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 Improved Health and Insurance Status Among Cigarette Smokers After Medicaid Expansion, 2011-2016

2018 ◽  
Vol 133 (3) ◽  
pp. 294-302 ◽  
Author(s):  
Clare C. Brown ◽  
J. Mick Tilford ◽  
T. Mac Bird
Keyword(s):  
Health Care ◽  
Low Income ◽  
Access To Health Care ◽  
Smoking Behavior ◽  
Ordinary Least Squares ◽  
Medicaid Expansion ◽  
High Concentration ◽  
Percentage Points ◽  
Access To Health ◽  
The Impact

Objectives: The high concentration of smokers among subgroups targeted by the Affordable Care Act and the historically worse health and lower access to health care among smokers warrants an evaluation of how Medicaid expansion affects smokers. We evaluated the impact of Medicaid expansion on smoking behavior, access to health care, and health of low-income adults, and we compared outcomes of all low-income people with outcomes of low-income current smokers by states’ Medicaid expansion status. Methods: We obtained data from the Behavioral Risk Factor Surveillance System (2011-2016) for low-income adults aged 18-64. We estimated multivariable linear ordinary least squares probability models using a quasi-experimental difference-in-difference approach to compare smoking behavior, access to health care, and health between people in expansion states and nonexpansion states and, specifically, on low-income adults and the subgroup of low-income current smokers. Results: Compared with low-income smokers in nonexpansion states, low-income smokers in expansion states were 7.6 percentage points (95% confidence interval [CI], 5.7-9.6; P < .001) more likely to have health insurance, 3.2 percentage points (95% CI, 1.3-5.2; P = .001) more likely to report good or better health, and 2.0 percentage points (95% CI, –3.9 to –0.1; P = .044) less likely to have cost-related barriers to care. Health and insurance gains among current smokers in expansion states were larger relative to health gains (1.6 percentage points; 95% CI, 0.5-2.7; P = .003) and insurance gains (4.6 percentage points; 95% CI, 3.5-5.8; P < .001) of all low-income adults in these states. Conclusions: Greater improvements among low-income smokers in Medicaid expansion states compared with nonexpansion states could influence future smoking behaviors and warrant longer-term monitoring. Additionally, health and insurance gains among low-income smokers in expansion states suggest the potential for Medicaid expansion to improve health among smokers compared with nonsmokers.

scholarly journals Patients’ Perception of Morocco’s Medicine Pricing Reform and Determinants of Their Access to Health Care and Medicine

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Amine Cheikh ◽  
Meryem Moutahir ◽  
Ismail Bennani ◽  
Houda Attjioui ◽  
Wadie Zerhouni ◽  
...  
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Access To Health Care ◽  
Insurance Coverage ◽  
Access To Medicines ◽  
Third Party ◽  
Health Coverage ◽  
Access To Health ◽  
Medicine Prices ◽  
The Impact

Background. In 2014, the Ministry of Health of Morocco implemented a reform of medicine pricing that leads to lower prices. This reform has brought about a new method of pricing medicines and a reduction in the prices of more than 1,400 of the 5,000 medicines on the market. The objective of this study was to survey patients’ perceptions of the impact of the reform on medicine prices and affordability of health care, including medicine. Methods. Between September 2017 and September 2018, 360 patients that visited a community pharmacy in four selected areas of different socioeconomic levels were interviewed based on a questionnaire. Findings were studied through univariate and multivariate analyses. Results. Three hundred patients (83%) were included given their completed questionnaire. The majority (89%) of respondents considered medicine prices as a potential barrier to access to health care. Lower medicine prices following the reform were not perceived to have actually impacted respondents’ spending on health care. In some cases, care was delayed, in particular by lower-income respondents and people without insurance and health coverage. Conclusion. The majority of patients participating in the study did not perceive the decrease in medicine prices as sufficient. In addition, the study findings pointed to the relevance of further determinants of access to medicines, such as health insurance coverage. Patients think that the generalized third-party payment mode, which does not oblige patients to spend out of their pockets to have their treatment but rather their health insurance funds that will pay for them, provides optimal access to medicines.

scholarly journals Trends in Insurance Status Among Patients Diagnosed With Cancer Before and After Implementation of the Affordable Care Act

2018 ◽  
Vol 14 (2) ◽  
pp. e92-e102 ◽  
Author(s):  
Haley A. Moss ◽  
Laura J. Havrilesky ◽  
S. Yousuf Zafar ◽  
Gita Suneja ◽  
Junzo Chino
Keyword(s):  
Breast Cancer ◽  
Affordable Care Act ◽  
Insurance Coverage ◽  
Insurance Status ◽  
Medicaid Expansion ◽  
Before And After ◽  
Medicaid Eligibility ◽  
The Affordable Care Act ◽  
Insurance Rates ◽  
The Impact

Purpose: The Affordable Care Act (ACA) aimed to increase insurance coverage through key provisions such as expansion of Medicaid eligibility and enforcement of an individual mandate. The objective of this study is to examine the impact of the ACA on insurance rates among patients newly diagnosed with colon, lung, or breast cancer. Methods: Using the SEER database, patients younger than age 65 years diagnosed with colon, lung, or breast cancer between 2008 and 2014 were identified. Insurance rates were examined before versus after passage of the ACA (2011) and before (2011 to 2013) versus after (2014) Medicaid expansion in nine expansion states and five nonexpansion states. Difference-in-differences models were used to estimate the differential impact of ACA in expansion compared with nonexpansion states. Results: A total of 414,085 patients with known insurance status were diagnosed with colon, lung, or breast cancer between 2008 and 2014. For all cancer types, there was a significant increase in patients enrolled in Medicaid after 2011 in expansion states. Between 2011 to 2013 and 2014, in patients living in states with Medicaid expansion, the uninsured rates decreased by ≥ 50% among patients with a new diagnosis of lung and colon cancer (6.5% in 2011 to 2013 to 3.1% in 2014 and 6.8% in 2011 to 2013 to 3.4% in 2014, respectively; P < .001); the uninsured rate decreased to a lesser degree for patients with breast cancer (2.7% in 2011 to 2013 to 1.6% in 2014; P < .001). This decrease in the rate of uninsured patients was absent in patients living in nonexpansion states. Conclusion: The ACA resulted in expanded insurance coverage for patients diagnosed with colon, lung, and breast cancer. However, the impact was only observed in states that increased their Medicaid eligibility.

The Impact of Medicaid Expansions on Nonprofit Hospitals

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Rui Wang ◽  
Khaldoun AbouAssi
Keyword(s):  
Affordable Care Act ◽  
Poverty Line ◽  
Policy Changes ◽  
Difference In Differences ◽  
Nonprofit Hospitals ◽  
Federal Poverty Line ◽  
Medicaid Eligibility ◽  
Using Data ◽  
The Impact ◽  
Medicaid Expansions

Abstract The 2010 Affordable Care Act expanded Medicaid eligibility to states’ residents with incomes below the federal poverty line, creating both opportunities and challenges to hospitals in states that adopted the new Medicaid eligibility. This article explores the effect of Medicaid expansions on nonprofit hospitals. Using data from Internal Revenue Service and a difference-in-differences design, this article examines the impact of the expansions on the number of, contributions to, and profitability of nonprofit hospitals. The results suggest that Medicaid expansions did not affect the number and profitability of nonprofit hospitals; however, the expansions were associated with a reduction in contributions to certain types of hospitals by around 23%. Therefore, the effects of policy changes vary by the type of nonprofit hospitals, which then need to find better strategies to cope with these changes.

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.

Improving Access to Health Care for Children, Youth, and Pregnant Women

PEDIATRICS ◽  
1990 ◽  
Vol 86 (4) ◽  
pp. 626-635
Author(s):  
PAUL W. NEWACHECK
Keyword(s):  
Health Care ◽  
Low Income ◽  
Access To Health Care ◽  
Community Health Centers ◽  
Universal Access ◽  
Insurance Coverage ◽  
The Elderly ◽  
Health Insurance Coverage ◽  
Access To Health ◽  
Low Income Families

Twenty-five years ago it seemed that America was on the verge of universal health care coverage.1 A large and growing number of workers and their dependents had gained employer-based health insurance coverage.2 Medicaid and Medicare were enacted to serve the needs of those who did not work—notably the poor and the elderly. Direct service programs, such as community health centers, maternal and infant care projects, and children and youth projects, were also established in the mid-1960s to serve low-income families. At the time, it appeared that this pluralistic approach to financing health care was leading to universal access to health care.

scholarly journals ­­Access to Health Insurance and Treatment Utilization for Opioid Use Disorder: Evidence From State Medicaid Expansions

2022 ◽  
Author(s):  
Anusua Datta ◽  
Willie Oglesby ◽  
Brandon George
Keyword(s):  
Substance Use ◽  
State Level ◽  
Opioid Use Disorder ◽  
Treatment Utilization ◽  
Medicaid Expansion ◽  
Opioid Use ◽  
Access To Health ◽  
Medicaid Beneficiaries ◽  
The Impact ◽  
Medicaid Expansions

Abstract Background. Medicaid is a major payer of substance use disorder treatment, yet the impact of Medicaid expansion on the opioid epidemic has not been sufficiently quantified. This study exploits state-level differences in Medicaid expansion to assess the impact of access to health insurance on treatment utilization for opioid use disorder (OUD) for adults in need.Method. We use admissions data from Treatment Episode Data Sets (TEDS) to fit a multivariate difference-in-difference model, with non-expanding states as controls, adjusting for age, gender, race/ethnicity, education, and other state-level factors. Results. Medicaid expansion led to substantial gain in OUD treatment utilization. Admissions for substance use disorder among Medicaid beneficiaries increased by 20-33 percentage points in expansion states. Admissions were significantly higher for the newly eligible Medicaid beneficiaries in the 30-34 age group. We also see an increase in treatment admissions for opioid and heroin use among the elderly over the age of 55. Uninsurance rates show a commensurate decline in the expansion states. Finally, we do not find strong evidence of crowding-out of private insurance. Conclusions. Overall, our findings suggest that Medicaid expansions had a positive impact on the financing and utilization of opioid use treatment.

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