The Effect of Louisiana Medicaid Expansion on Affordability of Health Care

2021 ◽  
pp. 003335492110414
Author(s):  
Yixue Shao ◽  
Charles Stoecker
Keyword(s):  
Health Care ◽  
Household Income ◽  
Analytical Models ◽  
Behavioral Risk ◽  
Medicaid Expansion ◽  
Poverty Level ◽  
Annual Household Income ◽  
Difference In Differences ◽  
Percentage Points ◽  
Health Care Affordability

Objectives Louisiana extended Medicaid coverage on July 1, 2016, to previously ineligible populations. We aimed to estimate the effect of Louisiana’s Medicaid expansion on self-reported affordability of health care. Methods We used 2011-2019 data from the Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS measured affordability of health care by asking respondents 2 questions: (1) whether they could not see a doctor due to cost in the previous 12 months and (2) whether they could not get a prescribed medication due to cost in the previous 12 months. We estimated difference-in-differences and difference-in-difference-in-differences analytical models using multivariable linear regression that compared trends in Louisiana with trends in states that did not expand Medicaid during the study period. Results Compared with adults aged <65 with annual household income >138% of the federal poverty level (FPL) in nonexpansion states, Medicaid expansion in Louisiana decreased the percentage of adults aged <65 with annual household income ≤138% FPL who reported being unable to see a doctor due to cost by 5.1 percentage points (95% CI, −6.5 to −3.6; P < .001) and unable to afford prescribed medication by 7.9 percentage points (95% CI, −9.2 to −6.6; P < .001). We found similar estimates when we limited the comparison group to Southern nonexpansion states. Conclusions Louisiana’s Medicaid expansion lowered cost barriers to health care. Further research may find improvements in health care affordability in states that have not yet expanded Medicaid.

Effects of the 2014 Affordable Care Act Medicaid Expansions on Health Care Access and Health Status of Poor Adults Aged 60-64 Years: Evidence from the First Six Years

2021 ◽  
Author(s):  
Redwan Bin Abdul Baten ◽  
George L Wehby
Keyword(s):  
Health Care ◽  
Health Status ◽  
Affordable Care Act ◽  
Health Care Access ◽  
Behavioral Risk ◽  
Long Term Effects ◽  
Poverty Level ◽  
Care Access ◽  
Percentage Points ◽  
Medicaid Expansions

Abstract Background and Objectives Little is known on effects of the Affordable Care Act (ACA) Medicaid expansions on health care access and health status of adults closest to 65. This study examines the effects of ACA Medicaid expansion on access and health status of poor adults aged 60-64 years. Research Design and Methods The study employs a difference-in-differences design comparing states that expanded Medicaid in 2014 under the ACA and non-expansion states over six years post expansion. The data are from the 2011-2019 Behavioral Risk Factor Surveillance System for individuals aged 60–64 years below the Federal Poverty Level. Results Having any health care coverage rate increased by 8.5 percentage-points (p&lt;0.01), while the rate of forgoing a needed doctor’s visit due to cost declined by 6.6 percentage points (p&lt;0.01). Similarly, rates of having a personal doctor/provider and completing a routine checkup increased by 9.1 (p&lt;0.01) and 4.8 (p&lt;0.1) percentage-points, respectively. Moreover, days not in good physical health in the past 30 declined by 1.5 days (p&lt;0.05), with suggestive evidence for decline in days not in good mental health and improvement in self-rated health. Discussion and Implications The ACA Medicaid expansions have improved health care access and health status of poor adults aged 60-64 years. Expanding Medicaid in the states that have not yet done so would reduce barriers to care and address unmet health needs for this population. Bridging coverage for individuals 60-64 years old by lowering Medicare eligibility age could have long-term effects on wellbeing and health services utilization.

scholarly journals Overturning the ACA’s Medicaid Expansion Would Likely Decrease Low-Income, Reproductive-Age Women’s Healthcare Spending and Utilization

2020 ◽  
Vol 57 ◽  
pp. 004695802098146
Author(s):  
Lucy Chen ◽  
Richard G. Frank ◽  
Haiden A. Huskamp
Keyword(s):  
Low Income ◽  
Medical Expenditure Panel Survey ◽  
Healthcare Spending ◽  
Reproductive Age ◽  
Medical Expenditure ◽  
Medicaid Expansion ◽  
Poverty Level ◽  
Difference In Differences ◽  
The Supreme Court ◽  
Household Incomes

In late 2020, the Supreme Court began hearing a case challenging the Affordable Care Act (ACA), which led to coverage gains for many low-income, reproductive-age women. To explore potential implications of a full ACA repeal for this population, we examined gains experienced after Medicaid expansion, assuming that such gains may be reversed. Using restricted 2013 to 2014 data from the Medical Expenditure Panel Survey for 1190 women ages 18 to 44 with household incomes below 138% of the federal poverty level, we compared the change in healthcare spending and utilization for women living in expansion states to the change in non-expansion states using a difference-in-differences design. We found that if Medicaid expansion were overturned, Medicaid coverage is likely to decrease, as well as Medicaid spending and prescription drug utilization.

scholarly journals The association of Medicaid expansion and racial/ethnic inequities in access, treatment, and outcomes for patients with acute myocardial infarction

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241785
Author(s):  
Erica M. Valdovinos ◽  
Matthew J. Niedzwiecki ◽  
Joanna Guo ◽  
Renee Y. Hsia
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Racial Disparities ◽  
Hospital Admissions ◽  
Hospital Readmissions ◽  
Medicaid Expansion ◽  
Difference In Differences ◽  
Percentage Points ◽  
White Patients

Introduction After having an acute myocardial infarction (AMI), racial and ethnic minorities have less access to care, decreased rates of invasive treatments such as percutaneous coronary intervention (PCI), and worse outcomes compared with white patients. The objective of this study was to determine whether the Affordable Care Act’s expansion of Medicaid eligibility was associated with changes in racial disparities in access, treatments, and outcomes after AMI. Methods Quasi-experimental, difference-in-differences-in-differences analysis of non-Hispanic white and minority patients with acute myocardial infarction in California and Florida from 2010–2015, using linear regression models to estimate the difference-in-differences. This population-based sample included all Medicaid and uninsured patients ages 18–64 hospitalized with acute myocardial infarction in California, which expanded Medicaid through the Affordable Care Act beginning as early as July 2011 in certain counties, and Florida, which did not expand Medicaid. The main outcomes included rates of admission to hospitals capable of performing PCI, rates of transfer for patients who first presented to hospitals that did not perform PCI, rates of PCI during hospitalization and rates of early (within 48 hours of admission) PCI, rates of readmission to the hospital within 30 days, and rates of in-hospital mortality. Results A total of 55,991 hospital admissions met inclusion criteria, 32,540 of which were in California and 23,451 were in Florida. Among patients with AMI who initially presented to a non-PCI hospital, the likelihood of being transferred increased by 12 percentage points (95% CI 2 to 21) for minority patients relative to white patients after the Medicaid expansion. The likelihood of undergoing PCI increased by 3 percentage points (95% CI 0 to 5) for minority patients relative to white patients after the Medicaid expansion. We did not find an association between the Medicaid expansion and racial disparities in overall likelihood of admission to a PCI hospital, hospital readmissions, or in-hospital mortality. Conclusions The Medicaid expansion was associated with a decrease in racial disparities in transfers and rates of PCI after AMI. We did not find an association between the Medicaid expansion and admission to a PCI hospital, readmissions, and in-hospital mortality. Additional factors outside of insurance coverage likely continue to contribute to disparities in outcomes after AMI. These findings are crucial for policy makers seeking to reduce racial disparities in access, treatment and outcomes in AMI.

scholarly journals Medicaid Expansion and Racial and Ethnic Disparities in Access to Health Care: Applying the National Academy of Medicine Definition of Health Care Disparities

2021 ◽  
Vol 58 ◽  
pp. 004695802199129
Author(s):  
Hyunjung Lee ◽  
Dominic Hodgkin ◽  
Michael P. Johnson ◽  
Frank W. Porell
Keyword(s):  
Health Care ◽  
Ethnic Groups ◽  
Access To Health Care ◽  
Ethnic Disparities ◽  
Medicaid Expansion ◽  
Poverty Level ◽  
Physician Visits ◽  
Access To Health ◽  
Definition Of ◽  
Racial Ethnic

Since 2014, 32 states implemented Medicaid expansion by removing the categorical criteria for childless adults and by expanding income eligibility to 138% of the federal poverty level (FPL) for all non-elderly adults. Previous studies found that the Affordable Care Act (ACA) Medicaid expansion improved rates of being insured, unmet needs for care due to cost, number of physician visits, and health status among low-income adults. However, a few recent studies focused on the expansion’s effect on racial/ethnic disparities and used the National Academy of Medicine (NAM) disparity approach with a limited set of access measures. This quasi-experimental study examined the effect of Medicaid expansion on racial/ethnic disparities in access to health care for U.S. citizens aged 19 to 64 with income below 138% of the federal poverty line. The difference-in-differences model compared changes over time in 2 measures of insurance coverage and 8 measures of access to health care, using National Health Interview Survey (NHIS) data from 2010 to 2016. Analyses used the NAM definition of disparities. Medicaid expansion was associated with significant decreases in uninsured rates and increases in Medicaid coverage among all racial/ethnic groups. There were differences across racial/ethnic groups regarding which specific access measures improved. For delayed care and unmet need for care, decreases in racial/ethnic disparities were observed. After the ACA Medicaid expansion, most access outcomes improved for disadvantaged groups, but also for others, with the result that disparities were not significantly reduced.

scholarly journals Health and Socio-economic Implications of Poverty in Bangladesh

2018 ◽  
Vol 14 (29) ◽  
pp. 301
Author(s):  
Sacchidanand Majumder ◽  
Soma Chowdhury Biswas
Keyword(s):  
Health Care ◽  
Chronic Diseases ◽  
Household Income ◽  
Access To Health Care ◽  
Construction Materials ◽  
Poverty Level ◽  
Economic Implications ◽  
Access To Health ◽  
Chronic Fever ◽  
Socio Economic Factors

The objective of this study was to explore the influences of the health and socio-economic factors associated with the poverty level of households in Bangladesh, through an analysis of data from the Household Income and Expenditure Survey (HIES) 2010 conducted by Bangladesh Bureau of Statistics (BBS). A total of all 12,240 households was considered in this study. CBN method was applied for estimating poverty of the household. A logistic regression analysis was used to identify the main factors that influence the household’s poverty. The results showed that the probability of the household being poor was higher when the household’s head suffered from various chronic diseases like chronic fever, injuries/disability, eczema, leprosy, and asthma/breathing trouble as compared to the household whose head didn’t suffer from any chronic diseases. From the analysis, it was also found that when a large number within household suffered from any chronic disease, the probability of the household being poor was increased. The household that had no access to health care was poorer than the household that had access to health care. The results also showed that with increased investment in health, the probability of the household being poor was decreased. The results showed that rural households were poorer than urban households. Monthly income, land ownership, construction materials of walls and roofs, types of the latrine, source of drinking water, household size; age, sex, and employment status of the household’s head all had a significant impact on the poverty level of the household.

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.

Medicaid Expansion and Medical Debt: Evidence From Louisiana, 2014–2019

2021 ◽  
pp. e1-e7
Author(s):  
Kevin Callison ◽  
Brigham Walker
Keyword(s):  
Public Health ◽  
Well Being ◽  
Medicaid Expansion ◽  
Difference In Differences ◽  
The Third ◽  
Medical Debt ◽  
Percentage Points ◽  
Medicaid Eligibility ◽  
Report Data ◽  
One Year

Objectives. To identify the association between Medicaid eligibility expansion and medical debt. Methods. We used difference-in-differences design to compare changes in medical debt for those gaining coverage through Louisiana’s Medicaid expansion with those in nonexpansion states. We matched individuals gaining Medicaid coverage because of Louisiana’s Medicaid expansion (n=196 556) to credit report data on medical debt and compared them with randomly selected credit reports of those living in Southern nonexpansion state zip codes with high rates of uninsurance (n=973 674). The study spanned July 2014 through July 2019. Results. One year after Louisiana Medicaid expansion, medical collections briefly rose before declining by 8.1 percentage points (95% confidence interval [CI]=–0.107, –0.055; P≤.001), or 13.5%, by the third postexpansion year. Balances also briefly rose before falling by 0.621 log points (95% CI=–0.817, –0.426; P≤.001), or 46.3%. Conclusions. Louisiana’s Medicaid expansion was associated with a reduction in the medical debt load for those gaining coverage. These results suggest that future Medicaid eligibility expansions may be associated with similar improvements in the financial well-being of enrollees. (Am J Public Health. Published online ahead of print July 2, 2021: e1–e7. https://doi.org/10.2105/AJPH.2021.306316 )

Impact of late Medicaid expansion on prostate cancer screening.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 141-141 ◽  
Author(s):  
Daniel Pucheril ◽  
Dimitar V. Zlatev ◽  
Matthew Mossanen ◽  
Alexander P Cole ◽  
Matthew D. Ingham ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Health Insurance ◽  
Cancer Screening ◽  
Prostate Cancer Screening ◽  
Behavioral Risk ◽  
Medicaid Expansion ◽  
Poverty Level ◽  
Multivariable Logistic Regression Model ◽  
Significant Difference ◽  
Personal Physician

141 Background: A key provision of the Affordable Care Act (ACA) was the expansion of Medicaid to childless adults living < 138% of the federal poverty level (FPL). Aside from a few early expansion states, the majority of states adopting the provision expanded coverage in January 2014, and are categorized as late expansion states (LES). Non-expansion states (NES) opposed expansion and did not adopt these broader provisions. Our objective was to determine the effects of this policy change on prostate cancer screening (PSAS) trends in LES and NES. Methods: The 2014 and 2016 Behavioral Risk Factor Surveillance System surveys reflect 2013 and 2015 health behaviors, and were queried for men 40-64, without history of prostate cancer, with a household income < 138% FPL, and residing in NES or LES. Descriptive statistics, stratified by expansion status and year, were generated for covariates. The Chi-Square test was used to compare proportions between years within state categories. Difference-in-differences (DID) analyses were employed to compare trends in men with health insurance, a personal physician, and undergoing PSAS. Within a multivariable logistic regression model, the interaction term year*state expansion status was used to determine the significance of DID estimates. Results: A weighted 8.8 million (n = 14,979) men met inclusion criteria. PSAS significantly declined from 2014 to 2016 in both NES (22.6% to 16.4%, p = 0.0006) and LES (20.5% to 15.8%, p = 0.003). In LES, the proportion of men with health insurance significantly increased from 2014 to 2016 (75.5% to 82.7%, p = 0.0002), however the proportion of insured men in NES was constant. Additionally, the proportion of respondents with a personal physician was unchanged from 2014 to 2016 in both NES and LES. DID analysis determined a significant difference in health insurance trends between 2014 and 2016 for LES compared to NES (+6.9%, p = 0.008). DID estimates were not significant for comparisons of trends for PSAS or access to a personal physician. Conclusions: The ACA’s Medicaid expansion provision has led to significant gains in insurance coverage for eligible persons in LES compared to NES, however, these gains have not translated into significantly different rates of access to a personal physician or PSAS.

scholarly journals The Role of the Medicaid Expansion in the Use of Preventive Health Care Services in California Men

2020 ◽  
Vol 14 (1) ◽  
pp. 155798832090319
Author(s):  
Grace L. Reynolds ◽  
Dennis G. Fisher
Keyword(s):  
Health Care ◽  
Preventive Care ◽  
Low Income ◽  
Health Care Services ◽  
Preventive Health Care ◽  
Preventive Health ◽  
Medicaid Expansion ◽  
Poverty Level ◽  
Care Services ◽  
Preventive Care Services

Men’s use of preventive care services may be constrained due to a number of factors including lack of health care insurance. California used the Medicaid expansion provisions of the Affordable Care Act (ACA) to enroll low-income men between the ages of 18 and 64 years in publicly funded health insurance. Most studies on the effect of the ACA on health care services have focused on racial/ethnic differences rather than gender. Data from the California Health Interview Survey for the 2015–2016 survey period were used to model the use of preventive health care services in the year prior to interview. Population weights were used in the analysis which was done using PROC SURVEY LOGISTIC in SAS software, version 9.4. The sample consisted of men between the ages of 18 and 64 years ( N = 6,180). Of these 66% ( n = 4,088) reporting receiving any preventive care services in the year prior to interview. The largest proportions of respondents fell into the youngest group aged 18–25 (17%) followed by the oldest group aged 60–64 (16.9%); 43% reported they were married, 57% had incomes at greater than 300% of the federal poverty level. There was no effect of race or ethnicity on receiving preventive care services. Having a chronic condition such as hypertension or diabetes was associated with a greater odds of receiving preventive care. Expanding Medicaid to include low-income men below the age of 65 is associated with increased use of preventive health care, especially among those with chronic conditions.

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