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 )

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.

The association of the affordable care's Medicaid expansion on survival in gynecologic cancer: A National Cancer Database study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 1501-1501
Author(s):  
Anna Jo Smith ◽  
Jeremy Applebaum ◽  
Amanda Nickles Fader
Keyword(s):  
Rural Women ◽  
Gynecologic Cancer ◽  
Intervention Group ◽  
Control Group ◽  
Cancer Type ◽  
National Cancer Database ◽  
Medicaid Expansion ◽  
Difference In Differences ◽  
Significant Difference ◽  
One Year

1501 Background: Under the Affordable Care Act’s 2014 Medicaid expansion, more than 12 million Americans gained health insurance. Whether such gains in insurance improve survival in gynecologic cancer is unknown. This study aims to determine whether Medicaid expansion is associated with improved survival among women with gynecologic cancers. Methods: We conducted a retrospective cohort study using a difference-in-differences study design comparing insurance status, stage at diagnosis, delays in treatment, and one-year survival before and after the ACA’s Medicaid expansion in Medicaid expansion states (intervention group) compared to women in non-expansion states (control group). Using hospital-reported data from the 2010-2016 National Cancer Database, we compared outcomes overall for women ages 40-64 years old with endometrial, cervical, ovarian, or vulva/vaginal cancer and then stratified by cancer type, stage, race, and rural/urban status. We adjusted for patient (area-level income, area-level education, distance traveled for care, comorbidities), clinical (co-morbidities, grade) and hospital (academic facility) characteristics. Results: Our sample included 241,713 women with gynecologic cancer, 119,392 in expansion states and 122,321 in non-expansion states. Post-Medicaid expansion, there was a statistically significant 0.8 % increase in 1-year survival among patients in expansion states compared to non-expansion states (95% CI 0.1-1.5). There was also a significant reduction in uninsurance (-1.1%, 95%CI, --1.5, -0.7) and delays of 30+ days from diagnosis to treatment (-2.4%, 95%CI -3.4, -1.2). There was no significant change in early-stage diagnosis (0%; 95%CI -0.7-0.7). Improvements in one-year survival after Medicaid expansion were driven by ovarian cancer (difference-in-differences 2.2%, 95%CI 0.6-3.8) and in white women (difference-in-differences 0.8%, 95%CI 0.1-1.5), while there was no significant difference in one-year survival for non-white or rural women. Conclusions: The Affordable Care Act’s Medicaid expansion was significantly associated with 1-year survival and insurance access among patients with gynecologic cancer. Insurance expansion efforts in non-Medicaid expansion states may improve survival for women with gynecologic cancer.

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 Association of COVID-19 Risk Misperceptions with Household Isolation in the United States (Preprint)

2021 ◽  
Author(s):  
Joseph A. Ladapo ◽  
Jonathan T. Rothwell ◽  
Christina M. Ramirez
Keyword(s):  
Public Health ◽  
Mental Health ◽  
Social Isolation ◽  
Health Risks ◽  
Medical Condition ◽  
Emotional Health ◽  
Well Being ◽  
Physical Contact ◽  
Percentage Points ◽  
Recovery Study

BACKGROUND Adverse mental and emotional health outcomes are increasingly recognized as a public health challenge associated with the coronavirus disease 2019 (COVID-19) pandemic. As early as March 2020, a national survey reported that 36% of U.S. adults felt the pandemic would have a serious impact on their mental health. In April 2020, another survey found that 14% of U.S. adults reported serious psychological distress, compared to 4% during a similar time period in 2018. Rates of loneliness have also been high, with 36% of U.S. adults—including 61% of adults aged 18-25—reporting significant loneliness in an October 2020 survey. More recently, a March 2021 survey found that 48% of adults reported higher levels of stress in their lives compared to before the pandemic, and 61% reporting undesired weight changes. This health sequelae of the COVID-19 pandemic are multifactorial, and social isolation is likely an important contributor. Because of physical distancing mandates, quarantines, and fear of illness, a substantial proportion of Americans have limited their physical contact with others outside of their household. This trend has likely contributed to social isolation and loneliness. Household isolation is analogous to quarantining, and research has shown that quarantining is a risk factor for a variety of adverse mental and emotional health outcomes. These include increased stress, anxiety, depression, fear, and detachment from other people. The Centers for Disease Control and Prevention (CDC) recently recommended that researchers examine drivers of adverse mental health during COVID-19 pandemic. One driver that has received little attention is the role that COVID-19 risk misperceptions may play in the behavioral decision to limit physical contact with others. While COVID-19 risk perceptions have been associated with protective health behaviors, they may lead to suboptimal behavioral choices, if individuals substantially overestimate or underestimate risk. Overestimation, in particular, is of concern in the context of mental and emotional health and well-being because it tends to amplify social isolation and reduce contact with others. Using survey data from the Franklin Templeton-Gallup Economics of Recovery Study, we assessed the association of COVID-19 risk misperceptions with household isolation. Our findings are relevant to policy measures to reduce COVID-19-related social isolation and may inform the management of future epidemics and pandemics. OBJECTIVE To examine the association of COVID-19 risk misperceptions with household isolation, a potential risk factor for social isolation and loneliness. METHODS We analyzed data from the Franklin Templeton-Gallup Economics of Recovery Study (July 2020-December 2020) of 24,649 U.S. adults. We also analyzed data from the Gallup Panel (March 2020-February 2021) which included 123,516 observations about loneliness. Primary outcome was household isolation, which we defined as a respondent reporting having no contact or very little contact with people outside their household, analogous to quarantining. RESULTS From July-December 2020, 53% to 57% of respondents reported living in household isolation. Most participants reported beliefs about COVID-19 health risks that were inaccurate, and overestimation of health risk was most common. For example, while deaths in persons younger than 55 years-old accounted for 7% of total U.S. deaths, respondents estimated that this population represented 43% of deaths. Overestimating COVID-19 health risks was associated with increased likelihood of household isolation, from 7.7 percentage points in July/August (P<0.001) to 11.8 percentage points in December (P<0.001). Characteristics associated with household isolation from the July/August 2020 survey and persisting in the December 2020 survey included younger age (18 to 39 years), having a serious medical condition, having a household member with a serious medical condition, and identifying as a Democrat. In the Gallup Panel, living in household isolation was associated with a higher prevalence of loneliness. CONCLUSIONS Pandemic-related harms to emotional and mental well-being may be attenuated by reducing risk overestimation and household isolation preferences that exceed public health guidelines.

scholarly journals Social Effects of Health Care Reform

2017 ◽  
Vol 3 ◽  
pp. 237802311770090
Author(s):  
Heeju Sohn ◽  
Stefan Timmermans
Keyword(s):  
Public Health ◽  
Low Income ◽  
Minority Groups ◽  
Insurance Coverage ◽  
Well Being ◽  
Social Consequences ◽  
Volunteer Work ◽  
Health Coverage ◽  
Medicaid Eligibility ◽  
Medicaid Expansions

Do public health policy interventions result in prosocial behaviors? The Patient Protection and Affordable Care Act’s Medicaid expansions were responsible for the largest gains in public insurance coverage since its inception in 1965. These gains were concentrated in states that opted to expand Medicaid eligibility, and they provide a unique opportunity to study not just medical but also social consequences of increased public health coverage. The authors examine the association between Medicaid and volunteer work. Volunteerism is implicated in individuals’ health and well-being, yet it is highly correlated with a person’s existing socioeconomic resources. Medicaid expansions improved financial security and a sense of health, two factors that predict volunteer work, for a socioeconomic group that has had low levels of volunteerism. Difference-in-difference analyses of the volunteer supplement of the Current Population Survey (2010–2015) find increased reports of formal volunteering for organizations as well as informal helping behaviors between neighbors for low-income nonelderly adults who would have likely benefited from expansions. Furthermore, increased volunteer work associated with Medicaid was greater among minority groups and narrowed existing ethnic differences in volunteerism in states that expanded Medicaid eligibility.

Using Public Health Approaches to Optimize Child Well-Being

2010 ◽  
Author(s):  
Lara R. Robinson ◽  
Camille Smith ◽  
Jennifer W. Kaminski ◽  
Rebecca H. Bitsko ◽  
Angelika H. Claussen ◽  
...  
Keyword(s):  
Public Health ◽  
Well Being

THE FACTORS OF CAREER SELF-DETERMINATION OF STUDENTS OF HIGHER EDUCATION INSTITUTIONS

2019 ◽  
Vol 7 (1) ◽  
pp. 9-20
Author(s):  
Inna Yeung
Keyword(s):  
Higher Education ◽  
Higher Education Institutions ◽  
Well Being ◽  
Young Person ◽  
Self Determination ◽  
Full Time ◽  
Actual Problem ◽  
The Third ◽  
The Right

Choice of profession is a social phenomenon that every person has to face in life. Numerous studies convince us that not only the well-being of a person depends on the chosen work, but also his attitude to himself and life in general, therefore, the right and timely professional choice is very important. Research about factors of career self-determination of students of higher education institutions in Ukraine shows that self-determination is an important factor in the socialization of young person, and the factors that determine students' career choices become an actual problem of nowadays. The present study involved full-time and part-time students of Institute of Philology and Mass Communications of Open International University of Human Development "Ukraine" in order to examine the factors of career self-determination of students of higher education institutions (N=189). Diagnostic factors of career self-determination of students studying in the third and fourth year were carried out using the author's questionnaire. Processing of obtained data was carried out using the Excel 2010 program; factorial and comparative analysis were applied. Results of the study showed that initial stage of career self-determination falls down on the third and fourth studying year at the university, when an image of future career and career orientations begin to form. At the same time, the content of career self-determination in this period is contradictory and uncertain, therefore, the implementation of pedagogical support of this process among students is effective.

LIME AND DAIRY PRODUCTION

1982 ◽  
pp. 93-103
Author(s):  
N.A. Thomson
Keyword(s):  
Soil Moisture ◽  
Dairy Cows ◽  
Milk Production ◽  
Soil Ph ◽  
Dairy Production ◽  
Pasture Production ◽  
The Third ◽  
One Year ◽  
Plasma Magnesium

In a four year grazing trial with dairy cows the application of 5000 kg lime/ ha (applied in two applications of 2500 kg/ha in winter of the first two years) significantly increased annual pasture production in two of the four years and dairy production in one year. In three of the four years lime significantly increased pasture growth over summer/autumn with concurrent increases in milk production. In the last year of the trial lime had little effect on pasture growth but a relatively large increase in milkfat production resulted. A higher incidence of grass staggers was recorded on the limed farmlets in spring for each of the four years. In the second spring immediately following the second application of lime significant depressions in both pasture and plasma magnesium levels were recorded. By the third spring differences in plasma magnesium levels were negligible but small depressions in herbage magnesium resulting from lime continued to the end of the trial. Lime significantly raised soil pH, Ca and Mg levels but had no effect on either soil K or P. As pH levels of the unlimed paddocks were low (5.2-5.4) in each autumn and soil moisture levels were increased by liming, these factors may suggest possible causes for the seasonality of the pasture response to lime

Eating NAFTA

2018 ◽  
Author(s):  
Alyshia Gálvez
Keyword(s):  
Public Health ◽  
Chronic Disease ◽  
Low Income ◽  
Food System ◽  
Dietary Habits ◽  
Trade Agreement ◽  
Well Being ◽  
Health Crisis ◽  
The North ◽  
The World

In the two decades since the North American Free Trade Agreement (NAFTA) went into effect, Mexico has seen an epidemic of diet-related illness. While globalization has been associated with an increase in chronic disease around the world, in Mexico, the speed and scope of the rise has been called a public health emergency. The shift in Mexican foodways is happening at a moment when the country’s ancestral cuisine is now more popular and appreciated around the world than ever. What does it mean for their health and well-being when many Mexicans eat fewer tortillas and more instant noodles, while global elites demand tacos made with handmade corn tortillas? This book examines the transformation of the Mexican food system since NAFTA and how it has made it harder for people to eat as they once did. The book contextualizes NAFTA within Mexico’s approach to economic development since the Revolution, noticing the role envisioned for rural and low-income people in the path to modernization. Examination of anti-poverty and public health policies in Mexico reveal how it has become easier for people to consume processed foods and beverages, even when to do so can be harmful to health. The book critiques Mexico’s strategy for addressing the public health crisis generated by rising rates of chronic disease for blaming the dietary habits of those whose lives have been upended by the economic and political shifts of NAFTA.

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