◽  
P2y12 Inhibitors ◽  
Healthcare It ◽  
Medicaid Eligibility ◽  
Receptor Blockers ◽  
Medicaid Beneficiaries

Introduction: Cardiovascular disease remains the leading cause of death in the United States. In 2014, the Affordable Care Act expanded Medicaid eligibility allowing low-income adults to access healthcare. It remains unclear how Medicaid expansion affected access to cardiovascular prescription drugs. Methods: We used the publicly available Medicaid State Drug Utilization dataset to evaluate the utilization of statins, P2Y12 receptor blockers (P2Y12-RB), and seven classes of oral antihypertensives. We used a difference-in-differences analysis to compare quarterly prescriptions per 1,000 Medicaid beneficiaries for each drug class among Medicaid expansion states versus non-expansion states during the three years before and five years after the 2014 Medicaid expansion. Results: Between 2011 and 2018, the number of annual prescriptions of statins, P2Y12-RB, and antihypertensives increased by 89.7% (11.0 to 20.8 million), 37% (1.7 to 2.3 million), and 76% (35.3 to 62.2 million). Medicaid expansion states had higher quarterly prescriptions per 1000 Medicaid beneficiaries compared to non-expansion states for statins (22.54 [CI 95%: 15.5 to 28.58], p<0.001), antiplatelets (1.68 [CI 95%: 1.15 to 2.21], p<0.001), and antihypertensives (63.21 [CI 95%: 47.31 to 79.11], p<0.001). Conclusion: National Medicaid use of statins, P2Y12-RB, and antihypertensives increased between 2011 to 2018. The Medicaid expansion was associated significant increases in per-capita utilization of all cardiovascular prescription drugs. These gains in utilization are likely providing long-term cardiovascular benefits to lower-income and previously underinsured populations. Figure 1: Trends in Quarterly Prescriptions/1000 Beneficiaries of statins, anti-platelets, and antihypertensives between 2011 to 2018 between expander and non-expander states. 1A: statins. 1B: P2Y12 inhibitors. 1C: Antihypertensives

scholarly journals Association of Medicaid Expansion with Rates of Utilization of Cardiovascular Therapies Among Medicaid Beneficiaries Between 2011 and 2018

2020 ◽  
Author(s):  
Andrew Sumarsono ◽  
Hussain Lalani ◽  
Matthew W. Segar ◽  
Shreya Rao ◽  
Muthiah Vaduganathan ◽  
...  
Keyword(s):  
Prescription Drugs ◽  
Low Income ◽  
Drug Prescription ◽  
Oral Anticoagulants ◽  
Temporal Trends ◽  
Medicaid Expansion ◽  
P2y12 Inhibitors ◽  
Prescription Rates ◽  
Medicaid Beneficiaries ◽  
Per Capita

Background : The Affordable Care Act expanded Medicaid eligibility allowing low-income individuals greater access to healthcare. However, the uptake of state Medicaid expansion has been variable. It remains unclear how the Medicaid expansion was associated with the temporal trends in use of evidence-based cardiovascular drugs. Methods : We used the publicly available Medicaid Drug Utilization and Current Population Survey to extract filled prescription rates per 1000 Medicaid beneficiaries of statins, antihypertensives, P2Y12 inhibitors, and direct oral anticoagulants (DOAC). We defined expander states as those who expanded Medicaid on January 1, 2014, and non-expander states as those who had not expanded by December 31, 2018. Difference-in-differences (DID) analyses were performed to compare the association of the Medicaid expansion with per-capita cardiovascular drug prescription rates in expander versus non-expander states. Results : Between 2011 and 2018, the total number of prescriptions among all Medicaid beneficiaries increased, with gains of 89.7% in statins (11.0 to 20.8 million), 76% in antihypertensives (35.3 to 62.2 million), and 37% in P2Y12 inhibitors (1.7 to 2.3 million). Medicaid expansion was associated with significantly greater increases in quarterly prescriptions (per 1000 Medicaid beneficiaries) of statins [DID estimate (95% CI): 22.5 (16.5 to 28.6), P<0.001], antihypertensives [DID estimate (95% CI): 63.2 (47.3 to 79.1), P<0.001], and P2Y12 inhibitors [DID estimate (95% CI): 1.7 (1.2 to 2.2), P<0.001]. Between 2013 and 2018, more than 75% of the expander states had increases in prescription rates of both statins and antihypertensives. In contrast, 44% of non-expander states saw declines in statins and antihypertensives. The Medicaid expansion was not associated with higher DOAC prescription rates [DID estimate (95% CI) 0.9 [-0.3 to 2.1], P=0.142). Conclusions : The 2014 Medicaid expansion was associated with a significant increase in per-capita utilization of cardiovascular prescription drugs among Medicaid beneficiaries. These gains in utilization may contribute to long-term cardiovascular benefits to lower-income and previously underinsured populations.

State Fiscal Considerations and Research Opportunities Emerging from the Affordable Care Act's Medicaid Expansion

2014 ◽  
Vol 40 (2-3) ◽  
pp. 237-252
Author(s):  
Jean C. Sullivan ◽  
Rachel Gershon
Keyword(s):  
Low Income ◽  
Insurance Coverage ◽  
Supreme Court Decision ◽  
Health Insurance Coverage ◽  
The United States ◽  
Primary Objective ◽  
Medicaid Expansion ◽  
Poverty Level ◽  
Assistance Program ◽  
Social Security Act

As enacted, the Affordable Care Act (ACA) directed states to provide Medicaid coverage to most nonelderly adults with incomes up to 138% of the Federal Poverty Level (the “Medicaid expansion group”) beginning in 2014. The Medicaid expansion provision of the ACA is an integral component of fulfilling the ACA’s primary objective to achieve near-universal health insurance coverage rates across the United States.Title XIX of the Social Security Act (Title XIX) is Medicaid’s enabling statute. Medicaid is a medical assistance program for certain low-income individuals, jointly funded and administered by federal and state governments. Certain features of the Medicaid program provide a framework within which the ACA and subsequent Supreme Court decision National Federation of Independent Business (NFIB) v. Sebelius can be understood.

scholarly journals Medicaid Expansion and Utilization of Antihyperglycemic Therapies

2020 ◽  
Author(s):  
Andrew Sumarsono ◽  
Leo F. Buckley ◽  
Sara R. Machado ◽  
Rishi K. Wadhera ◽  
Haider J. Warraich ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Low Income ◽  
Population Level ◽  
Health Impact ◽  
Medicaid Expansion ◽  
Difference In Difference ◽  
Medicaid Beneficiaries ◽  
Spending Growth ◽  
Future Evaluation

<b>Objective:</b> Certain antihyperglycemic therapies modify cardiovascular and kidney outcomes among persons with type 2 diabetes mellitus (T2DM), but uptake in practice appears restricted to certain demographics. We examine the association of Medicaid expansion with use of and expenditures related to antihyperglycemic therapies among Medicaid beneficiaries. <p><b> </b></p> <p><b>Methods:</b> We employed a difference-in-difference design to analyze the association of Medicaid expansion on prescription of non-insulin antihyperglycemic therapies. We used 2012-2017 National & State Medicaid data to compare prescription claims and costs between states that did (n=25) and did not expand (n=26) Medicaid by January 2014. </p> <p><b> </b></p> <p><b>Results:</b> Following Medicaid expansion in 2014, average non-insulin antihyperglycemic therapies per state/1,000 enrollees increased by 4.2%/quarter in expansion states and 1.6%/quarter in non-expansion states. For SGLT2i and GLP-1RA, quarterly growth rates per-1,000 enrollees were 125.3% and 20.7% for expansion states and 87.6% and 16.0% for non-expansion states, respectively. Expansion states had faster utilization and total spending growth in SGLT2i and GLP-1RA than non-expansion states. Difference-in-difference estimates for change in volume of prescriptions after Medicaid expansion between expansion vs. non-expansion states was 1.68 (1.09 to 2.26;P<0.001) for all non-insulin therapies, 0.125 (-0.003 to 0.25;P=0.056) for SGLT2i, and 0.12 (0.055 to 0.18;P<0.001) for GLP-1RA.</p> <p><b> </b></p> <p><b>Conclusion:</b> Use of non-insulin antihyperglycemic therapies, including SGLT2i and GLP-1RA, increased among low-income adults in both Medicaid expansion and non-expansion states, with a significantly greater increase in overall use and in GLP-1RA use in expansion states. Future evaluation of the population-level health impact of expanded access to these therapies is needed. </p>

Medicaid Expansions and Participation in Supplemental Security Income by Noncitizens

2021 ◽  
pp. e1-e7
Author(s):  
Felix M. Muchomba ◽  
Neeraj Kaushal
Keyword(s):  
Low Income ◽  
Supplemental Security Income ◽  
Medicaid Expansion ◽  
Participation Rates ◽  
Social Security Administration ◽  
Eligibility Criteria ◽  
The Social ◽  
Before And After ◽  
Medicaid Eligibility ◽  
Using Data

Objectives. To estimate the effect of Medicaid expansion on noncitizens’ and citizens’ participation in the Supplemental Security Income (SSI) program. The Affordable Care Act (ACA) expanded Medicaid eligibility to cover low-income nonelderly adults without children, thus delinking their Medicaid participation from participation in the SSI program. Methods. Using data from the Social Security Administration for 2009 through 2018 (n = 1020 state-year observations) and the Current Population Survey for 2009 through 2019 (n = 78 776 respondents), we employed a difference-in-differences approach comparing SSI participation rates in US states that adopted Medicaid expansion with participation rates in nonexpansion states before and after ACA implementation. Results. Medicaid expansion reduced the SSI (disability) participation of nonelderly noncitizens by 12% and of nonelderly citizens by 2%. Estimates remained robust with administrative and survey data. Conclusions. Medicaid expansion caused a substantially larger decline in the SSI participation of noncitizens, who face more restrictive SSI eligibility criteria, than of citizens. Our estimates suggest an annual savings of $619 million in the federal SSI cost because of the decline in SSI participation among noncitizens and citizens. (Am J Public Health. Published online ahead of print April 15, 2021: e1–e7. https://doi.org/10.2105/AJPH.2021.306235 )

scholarly journals How did the Affordable Care Act Medicaid Expansion Affect Coverage and Access to Care for Low-Income Parents Who Were Eligible for Medicaid Before the Law Was Passed?

2021 ◽  
Vol 58 ◽  
pp. 004695802110502
Author(s):  
Stacey McMorrow ◽  
Genevieve M. Kenney
Keyword(s):  
Access To Care ◽  
Low Income ◽  
Medicaid Expansion ◽  
Eligibility Criteria ◽  
Access Problems ◽  
Medicaid Eligibility ◽  
The Law ◽  
Medical Bills ◽  
The Impact ◽  
Percent Decline

We use the National Health Interview Survey from 2010 to 2017 and a difference-in-differences approach to assess the impact of the Affordable Care Cct (ACA) Medicaid expansion on coverage and access to care for a subset of low-income parents who were already eligible for Medicaid when the ACA was passed. Any gains in coverage would typically be expected to improve access to and affordability of care, but there were concerns that by increasing the total population with coverage and thereby straining provider capacity, that the ACA would reduce access to care for individuals who were already eligible for Medicaid prior to the passage of the law. We found that the expansion reduced uninsurance among previously eligible parents by 12.6 percentage points, or a 40 percent decline from their 2012–2013 uninsurance rate. Moreover, these effects grew stronger over time with a 55 percent decline in uninsurance 2 to 3 years following expansion. Though we identified very few statistically significant impacts of the expansion on affordability of care, descriptive estimates show substantial declines in unmet needs due to cost and problems paying family medical bills. Descriptively, we find no significant increases in provider access problems for previously eligible parents, and very limited evidence that the Medicaid expansion was associated with more constrained provider capacity. Though sample size constraints were likely a factor in our ability to identify impacts on access and affordability measures, our overall findings suggest that the ACA Medicaid expansion positively affected our sample of low-income parents who met pre-ACA Medicaid eligibility criteria.

scholarly journals The Line Between Medicaid and Marketplace: Coverage Effects from Wisconsin’s Partial Expansion

2021 ◽  
Author(s):  
Laura Dague ◽  
Marguerite Burns ◽  
Donna Friedsam
Keyword(s):  
Health Insurance ◽  
Low Income ◽  
Medicaid Expansion ◽  
Poverty Level ◽  
Claims Database ◽  
Medicaid Coverage ◽  
Medicaid Enrollment ◽  
Medicaid Eligibility ◽  
Balanced Budget ◽  
Parents And Caregivers

Abstract Context: States have sought to experiment with the income eligibility threshold between Medicaid coverage and access to subsidized Marketplace plans in an effort to increase coverage for low-income adults while meeting other state priorities, particularly a balanced budget. In 2014, Wisconsin opted against adoption of an ACA Medicaid expansion, instead setting the Medicaid eligibility threshold at 100% of the poverty level—a state-funded partial expansion. Childless adults gained new eligibility, while parents and caregivers with incomes between 101–200% of poverty lost existing eligibility. Methods: We use Wisconsin’s all-payer claims database to assess health insurance gains, losses, and transitions among low-income adults affected by this partial expansion. Findings: We find that less than one third of adults who lost Medicaid eligibility definitely took up commercial coverage, and many returned to Medicaid. Among those newly Medicaid eligible, there was little evidence of crowd-out. Both groups experienced limited continuity of coverage. Overall, new Medicaid enrollment of childless adults was offset by coverage losses among parents and caregivers, rendering Wisconsin’s overall coverage gains similar to non-expansion states. Conclusions: Wisconsin’s experience demonstrates the difficulty in relying on the Marketplace to cover the near poor and suggests that full Medicaid expansion more effectively increases coverage.

scholarly journals Medicaid Expansion and Utilization of Antihyperglycemic Therapies

2020 ◽  
Author(s):  
Andrew Sumarsono ◽  
Leo F. Buckley ◽  
Sara R. Machado ◽  
Rishi K. Wadhera ◽  
Haider J. Warraich ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Low Income ◽  
Population Level ◽  
Health Impact ◽  
Medicaid Expansion ◽  
Difference In Difference ◽  
Medicaid Beneficiaries ◽  
Spending Growth ◽  
Future Evaluation

<b>Objective:</b> Certain antihyperglycemic therapies modify cardiovascular and kidney outcomes among persons with type 2 diabetes mellitus (T2DM), but uptake in practice appears restricted to certain demographics. We examine the association of Medicaid expansion with use of and expenditures related to antihyperglycemic therapies among Medicaid beneficiaries. <p><b> </b></p> <p><b>Methods:</b> We employed a difference-in-difference design to analyze the association of Medicaid expansion on prescription of non-insulin antihyperglycemic therapies. We used 2012-2017 National & State Medicaid data to compare prescription claims and costs between states that did (n=25) and did not expand (n=26) Medicaid by January 2014. </p> <p><b> </b></p> <p><b>Results:</b> Following Medicaid expansion in 2014, average non-insulin antihyperglycemic therapies per state/1,000 enrollees increased by 4.2%/quarter in expansion states and 1.6%/quarter in non-expansion states. For SGLT2i and GLP-1RA, quarterly growth rates per-1,000 enrollees were 125.3% and 20.7% for expansion states and 87.6% and 16.0% for non-expansion states, respectively. Expansion states had faster utilization and total spending growth in SGLT2i and GLP-1RA than non-expansion states. Difference-in-difference estimates for change in volume of prescriptions after Medicaid expansion between expansion vs. non-expansion states was 1.68 (1.09 to 2.26;P<0.001) for all non-insulin therapies, 0.125 (-0.003 to 0.25;P=0.056) for SGLT2i, and 0.12 (0.055 to 0.18;P<0.001) for GLP-1RA.</p> <p><b> </b></p> <p><b>Conclusion:</b> Use of non-insulin antihyperglycemic therapies, including SGLT2i and GLP-1RA, increased among low-income adults in both Medicaid expansion and non-expansion states, with a significantly greater increase in overall use and in GLP-1RA use in expansion states. Future evaluation of the population-level health impact of expanded access to these therapies is needed. </p>

Demonstrating Nutrient Cost Gradients: A Brooklyn Case Study

2014 ◽  
Vol 84 (5-6) ◽  
pp. 244-251 ◽  
Author(s):  
Robert J. Karp ◽  
Gary Wong ◽  
Marguerite Orsi
Keyword(s):  
Low Income ◽  
Energy Content ◽  
Food Selection ◽  
The United States ◽  
United States Department ◽  
Micronutrient Deficiencies ◽  
Caloric Density ◽  
Low Income Families ◽  
The Cost ◽  
The Impact

Abstract. Introduction: Foods dense in micronutrients are generally more expensive than those with higher energy content. These cost-differentials may put low-income families at risk of diminished micronutrient intake. Objectives: We sought to determine differences in the cost for iron, folate, and choline in foods available for purchase in a low-income community when assessed for energy content and serving size. Methods: Sixty-nine foods listed in the menu plans provided by the United States Department of Agriculture (USDA) for low-income families were considered, in 10 domains. The cost and micronutrient content for-energy and per-serving of these foods were determined for the three micronutrients. Exact Kruskal-Wallis tests were used for comparisons of energy costs; Spearman rho tests for comparisons of micronutrient content. Ninety families were interviewed in a pediatric clinic to assess the impact of food cost on food selection. Results: Significant differences between domains were shown for energy density with both cost-for-energy (p < 0.001) and cost-per-serving (p < 0.05) comparisons. All three micronutrient contents were significantly correlated with cost-for-energy (p < 0.01). Both iron and choline contents were significantly correlated with cost-per-serving (p < 0.05). Of the 90 families, 38 (42 %) worried about food costs; 40 (44 %) had chosen foods of high caloric density in response to that fear, and 29 of 40 families experiencing both worry and making such food selection. Conclusion: Adjustments to USDA meal plans using cost-for-energy analysis showed differentials for both energy and micronutrients. These differentials were reduced using cost-per-serving analysis, but were not eliminated. A substantial proportion of low-income families are vulnerable to micronutrient deficiencies.

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