scholarly journals Associations between insurance-related affordable care act policy changes with HPV vaccine completion

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Summer Sherburne Hawkins ◽  
Krisztina Horvath ◽  
Jessica Cohen ◽  
Lydia E. Pace ◽  
Christopher F. Baum
Keyword(s):  
Health Insurance ◽  
Affordable Care Act ◽  
Hpv Vaccine ◽  
Private Insurance ◽  
Policy Changes ◽  
Percentage Point Increase ◽  
Insurance Type ◽  
Point Increase ◽  
Vaccine Completion ◽  
Privately Insured

Abstract Background Although all 11- or 12-year-olds in the US were recommended to receive a 3-dose series of the human papillomavirus (HPV) vaccine within a 12-month period prior to 2016, rates of completion of the HPV vaccine series remained suboptimal. The effects of the Affordable Care Act (ACA), including private insurance coverage with no cost-sharing and health insurance expansions, on HPV vaccine completion are largely unknown. The aim of this study was to examine the associations between the ACA’s 2010 provisions and 2014 insurance expansions with HPV vaccine completion by sex and health insurance type. Methods Using 2009–2015 public and private health insurance claims from Maine, New Hampshire, and Massachusetts, we identified 9-to-26-year-olds who had at least one HPV vaccine dose. We conducted a logistic regression model to examine the associations between the ACA policy changes with HPV vaccine completion (defined as receiving a 3-dose series within 12 months from the date of initiation) as well as interactions by sex and health insurance type. Results Over the study period, among females and males who initiated the HPV vaccine, 27.6 and 28.0%, respectively, completed the series within 12 months. Among females, the 2010 ACA provision was associated with a 4.3 percentage point increases in HPV vaccine completion for the privately-insured (0.043; 95% CI: 0.036–0.061) and a 5.7 percentage point increase for Medicaid enrollees (0.057; 95% CI: 0.032–0.081). The 2014 health insurance expansions were associated with a 9.4 percentage point increase in vaccine completion for females with private insurance (0.094; 95% CI: 0.082–0.107) and a 8.5 percentage point increase for Medicaid enrollees (0.085; 95% CI: 0.068–0.102). Among males, the 2014 ACA reforms were associated with a 5.1 percentage point increase in HPV vaccine completion for the privately-insured (0.051; 95% CI: 0.039–0.063) and a 3.4 percentage point increase for Medicaid enrollees (0.034; 95% CI: 0.017–0.050). In a sensitivity analysis, findings were similar with HPV vaccine completion within 18 months. Conclusions Despite low HPV vaccine completion overall, both sets of ACA provisions were associated with increases in completion among females and males. Our results suggest that expanding Medicaid across the remaining states could increase HPV vaccine completion among publicly-insured youth and prevent HPV-related cancers.

scholarly journals Medicaid Health Insurance Status Limits Patient Accessibility to Rehabilitation Services Following ACL Reconstruction Surgery

2018 ◽  
Vol 6 (4) ◽  
pp. 232596711876335 ◽  
Author(s):  
Miranda J. Rogers ◽  
Ian Penvose ◽  
Emily J. Curry ◽  
Anthony DeGiacomo ◽  
Xinning Li
Keyword(s):  
Health Insurance ◽  
Acl Reconstruction ◽  
Metropolitan Area ◽  
Private Insurance ◽  
The United States ◽  
The State ◽  
Median Income ◽  
Insurance Type ◽  
Insured Patients ◽  
Privately Insured

Background: In the senior author’s (X.L.) orthopaedic sports medicine clinic in the United States (US), patients appear to have difficulty finding physical therapy (PT) practices that accept Medicaid insurance for postoperative rehabilitation. Purpose: To determine access to PT services for privately insured patients versus those with Medicaid who underwent anterior cruciate ligament (ACL) reconstruction in the largest metropolitan area in the state of Massachusetts, which underwent Medicaid expansion as part of the Affordable Care Act. Study Design: Cross-sectional study. Methods: Locations offering PT services were identified through Google, Yelp, and Yellow Pages internet searches. Each practice was contacted and queried about health insurance type accepted (Medicaid [public] vs Blue Cross Blue Shield [private]) for postoperative ACL reconstruction rehabilitation. Additional data collection points included time to first appointment, reason for not accepting insurance, and ability to refer to a location accepting insurance type. Median income and percentage of households living in poverty were also noted through US Census data for the town in which the practice was located. Results: Of the 157 PT locations identified, contact was made with 139 to achieve a response rate of 88.5%. Overall, 96.4% of practices took private insurance, while 51.8% accepted Medicaid. Among those locations that did not accept Medicaid, only 29% were able to refer to a clinic that would accept it. “No contract” was the most common reason why Medicaid was not accepted (39.4%). Average time to first appointment was 5.8 days for privately insured patients versus 8.4 days for Medicaid patients ( P = .0001). There was no significant difference between clinic location (town median income or poverty level) and insurance type accepted. Conclusion: The study results reveal that 43% fewer PT clinics accept Medicaid as compared with private insurance for postoperative ACL reconstruction rehabilitation in a large metropolitan area. Furthermore, Medicaid patients must wait significantly longer for an initial appointment. Access to PT care is still limited despite the expansion of Medicaid insurance coverage to all patients in the state.

Health Insurance Status as a Predictor of Mode of Colon Cancer Detection but Not Stage at Diagnosis: Implications for Early Detection

2021 ◽  
pp. 003335492199917
Author(s):  
Lindsey A. Jones ◽  
Katherine C. Brewer ◽  
Leslie R. Carnahan ◽  
Jennifer A. Parsons ◽  
Blase N. Polite ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Health Insurance ◽  
Early Detection ◽  
Late Stage ◽  
Early Stage ◽  
Insurance Status ◽  
Stage At Diagnosis ◽  
Health Insurance Status ◽  
Percentage Point Increase ◽  
Point Increase

Objective For colon cancer patients, one goal of health insurance is to improve access to screening that leads to early detection, early-stage diagnosis, and polyp removal, all of which results in easier treatment and better outcomes. We examined associations among health insurance status, mode of detection (screen detection vs symptomatic presentation), and stage at diagnosis (early vs late) in a diverse sample of patients recently diagnosed with colon cancer from the Chicago metropolitan area. Methods Data came from the Colon Cancer Patterns of Care in Chicago study of racial and socioeconomic disparities in colon cancer screening, diagnosis, and care. We collected data from the medical records of non-Hispanic Black and non-Hispanic White patients aged ≥50 and diagnosed with colon cancer from October 2010 through January 2014 (N = 348). We used logistic regression with marginal standardization to model associations between health insurance status and study outcomes. Results After adjusting for age, race, sex, and socioeconomic status, being continuously insured 5 years before diagnosis and through diagnosis was associated with a 20 (95% CI, 8-33) percentage-point increase in prevalence of screen detection. Screen detection in turn was associated with a 15 (95% CI, 3-27) percentage-point increase in early-stage diagnosis; however, nearly half (47%; n = 54) of the 114 screen-detected patients were still diagnosed at late stage (stage 3 or 4). Health insurance status was not associated with earlier stage at diagnosis. Conclusions For health insurance to effectively shift stage at diagnosis, stronger associations are needed between health insurance and screening-related detection; between screening-related detection and early stage at diagnosis; or both. Findings also highlight the need to better understand factors contributing to late-stage colon cancer diagnosis despite screen detection.

scholarly journals Have the ACA's Exchanges Succeeded? It's Complicated

2020 ◽  
Vol 45 (4) ◽  
pp. 661-676 ◽  
Author(s):  
David K. Jones ◽  
Sarah H. Gordon ◽  
Nicole Huberfeld
Keyword(s):  
Health Insurance ◽  
Affordable Care Act ◽  
Health Reform ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Rapid Evolution ◽  
Middle Income ◽  
State Variation ◽  
Individual Decisions ◽  
Insurance Exchanges

Abstract The fight over health insurance exchanges epitomizes the rapid evolution of health reform politics in the decade since the passage of the Affordable Care Act (ACA). The ACA's drafters did not expect the exchanges to be contentious because they would expand private insurance coverage to low- and middle-income individuals who were increasingly unable to obtain employer-sponsored health insurance. Instead, exchanges became one of the primary fronts in the war over Obamacare. Have the exchanges been successful? The answer is not straightforward and requires a historical perspective through a federalism lens. What the ACA has accomplished has depended largely on whether states were invested in or resistant to implementation, as well as individual decisions by state leaders working with federal officials. Our account demonstrates that the states that have engaged with the ACA most consistently appear to have experienced greater exchange-related success. But each aspect of states' engagement with or resistance to the ACA must be counted to fully paint this picture, with significant variation among states. This variation should give pause to those considering next steps in health reform, because state variation can mean innovation and improvement but also lack of coverage, disparities, and diminished access to care.

scholarly journals Health Reform and Utilization of High-Volume Hospitals for Complex Cancer Operations

2018 ◽  
Vol 14 (1) ◽  
pp. e42-e50 ◽  
Author(s):  
Andrew P. Loehrer ◽  
David C. Chang ◽  
Zirui Song ◽  
George J. Chang
Keyword(s):  
New York ◽  
Private Insurance ◽  
Insurance Coverage ◽  
High Volume ◽  
Percentage Point Increase ◽  
Point Increase ◽  
Coverage Expansion ◽  
Incident Rate ◽  
And Control ◽  
The Impact

Purpose: Underinsured patients are less likely to receive complex cancer operations at hospitals with high surgical volumes (high-volume hospitals, or HVHs), which contributes to disparities in care. To date, the impact of insurance coverage expansion on site of complex cancer surgery remains unknown. Methods: Using the 2006 Massachusetts coverage expansion as a natural experiment, we searched the Hospital Cost and Utilization Project state inpatient databases for Massachusetts and control states (New York, New Jersey, and Florida) between 2001 and 2011 to evaluate changes in the utilization of HVHs for resections of bladder, esophageal, stomach, pancreatic, rectal, or lung cancer after the expansion of insurance coverage. We studied nonelderly, adult patients with private insurance and those with government-subsidized or self-pay (GSSP) coverage with a difference-in-differences framework. Results: We studied 11,687 patients in Massachusetts and 56,300 patients in control states. Compared with control states, the 2006 Massachusetts insurance expansion was associated with a 14% increased rate of surgical intervention for GSSP patients (incident rate ratio, 1.14; P = .015), but there was no significant change in the probability of GSSP patients undergoing surgery at an HVH (1.0 percentage-point increase; P = .710). The reform was associated with no change in the uninsured payer-mix at HVHs (0.6 percentage-point increase; P = .244) and with a 5.1 percentage-point decrease for the uninsured payer mix at low-volume hospitals ( P < .001). Conclusion: The 2006 Massachusetts insurance expansion, a model for the Affordable Care Act, was associated with increased rates of complex cancer operations and increased insurance coverage but with no change in utilization of HVH for complex cancer operations.

Association of the Affordable Care Act with survival among adolescents and young adults with lymphomas in California.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6532-6532
Author(s):  
Renata Abrahão ◽  
Julianne J.P. Cooley ◽  
Frances Belda Maguire ◽  
Cyllene Morris ◽  
Arti Parikh-Patel ◽  
...  
Keyword(s):  
Young Adults ◽  
Health Insurance ◽  
Affordable Care Act ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Adolescents And Young Adults ◽  
Stage At Diagnosis ◽  
Medicaid Enrollment ◽  
Race Ethnicity ◽  
The Affordable Care Act

6532 Background: Our recent study showed that the implementation of the Affordable Care Act (ACA) was associated with increased health insurance coverage among adolescents and young adults (AYAs, 15–39 years) diagnosed with lymphomas in California and decreased likelihood of late stage at diagnosis. However, AYAs of Black or Hispanic race/ethnicity (vs Whites) and those living in lower socioeconomic (SES) neighborhoods were at higher risk of presenting with advanced stage. We aimed to determine whether the increased insurance coverage under the ACA was associated with improved survival, and to identify the main predictors of survival among AYAs with lymphomas. Methods: We used data from the California Cancer Registry linked to Medicaid enrollment files on AYAs diagnosed with a primary non-Hodgkin (NHL) or Hodgkin (HL) lymphoma during March 2005–September 2010 (pre-ACA), October 2010–December 2013 (early ACA) or 2014–2017 (full ACA). Patients were followed from lymphoma diagnosis until death, loss to follow-up or end of the study (12/31/2018). Health insurance was categorized as continuous Medicaid, discontinuous Medicaid, Medicaid enrollment at diagnosis/uninsured, other public or private. We used multivariable Cox proportional regression to examine the associations between all-cause survival and era of diagnosis, adjusting for sex, age and stage at diagnosis, health insurance, race/ethnicity, neighborhood SES, treatment facility, comorbidities, and marital status. Results: Of 11,221 AYAs, 5,878 were diagnosed with NHL and 5,343 with HL. Most patients were male (56%), White (45%), presented with earlier stage (I/II, 56%), and had private insurance (57%). The proportion of AYAs who received initial care at National Cancer Institute-Designated Cancer Centers (NCI-CCs) increased from 24% pre-ACA to 31% after full ACA implementation (p < 0.001). AYAs diagnosed in the early (aHR = 0.76, 95% CI 0.67–0.88) and full ACA (aHR = 0.55, 95%CI 0.47–0.64) eras had better survival than those diagnosed pre-ACA. Compared to those with private insurance, survival was worse among patients with no insurance (HR = 2.13, 95% CI 1.83–2.49), discontinuous Medicaid (HR = 2.17, 95% CI 1.83–2.56) and continuous Medicaid (HR = 1.93, 95% CI 1.63–2.29) at diagnosis. Regardless of their insurance, older AYAs, males, unmarried, those with later stage (II–IV), residents in lower SES neighborhoods, and those of Black, Hispanic, Asian/Pacific Islander, and American Indian/Alaskan Native race/ethnicity experienced worse survival. Conclusions: Following the ACA implementation in California, AYAs diagnosed with lymphomas experienced increased access to care at NCI-CCs and improved survival. Yet, racial/ethnic and socioeconomic survival disparities persisted. Moving forward, policy actions are required to mitigate structural and social determinants of health disparities in this population.

scholarly journals Influence of insurance type on rate and type of initial concussion-related medical visits among youth

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chris Radlicz ◽  
Kenneth Jackson ◽  
Amanda Hautmann ◽  
Junxin Shi ◽  
Jingzhen Yang
Keyword(s):  
Sports Medicine ◽  
Private Insurance ◽  
Urgent Care ◽  
Care Utilization ◽  
Care Seeking ◽  
Medical Visits ◽  
Insurance Type ◽  
Publicly Insured ◽  
Efficient Care ◽  
Privately Insured

Abstract Background A growing number of studies report increased concussion-related health care utilization in recent years, but factors impacting care-seeking behaviors among youth following a concussion are not well described. This study aimed to evaluate the influence of insurance type on the rate and type of initial concussion visits and the time from injury to the initial visit in youth. Methods We extracted and analyzed initial concussion-related medical visits for youth ages 10 to 17 from electronic health records. Patients must have visited Nationwide Children’s Hospital’s (NCH) concussion clinic at least once between 7/1/2012 and 12/31/2017. We evaluated the trends and patterns of initial concussion visits across the study period using regression analyses. Results Of 4955 unique concussion visits included, 60.1% were males, 80.5% were white, and 69.5% were paid by private insurance. Patients’ average age was 13.9 years (SD = 3.7). The rate of the initial concussion visits per 10,000 NCH visits was consistently higher in privately insured than publicly insured youth throughout the study period (P < .0001). Privately insured youth had greater odds of initial concussion visits to sports medicine clinics (AOR = 1.45, 95% CI = 1.20, 1.76) but lower odds of initial concussion visits to the ED/urgent care (AOR = 0.74, 95% CI = 0.60, 0.90) than publicly insured youth. Days from injury to initial concussion visit significantly decreased among both insurance types throughout the study (P < .0001), with a greater decrease observed in publicly insured than privately insured youth (P = .011). Conclusions Results on the differences in the rate, type, and time of initial concussion-related visits may help inform more efficient care of concussion among youth with different types of insurance.

scholarly journals The Decline, Rebound, and Further Rise in SNAP Enrollment: Disentangling Business Cycle Fluctuations and Policy Changes

2018 ◽  
Vol 10 (4) ◽  
pp. 153-176 ◽  
Author(s):  
Peter Ganong ◽  
Jeffrey B. Liebman
Keyword(s):  
Great Recession ◽  
State Policy ◽  
Policy Changes ◽  
Assistance Program ◽  
The Great Recession ◽  
Percentage Point Increase ◽  
The Past ◽  
Point Increase ◽  
Program Enrollment ◽  
Nutrition Assistance

One-in-seven Americans received benefits from the Supplemental Nutrition Assistance Program in 2011, an all-time high. We analyze changes in program enrollment over the past two decades, quantifying the contributions of unemployment and state policy changes. Using instrumental variables to address measurement error, we estimate that a 1 percentage point increase in unemployment raises enrollment by 15 percent. Unemployment explains most of the decrease in enrollment in the late 1990s, state policy changes explain more of the increase in enrollment in the early 2000s, and unemployment explains most of the increase in enrollment in the aftermath of the Great Recession. (JEL E24, E32, H53, H75, I12, I18, I58)

scholarly journals Health insurance enrollment strategies during the Affordable Care Act (ACA): a scoping review on what worked and for whom

2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Angelo Ercia ◽  
Nga Le ◽  
Runguo Wu
Keyword(s):  
Health Insurance ◽  
Affordable Care Act ◽  
Scoping Review ◽  
Empirical Studies ◽  
Private Insurance ◽  
Community Outreach ◽  
Inclusion Criteria ◽  
Quasi Experimental ◽  
The Affordable Care Act ◽  
Keyword Searches

Abstract Background The Affordable Care Act (ACA) provided an opportunity for millions of people in the U.S. to get coverage from the publicly funded Medicaid program or private insurance from the newly established marketplace. However, enrolling millions of people for health insurance was an enormous task. The aim of this review was to examine the strategies used to enroll people for health insurance and their effectiveness after implementing the ACA’s coverage expansion. Methods The PRISMA Extension for Scoping Review (PRISMA-ScR) guided this review. Included studies were empirical studies that met the inclusion criteria and published between 2010 and 2020. Studies were searched mainly from two scholarly databases, CINAHL Plus and Medline (PubMed) using keyword searches. Hand searches from the references of selected journals were also performed. Content analysis was conducted by two authors in which codes were inductively developed to identify themes. Results There were 2213 potential studies identified from the search, but 10 met the inclusion criteria. The research design of the studies varied. Two studies were randomized trials, one quasi-experimental trial, three mixed-methods, two qualitative and two quantitative. All studies focused on strategies used to inform and help people enroll for either Medicaid or private insurance from the marketplace. This review identified three key strategies used to help enroll people for coverage: 1) individual assistance; 2) community outreach; and 3) health education and promotion (HE&P). Conclusion Community-based organizations were likely to use a combination of the three strategies simultaneously to reach uninsured individuals and directly help them enroll for health insurance. Other organizations that aimed to reach a wider segment of the population used single strategies, such as community outreach or HE&P.

scholarly journals Effect of the COVID-19 pandemic on health insurance coverage among trauma patients: a study of six level I trauma centers

2021 ◽  
Vol 6 (1) ◽  
pp. e000640
Author(s):  
Erica Sercy ◽  
Therese M Duane ◽  
Mark Lieser ◽  
Robert M Madayag ◽  
Gina Berg ◽  
...  
Keyword(s):  
Health Insurance ◽  
Clinical Characteristics ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Trauma Patients ◽  
Trauma Centers ◽  
Insurance Type ◽  
Period 2 ◽  
Insured Patients ◽  
Privately Insured

BackgroundIncreased unemployment during the COVID-19 pandemic has likely led to widespread loss of employer-provided health insurance. This study examined trends in health insurance coverage among trauma patients during the COVID-19 pandemic, including differences in demographics and clinical characteristics by insurance type.MethodsThis was a retrospective study on adult patients admitted to six level 1 trauma centers between January 1, 2018 and June 30, 2020. The primary exposure was hospital admission date: January 1, 2018 to December 31, 2018 (Period 1), January 1, 2019 to March 15, 2020 (Period 2), and March 16, 2020 to June 30, 2020 (Period 3). Covariates included demographic and clinical variables. χ² tests examined whether the rates of patients covered by each insurance type differed between the pandemic and earlier periods. Mann-Whiney U and χ² tests investigated whether patient demographics or clinical characteristics differed within each insurance type across the study periods.ResultsA total of 31 225 trauma patients admitted between January 1, 2018 and June 30, 2019 were included. Forty-one per cent (n=12 651) were admitted in Period 1, 49% (n=15 258) were from Period 2, and 11% (n=3288) were from Period 3. Percentages of uninsured patients increased significantly across the three periods (Periods 1 to 3: 15%, 16%, 21%) (ptrend=0.02); however, there was no accompanying decrease in the percentages of commercial/privately insured patients (Periods 1 to 3: 40%, 39%, 39%) (ptrend=0.27). There was a significant decrease in the percentage of patients on Medicare during the pandemic period (Periods 1 to 3: 39%, 39%, 34%) (p<0.01).DiscussionThis study found that job loss during the COVID-19 pandemic resulted in increases of uninsured trauma patients. However, there was not a corresponding decrease in commercial/privately insured patients, as may have been expected; rather, a decrease in Medicare patients was observed. These findings may be attributable to a growing workforce during the study period, in combination with a younger overall patient population during the pandemic.Level of evidenceRetrospective, level III study.

scholarly journals Mandated Health Insurance and Provider Reimbursement via Private Insurance

2017 ◽  
Vol 4 ◽  
pp. 233339281668720 ◽  
Author(s):  
Andrew Friedson ◽  
Allison Marier
Keyword(s):  
Health Insurance ◽  
Affordable Care Act ◽  
Low Income ◽  
Private Insurance ◽  
National Level ◽  
Potential Outcomes ◽  
Preventative Care ◽  
Physician Reimbursement ◽  
Patient Protection ◽  
The Us

In 2006, Massachusetts passed a reform that required individuals to purchase health insurance and provided subsidized health insurance to low-income individuals. The US Patient Protection and Affordable Care Act (ACA) was modeled after this reform, making Massachusetts an ideal place to look at potential outcomes from the ACA. Postreform, the proportion of the health-insured population in Massachusetts greatly increased, which potentially changed physician reimbursement for procedures as usage of care, particularly preventative care for children increased. We find that reimbursement for well-infant visits rose temporarily by approximately 4% the year after the reform but that the effective price increase did not persist. It is likely that this lack of persistence is due to an increase in the supply of physicians. This has important implications for the ACA, as expanding physician capacity is more difficult on a national level.

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