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Medicaid expansion

Sherry Glied, Adlan Jackson
We describe the patterns of coverage gains associated with the Affordable Care Act (ACA) expansions and use these patterns to assess the potential impact of alternative repeal or repeal and replace strategies because Congress and the president are weighing options to repeal or replace the ACA. We find that specific provisions of the ACA, including the Medicaid expansion and the structure of premium subsidies, have been associated with large and robust gains in insurance coverage. We evaluate the impact of retaining dependent coverage and high-risk pool provisions and show, on the basis of the ACA experience, that these provisions would have little effect on coverage...
February 16, 2017: American Journal of Public Health
Sarah E Gollust, Laura M Baum, Jeff Niederdeppe, Colleen L Barry, Erika Franklin Fowler
OBJECTIVES: To examine the public health and policy-relevant messages conveyed through local television news during the first stage of Affordable Care Act (ACA) implementation, when about 10 million Americans gained insurance. METHODS: We conducted a content analysis of 1569 ACA-related local evening television news stories, obtained from sampling local news aired between October 1, 2013, and April 19, 2014. Coders systematically collected data using a coding instrument tracking major messages and information sources cited in the news...
February 16, 2017: American Journal of Public Health
Sean P Keehan, Devin A Stone, John A Poisal, Gigi A Cuckler, Andrea M Sisko, Sheila D Smith, Andrew J Madison, Christian J Wolfe, Joseph M Lizonitz
Under current law, national health expenditures are projected to grow at an average annual rate of 5.6 percent for 2016-25 and represent 19.9 percent of gross domestic product by 2025. For 2016, national health expenditure growth is anticipated to have slowed 1.1 percentage points to 4.8 percent, as a result of slower Medicaid and prescription drug spending growth. For the rest of the projection period, faster projected growth in medical prices is partly offset by slower projected growth in the use and intensity of medical goods and services, relative to that observed in 2014-16 associated with the Affordable Care Act coverage expansions...
February 15, 2017: Health Affairs
David L Rosen, Catherine A Grodensky, Anna R Miller, Carol E Golin, Marisa E Domino, Wizdom Powell, David A Wohl
In 2011, North Carolina (NC) created a program to facilitate Medicaid enrollment for state prisoners experiencing community inpatient hospitalization during their incarceration. The program, which has been described as a model for prison systems nationwide, has saved the NC prison system approximately $10 million annually in hospitalization costs and has potential to increase prisoners' access to Medicaid benefits as they return to their communities. This study aims to describe the history of NC's Prison-Based Medicaid Enrollment Assistance Program (PBMEAP), its structure and processes, and program personnel's perspectives on the challenges and facilitators of program implementation...
February 13, 2017: Journal of Urban Health: Bulletin of the New York Academy of Medicine
Christopher K Rogers, Ning Jackie Zhang
Cardiovascular disease (CVD) is one of the most prevalent chronic diseases nationally and disproportionately affects low-income individuals. There are substantial disparities on CVD outcomes that stem from the lack of health insurance among low-income populations. The Affordable Care Act expands Medicaid health insurance to low-income populations, and aims to increase the utilization of health, social, and economic preventive services to reduce health disparities and prevent chronic diseases. The authors analyzed data from the 2014 Behavioral Risk Factor Surveillance System to understand the potential impact of Medicaid expansion on disparities in CVD among low-income populations...
February 13, 2017: Population Health Management
Nathalie Huguet, Heather Angier, Miguel Marino, K John McConnell, Megan J Hoopes, Jean P O'Malley, Lewis A Raynor, Sonja Likumahuwa-Ackman, Heather Holderness, Jennifer E DeVoe
BACKGROUND: It is hypothesized that Affordable Care Act (ACA) Medicaid expansions could substantially improve access to health insurance and healthcare services for patients at risk for diabetes mellitus (DM), with pre-DM, or already diagnosed with DM. The ACA called for every state to expand Medicaid coverage by 2014. In a 2012 legal challenge, the US Supreme Court ruled that states were not required to implement Medicaid expansions. This 'natural experiment' presents a unique opportunity to learn whether and to what extent Medicaid expansion can affect healthcare access and services for patients with DM risk, pre-DM, or DM...
February 10, 2017: Implementation Science: IS
John A Graves, Sayeh S Nikpay
The introduction of Medicaid expansions and state Marketplaces under the Affordable Care Act (ACA) have reduced the uninsurance rate to historic lows, changing the choices Americans make about coverage. In this article we shed light on these changing dynamics. We drew upon multistate transition models fit to nationally representative longitudinal data to estimate coverage transition probabilities between major insurance types in the years leading up to and including 2014. We found that the ACA's unprecedented coverage changes increased transitions to Medicaid and nongroup coverage among the uninsured, while strengthening the existing employer-sponsored insurance system and improving retention of public coverage...
February 1, 2017: Health Affairs
Laura G Burke, Thomas C Tsai, Jie Zheng, E John Orav, Ashish K Jha
OBJECTIVES: To address concerns that expanding insurance coverage without expanding provider supply can lead to worse access for the previously insured, we examined whether previously insured Medicaid beneficiaries faced greater difficulties accessing primary care after statewide insurance expansion in Massachusetts. STUDY DESIGN: We used the Medicaid Analytic eXtract databases for Massachusetts and 3 New England control states for 2006 and 2009. We calculated rates of overall, acute, and chronic preventable admissions (or Prevention Quality Indicators [PQIs]) and a composite of control conditions for adults aged 21 to 64 years...
January 1, 2017: American Journal of Managed Care
Waddah B Al-Refaie, Chaoyi Zheng, Manila Jindal, Michele L Clements, Patryce Toye, Lynt B Johnson, David Xiao, Timothy Westmoreland, Thomas DeLeire, Nawar Shara
INTRO: While the ACA expanded Medicaid access, it is unknown whether this has led to greater access to complex surgical care. Evidence on the effect of Medicaid expansion on access to surgical cancer care, a proxy for complex care, is sparse. Utilizing New York's 2001 statewide Medicaid expansion as a natural experiment, we investigated how expansion affected utilization of surgical cancer care among beneficiaries overall and among racial minorities. METHODS: The New York (NY) State Inpatient Database (1997-2006), we identified 67,685 non-elderly adults (18-64 years) who underwent cancer surgery...
January 23, 2017: Journal of the American College of Surgeons
Benjamin D Sommers, Arnold M Epstein
As the debate over repeal of the Affordable Care Act (ACA) takes center stage in U.S. politics, it’s important to keep in mind that the law is not a single policy. Though popularly derided by its opponents as the monolithic "Obamacare," the ACA is a multifaceted law with several distinct components..
February 9, 2017: New England Journal of Medicine
(no author information available yet)
Medicaid expansion often means a hollow benefit, says this resident fellow at the American Enterprise Institute. There will be some reluctance for sweeping reform, but the exchanges are in trouble and have little political support. Expect some movement there.
September 2016: Managed Care
Christopher J Conover
This commentary argues against Medicaid expansion in North Carolina for 5 reasons: Expansion will reduce access to care for highly vulnerable individuals who are already enrolled in Medicaid; it is unlikely to save lives; it is unaffordable in the long run; its current financing structure encourages fiscal irresponsibility; and it will eliminate more jobs than it creates.
January 2017: North Carolina Medical Journal
Robert W Seligson
No abstract text is available yet for this article.
January 2017: North Carolina Medical Journal
Donald H Taylor
North Carolina's refusal to expand its Medicaid program has left many thousands of North Carolinians without health insurance and has imposed unnecessary costs on all of the state's residents through higher premiums in the state's health insurance marketplace. Expanding Medicaid is the most efficient way to extend coverage to the state's uninsured population, and expansion would bring a substantial amount of new federal money into the state. This money can serve as a catalyst for ambitious reforms to the Medicaid program that can lower costs, improve quality of care, and increase value for patients and taxpayers alike...
January 2017: North Carolina Medical Journal
Aparna Soni, Michael Hendryx, Kosali Simon
PURPOSE: To analyze the differential rural-urban impacts of the Affordable Care Act Medicaid expansion on low-income childless adults' health insurance coverage. METHODS: Using data from the American Community Survey years 2011-2015, we conducted a difference-in-differences regression analysis to test for changes in the probability of low-income childless adults having insurance in states that expanded Medicaid versus states that did not expand, in rural versus urban areas...
January 23, 2017: Journal of Rural Health
Hugo Torres, Elisabeth Poorman, Uma Tadepalli, Cynthia Schoettler, Chin Ho Fung, Nicole Mushero, Lauren Campbell, Gaurab Basu, Danny McCormick
Background: Half of Americans have at least 1 chronic disease. Many in this group, particularly racial/ethnic minorities, lacked insurance coverage and access to care before the Patient Protection and Affordable Care Act (ACA) was enacted. Objective: To determine whether the ACA has had an effect on insurance coverage, access to care, and racial/ethnic disparities among adults with chronic disease. Design: Quasi-experimental policy intervention...
January 24, 2017: Annals of Internal Medicine
Daniel B Gingold, Rachelle Pierre-Mathieu, Brandon Cole, Andrew C Miller, Joneigh S Khaldun
OBJECTIVES: The effect of the Affordable Care Act on emergency department (ED) high utilizers has not yet been thoroughly studied. We sought to determine the impact of changes in insurance eligibility following the 2014 Medicaid expansion on ED utilization for ambulatory care sensitive conditions (ACSC) by high ED utilizers in an urban safety net hospital. METHODS: High utilizers were defined as patients with ≥4 visits in the 6months before their most recent visit in the study period (July-December before and after Maryland's Medicaid expansion in January 2014)...
January 13, 2017: American Journal of Emergency Medicine
Khadijah Breathett, Larry A Allen, Laura Helmkamp, Kathryn Colborn, Stacie L Daugherty, Prateeti Khazanie, Richard Lindrooth, Pamela N Peterson
OBJECTIVES: The aim of this study was to determine if the Affordable Care Act (ACA) Medicaid Expansion was associated with increased census-adjusted heart transplant listing rates for racial/ethnic minorities. BACKGROUND: Underinsurance limits access to transplants, especially among racial/ethnic minorities. Changes in racial/ethnic listing rates post-ACA Medicaid Expansion are unknown. METHODS: Using the Scientific Registry of Transplant Recipients, we analyzed 5,651 patients from early adopter states (implemented the ACA Medicaid Expansion by January 2014) and 4,769 patients from non-adopter states (no implementation during the study period) from 2012 to 2015...
February 2017: JACC. Heart Failure
Abigail R Barker, Kelsey Huntzberry, Timothy D McBride, Keith J Mueller
Purpose. From October 2013—before implementation of the Affordable Care Act (ACA)—to November 2016, Medicaid enrollment grew by 27 percent. However, very little attention has been paid to date to how changes in Medicaid enrollment vary within states across the rural-urban continuum. This brief reports and analyzes changes in enrollment in metropolitan, micropolitan, and rural (noncore) areas in both expansion states (those that used ACA funding to expand Medicaid coverage) and nonexpansion states (those that did not use ACA funding to expand Medicaid coverage)...
January 2017: Rural Policy Brief
Abigail R Barker, Kelsey A Huntzberry, Timothy D McBride, Leah M Kemper, Keith J Mueller
Purpose. In this brief, cumulative county-level enrollment in Health Insurance Marketplaces (HIMs) through March 2016 is presented for state HIMs operated as Federally Facilitated Marketplaces (FFMs) and for those operated as Federally Supported State-Based Marketplaces (FS-SBMs). Enrollment rates in metropolitan and non-metropolitan areas of each state, defined as the percentage of “potential market” participants selecting plans, are presented. Monitoring annual enrollment rates provides a gauge of how well state outreach and enrollment efforts are proceeding and helps identify states with strong non-metropolitan enrollment as models for other states to emulate...
January 2017: Rural Policy Brief
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