Medicaid's Role in Health Reform and Closing the Coverage Gap

2016 ◽  
Vol 44 (4) ◽  
pp. 580-584 ◽  
Author(s):  
Diane Rowland ◽  
Barbara Lyons
Keyword(s):  
Health Outcomes ◽  
Affordable Care Act ◽  
Low Income ◽  
Health Reform ◽  
Medicaid Expansion ◽  
Public And Private ◽  
Coverage Gap ◽  
The Poor ◽  
Uninsured Adults ◽  
Improve Access

Medicaid coverage matters for millions of low-income Americans, and especially for those with ongoing and serious health challenges. A source of comprehensive and affordable coverage, Medicaid has long been a cornerstone of federal and state efforts to improve access and health outcomes for very poor and medically vulnerable populations. The Affordable Care Act (ACA) leveraged Medicaid's role in serving the poor to broaden the program's reach to millions of low-income uninsured adults, and positioned the program as a fundamental component of the newly established continuum of public and private coverage. Looking ahead, if more states embrace the Medicaid expansion, there is the potential to build on this progress to significantly reduce the number of uninsured Americans.

COVID-19 will strain US health provision and budgets

2020 ◽  
Keyword(s):  
Public Health ◽  
Health Insurance ◽  
Affordable Care Act ◽  
Low Income ◽  
Healthcare Reform ◽  
Public Health Insurance ◽  
Medicaid Expansion ◽  
Public And Private ◽  
Content Type ◽  
Low Income Families

Significance High and rising case numbers have strained public and private health systems. Medicaid, which caters to low-income families and will experience surging demand as job losses rise, is in particular distress, mainly because states co-fund and administer it. The strains are propelling healthcare reform as an electoral issue. Impacts Biden is unlikely to endorse ‘Medicare for all’ but will push his public health insurance option. The Republicans will struggle to elucidate a clear alternative to the Affordable Care Act before November. COVID-19 will fuel calls for Medicaid expansion, including in smaller conservative states.

The Effect of the Affordable Care Act Medicaid Expansion on Disparities in Access to Care and Health Status

2018 ◽  
Vol 77 (5) ◽  
pp. 461-473 ◽  
Author(s):  
Hyunjung Lee ◽  
Frank W. Porell
Keyword(s):  
Health Status ◽  
Health Outcomes ◽  
Access To Care ◽  
Affordable Care Act ◽  
Low Income ◽  
Ethnic Disparities ◽  
Behavioral Risk ◽  
Medicaid Expansion ◽  
The Affordable Care Act ◽  
Racial Ethnic

Before the Affordable Care Act Medicaid expansion, nonelderly childless adults were not generally eligible for Medicaid regardless of their income, and Hispanics had much higher uninsured rates than other racial/ethnic subgroups. We estimated difference-in-differences models on Behavioral Risk Factor Surveillance data (2011-2016) to estimate the impacts of Medicaid expansion on racial/ethnic disparities in insurance coverage, access to care, and health status in this vulnerable subpopulation. Uninsured rates among all poor childless adults declined by roughly 9 percentage points more in states that expanded Medicaid. While expansion also had favorable impacts on most access and health outcomes among Whites in expansion states, there were relatively few such impacts among Blacks and Hispanics. Through 2016, Affordable Care Act Medicaid expansion was more effective in improving access and health outcomes among White low-income childless adults than mitigating racial/ethnic disparities.

scholarly journals The Affordable Care Act Medicaid Expansion and Smoking Cessation Among Low-Income Smokers

2019 ◽  
Vol 57 (6) ◽  
pp. e203-e210 ◽  
Author(s):  
J. Travis Donahoe ◽  
Edward C. Norton ◽  
Michael R. Elliott ◽  
Andrea R. Titus ◽  
Lucie Kalousová ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Affordable Care Act ◽  
Low Income ◽  
Medicaid Expansion ◽  
The Affordable Care Act

Changes in Insurance Coverage and Stage at Diagnosis Among Nonelderly Patients With Cancer After the Affordable Care Act

2017 ◽  
Vol 35 (35) ◽  
pp. 3906-3915 ◽  
Author(s):  
Ahmedin Jemal ◽  
Chun Chieh Lin ◽  
Amy J. Davidoff ◽  
Xuesong Han
Keyword(s):  
Affordable Care Act ◽  
Low Income ◽  
Early Stage ◽  
Significant Shift ◽  
Cancer Type ◽  
Medicaid Expansion ◽  
Newly Diagnosed ◽  
Difference In Differences ◽  
Cancer Data ◽  
The Affordable Care Act

Purpose To examine change in the percent uninsured and early-stage diagnosis among nonelderly patients with newly diagnosed cancer after the Affordable Care Act (ACA). Patients and Methods By using the National Cancer Data Base, we estimated absolute change (APC) and relative change in percent uninsured among patients with newly diagnosed cancer age 18 to 64 years between 2011 to the third quarter of 2013 (pre-ACA implementation) and the second to fourth quarter of 2014 (post-ACA) in Medicaid expansion and nonexpansion states by family income level. We also examined demographics-adjusted difference in differences in APC between Medicaid expansion and nonexpansion states. We similarly examined changes in insurance and early-stage diagnosis for the 15 leading cancers in men and women (top 17 cancers total). Results Between the pre-ACA and post-ACA periods, percent uninsured among patients with newly diagnosed cancer decreased in all income categories in both Medicaid expansion and nonexpansion states. However, the decrease was largest in low-income patients who resided in expansion states (9.6% to 3.6%; APC, −6.0%; 95% CI, −6.5% to −5.5%) versus their counterparts who resided in nonexpansion states (14.7% to 13.3%; APC, −1.4%; 95% CI, −2.0% to −0.7%), with an adjusted difference in differences of −3.3 (95% CI, −4.0 to −2.5). By cancer type, the largest decrease in percent uninsured occurred in patients with smoking- or infection-related cancers. A small but statistically significant shift was found toward early-stage diagnosis for colorectal, lung, female breast, and pancreatic cancer and melanoma in patients who resided in expansion states. Conclusion Percent uninsured among nonelderly patients with newly diagnosed cancer declined substantially after the ACA, especially among low-income people who resided in Medicaid expansion states. A trend toward early-stage diagnosis for select cancers in expansion states also was found. These results reinforce the importance of policies directed at providing affordable coverage to low-income, vulnerable populations.

The association between the Affordable Care Act on insurance status, cancer stage, and overall survival in patients with renal cell carcinoma.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 281-281
Author(s):  
Juan Javier-Desloges ◽  
Julia Yuan ◽  
Shady Soliman ◽  
Kevin Hakimi ◽  
Margaret Frances Meagher ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Affordable Care Act ◽  
Low Income ◽  
Cox Regression ◽  
Stage Migration ◽  
Insurance Status ◽  
Cancer Stage ◽  
Medicaid Expansion ◽  
Middle Income ◽  
Income Status

281 Background: We aimed to determine whether insurance expansions implemented through the Patient Protection and Affordable Care Act (ACA) were associated with changes in insurance coverage status, stage at diagnosis, and overall survival for patients with renal cell carcinoma (RCC). Methods: We identified patients 40 to 64 years old diagnosed with RCC between 2010 and 2016 in the National Cancer Database. States were categorized as participating on time in Medicaid expansion or not participating. We stratified patients into advanced cancer (stage III + IV) and localized cancer (stage I + II) groups. We stratified patients into low, middle, and high income groups. Stage trend and insurance trend analysis were performed to based on income status amongst patients living in expansion and non-expansion states. Absolute percentage change (APC) was calculated for insurance status and stage migration. Cox Regression Multivariable Analysis was conducted to assess risk of all-cause mortality (ACM) for patients before and after the implementation of the ACA, adjusting for insurance status, income, education, age, race, ethnicity, comorbidity, and living in an expansion state. Results: We identified 78,099 patients who met inclusion criteria. Following implementation of ACA, APC of patients with insurance increased in both Medicaid and non-expansion states by 4.0% and 2.10% (p<0.01), respectively. The largest increases occurred in expansion states, with low income patients acquiring Medicaid (APC +11.0% p<0.01), middle income patients acquiring Medicaid (APC +8.20% p<0.01), and high-income patients acquiring Medicaid (APC +4.0% p<0.01). In our stage trend analysis, there was a higher proportion of patients with localized stage disease after the implementation of the ACA in low income (APC +4.0% p<0.01) and middle-income patients (APC +1.6% p=0.02.) who live in expansions states, as well as middle income patients in non-expansions states (APC 1.4% p=0.02). Cox Regression MVA revealed that before ACA implementation, low income and middle income were associated with higher risk of mortality (HR 1.29 95%CI 1.18-1.40 p<0.01) and (HR 1.18 95% CI 1.10-1.26, p<0.01, but was not following ACA implementation (p=0.20) and (p=0.05) respectively. Conclusions: Following the implementation of the ACA the proportion of patients with newly diagnosed RCC with health insurance increased with the largest effects seen in Medicaid expansions states. In addition, higher proportions of patients were diagnosed with localized disease in Medicaid expansion states amongst low- and middle-income patients. Furthermore, income status ceased being a risk factor for mortality following ACA implementation. Our findings suggest that ACA implementation has been associated with downward stage migration in low/middle-income patients and attenuation of income status as a risk for mortality in RCC.

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 Implementing Health Reform at the State Level: Access and Care for Vulnerable Populations

2011 ◽  
Vol 39 (S1) ◽  
pp. 69-72
Author(s):  
John V. Jacobi ◽  
Sidney D. Watson ◽  
Robert Restuccia
Keyword(s):  
Low Income ◽  
Care Delivery ◽  
State Level ◽  
Chronically Ill ◽  
Vulnerable Groups ◽  
Public And Private ◽  
Implementation Challenges ◽  
Regulatory Coordination ◽  
Market Driven ◽  
Improve Access

The Affordable Care Act1 (ACA) promises to improve access to coverage and care for two vulnerable groups: low-income persons who are excluded by a lack of resources and chronically ill and disabled people who are excluded by the dysfunction of our existing insurance and care delivery systems. ACA’s sprawling provisions raise a wealth of implementation challenges that are exacerbated by the compromises required to move reform through Congress. In particular, the compromise between regulatory/public program advocates and advocates for private, market-driven programs requires thoughtful regulatory coordination between public and private health systems.

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