The Impact of Insurance Expansions on the Already Insured: The Affordable Care Act and Medicare

2020 ◽  
Vol 12 (4) ◽  
pp. 288-318
Author(s):  
Colleen M. Carey ◽  
Sarah Miller ◽  
Laura R. Wherry
Keyword(s):  
Access To Care ◽  
Affordable Care Act ◽  
Medicare Beneficiaries ◽  
Medicare Population ◽  
Large Panel ◽  
The Affordable Care Act ◽  
The Impact ◽  
Medicaid Expansions ◽  
Rule Out

Some states have not adopted the Affordable Care Act (ACA) Medicaid expansions due to concerns that the expansions may impair access to care and utilization for those who are already insured. We investigate such negative spillovers using a large panel of Medicare beneficiaries. Across many subgroups and outcomes, we find no evidence that the expansions reduced utilization among Medicare beneficiaries and can rule out all but very small changes in utilization or spending. These results indicate that the expansions in Medicaid did not impair access to care or utilization for the Medicare population. (JEL G22, H51, I13, I18, I38)

scholarly journals The impact of the Affordable Care Act on patient coverage and access to care: perspectives from FQHC administrators in Arizona, California and Texas

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Angelo Ercia
Keyword(s):  
Access To Care ◽  
Affordable Care Act ◽  
Health Care Services ◽  
Healthcare Services ◽  
Structured Interviews ◽  
Care Services ◽  
Healthcare Needs ◽  
The Affordable Care Act ◽  
Insured Patients ◽  
The Impact

Abstract Background The Affordable Care Act (ACA) enabled millions of people to gain coverage that was expected to improve access to healthcare services. However, it is unclear the extent of the policy’s impact on Federally Qualified Health Centers (FQHC) and the patients they served. This study sought to understand FQHC administrators’ views on the ACA’s impact on their patient population and organization. It specifically explores FQHC administrators’ perspective on 1) patients’ experience with gaining coverage 2) their ability to meet patients’ healthcare needs. Methods Twenty-two semi-structured interviews were conducted with administrators from FQHCs in urban counties in 2 Medicaid-expanded states (Arizona and California) and 1 non-expanded state (Texas). An inductive thematic analysis approach was used to analyze the interview data. Results All FQHC administrators reported uninsured patients were more likely to gain coverage from Medicaid than from private health insurance. Insured patients generally experienced an improvement in accessing healthcare services but depended on their plan’s covered services, FQHCs’ capacity to meet demand, and specialist providers’ willingness to accept their coverage type. Conclusion Gaining coverage helped improved newly insured patients’ access to care, but limitations remained. Additional policies are required to better address the gaps in the depth of covered services in Medicaid and the most affordable PHI plans and capacity of providers to meet demand to ensure beneficiaries can fully access the health care services they need.

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

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.

Reducing Racial and Ethnic Disparities in Access to Care: Has the Affordable Care Act Made a Difference?

2017 ◽  
Author(s):  
Douglas McCarthy McCarthy ◽  
David C. Radley Radley ◽  
Pamela Riley Riley ◽  
Susan L. Hayes Hayes
Keyword(s):  
Access To Care ◽  
Affordable Care Act ◽  
Ethnic Disparities ◽  
Racial And Ethnic Disparities ◽  
The Affordable Care Act

scholarly journals All Medicaid Expansions Are Not Created Equal: The Geography and Targeting of the Affordable Care Act

2019 ◽  
Vol 2019 (2) ◽  
pp. 1-92
Author(s):  
Craig Garthwaite ◽  
John Graves ◽  
Tal Gross ◽  
Zeynal Karaca ◽  
Victoria Marone ◽  
...  
Keyword(s):  
Affordable Care Act ◽  
The Affordable Care Act ◽  
Medicaid Expansions

The Impact of the Affordable Care Act Medicaid Expansions on the Sources of Health Insurance Coverage of Undergraduate Students in the United States

2021 ◽  
pp. 107755872110158
Author(s):  
Priyanka Anand ◽  
Dora Gicheva
Keyword(s):  
United States ◽  
Health Insurance ◽  
Undergraduate Students ◽  
Affordable Care Act ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Percentage Points ◽  
The Affordable Care Act ◽  
Medicaid Expansions

This article examines how the Affordable Care Act Medicaid expansions affected the sources of health insurance coverage of undergraduate students in the United States. We show that the Affordable Care Act expansions increased the Medicaid coverage of undergraduate students by 5 to 7 percentage points more in expansion states than in nonexpansion states, resulting in 17% of undergraduate students in expansion states being covered by Medicaid postexpansion (up from 9% prior to the expansion). In contrast, the growth in employer and private direct coverage was 1 to 2 percentage points lower postexpansion for students in expansion states compared with nonexpansion states. Our findings demonstrate that policy efforts to expand Medicaid eligibility have been successful in increasing the Medicaid coverage rates for undergraduate students in the United States, but there is evidence of some crowd out after the expansions—that is, some students substituted their private and employer-sponsored coverage for Medicaid.

The Impact of the Affordable Care Act Insurance Expansions on Opioid‐Related Emergency Department Visits

2021 ◽  
Vol 56 (S2) ◽  
pp. 64-64
Author(s):  
Sandra Decker ◽  
Michael Dworsky ◽  
Teresa Gibson ◽  
Rachel Henke ◽  
Kimberly McDermott
Keyword(s):  
Emergency Department ◽  
Affordable Care Act ◽  
Emergency Department Visits ◽  
The Affordable Care Act ◽  
The Impact

Change in facility-level share of Medicaid patients with cancer following implementation of the affordable care act.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18543-e18543
Author(s):  
Matthew Buck ◽  
Patrick C Demkowicz ◽  
James Nie ◽  
Victoria A. Marks ◽  
Michelle C. Salazar ◽  
...  
Keyword(s):  
Affordable Care Act ◽  
Insurance Coverage ◽  
Study Endpoint ◽  
Primary Study ◽  
Factors Associated ◽  
Percentage Points ◽  
The Affordable Care Act ◽  
Facility Level ◽  
Insured Patients ◽  
Medicaid Expansions

e18543 Background: Although Medicaid expansions associated with the Affordable Care Act (ACA) significantly increased insurance coverage for Americans with cancer, there is evidence that some facilities limit the number of Medicaid patients they treat due to lower reimbursement. We aimed to assess facility-level changes in the proportion of patients with Medicaid who were diagnosed with cancer in relation to Medicaid expansions associated with the ACA. Methods: We identified adult patients with the 19 most commonly diagnosed cancers using the National Cancer Database who were diagnosed with cancer from 2010 through 2017. We clustered Commission on Cancer (CoC) accredited institutions and included those diagnosing at least 10 patients in each year. The primary study endpoint was the change in the proportion of Medicaid-insured individuals relative to the implementation of the ACA (pre- and post-Jan 1, 2014). We used adjusted difference-in-differences (DID) estimation and multivariable logistic regression to examine patient and facility-level factors associated with changes in the proportion of Medicaid insured individuals. Results: We identified 1,064 eligible facilities in the study period. There were considerable changes in the share of Medicaid insured patients at the facility-level (range -20.0% to +44.7%, IQR -0.64% to +5.63%). There were significantly larger changes in facilities located in Medicaid expansion states (11.5 to 16.5% percentage points) versus non-expansion states (9.2 to 8.9% percentage points) with adjusted DID +5.79% (p < 0.001). Despite overall increases, 14.6% of facilities in expansion states experienced reductions in their share of Medicaid insured patients. Facility factors associated with decreasing share of Medicaid patients were non-expansion status (OR: 6.25, 95% CI 3.89 – 9.98, p < 0.001) and higher baseline Medicaid population (OR: 2.93, 95% CI 2.00 – 4.35, p < 0.001). There was also significant regional variation with larger decreases in the West South Central (OR: 5.86, 95% CI 2.30 – 15.74, p < 0.001) and West North Central (OR: 2.46, 95% CI 1.07 – 5.87, p = 0.037) regions. Conclusions: Although state expansions associated with the ACA led to increases in the share of Medicaid-insured patients diagnosed with cancer at CoC facilities, there was considerable variation in changes at the facility-level. These findings highlight that improved insurance coverage may not be sufficient to improve access to care, and facility-level policies may remain a source of access disparity.

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