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https://www.readbyqxmd.com/read/28685885/mental-health-and-substance-use-care-among-young-adults-before-and-after-affordable-care-act-aca-implementation-a-rural-and-urban-comparison
#1
Laura J Chavez, Kelly J Kelleher, Steven C Matson, Thomas M Wickizer, Deena J Chisolm
PURPOSE: Rural young adults experience greater unmet need for mental health (MH) and alcohol or drug (AOD) treatment and lower health insurance coverage than urban residents. It is unknown whether Affordable Care Act (ACA) reforms in 2010 (dependent coverage extended to age 26) or 2014 (Medicaid expansion) closed rural/urban gaps in insurance and treatment. The present study compared changes in rates of health insurance, MH treatment, and AOD treatment for rural and urban young adults over a period of ACA reforms...
July 7, 2017: Journal of Rural Health
https://www.readbyqxmd.com/read/28670682/identifying-homeless-medicaid-enrollees-using-enrollment-addresses
#2
Katherine D Vickery, Nathan D Shippee, Peter Bodurtha, Laura M Guzman-Corrales, Elyse Reamer, Dana Soderlund, Stephanie Abel, Danielle Robertshaw, Lillian Gelberg
OBJECTIVE: To design and test the validity of a method to identify homelessness among Medicaid enrollees using mailing address data. DATA SOURCES/STUDY SETTING: Enrollment and claims data on Medicaid expansion enrollees in Hennepin and Ramsey counties who also provided self-reported information on their current housing situation in a psychosocial needs assessment. STUDY DESIGN: Construction of address-based indicators and comparison with self-report data...
July 3, 2017: Health Services Research
https://www.readbyqxmd.com/read/28664993/medicaid-expansions-and-cervical-cancer-screening-for-low-income-women
#3
Lindsay M Sabik, Wafa W Tarazi, Stephanie Hochhalter, Bassam Dahman, Cathy J Bradley
OBJECTIVE: Medicaid coverage for low-income women may play an important role in ensuring access to preventive care. This study examines how Medicaid eligibility expansions to nonelderly adults impact cervical cancer screening among low-income women. DATA SOURCES: We use data from the Behavioral Risk Factor Surveillance System from 2000 to 2010. The primary outcome of interest is whether women in the relevant guideline consistent age range reported having a Pap test in the previous year...
June 30, 2017: Health Services Research
https://www.readbyqxmd.com/read/28664983/changes-in-hospital-inpatient-utilization-following-health-care-reform
#4
Gary Pickens, Zeynal Karaca, Eli Cutler, Michael Dworsky, Christine Eibner, Brian Moore, Teresa Gibson, Sharat Iyer, Herbert S Wong
OBJECTIVE: To estimate the effects of 2014 Medicaid expansions on inpatient outcomes. DATA SOURCES: Health Care Cost and Utilization Project State Inpatient Databases, 2011-2014; population and unemployment estimates. STUDY DESIGN: Retrospective study estimating effects of Medicaid expansions using difference-in-differences regression. Outcomes included total admissions, referral-sensitive surgical and preventable admissions, length of stay, cost, and patient illness severity...
June 30, 2017: Health Services Research
https://www.readbyqxmd.com/read/28661254/early-experience-with-the-aca-coverage-gains-pooling-of-risk-and-medicaid-expansion
#5
Linda J Blumberg, John Holahan
We provide an overview of the characteristics of those who have gained insurance coverage due to the ACA as well as the characteristics of the remaining uninsured. We also describe the implications for the broader sharing of health care risks required under the law, and how they vary by individuals' health status. Finally, we assess the implications of state decisions to expand or not expand Medicaid eligibility under the law, how those decisions affect state finances, health care providers, residents, and how the effects may vary for those states using waivers to expand eligibility using strategies designed to be more broadly politically acceptable...
December 2016: Journal of Law, Medicine & Ethics: a Journal of the American Society of Law, Medicine & Ethics
https://www.readbyqxmd.com/read/28661251/making-health-care-truly-affordable-after-health-care-reform
#6
Timothy Stoltzfus Jost, Harold A Pollack
The Affordable Care Act (ACA) is an essential first step toward making health insurance more affordable for lower and moderate income Americans. It has accomplished historic reductions in the proportion of Americans who are uninsured. The number of Americans reporting delaying medical care for financial reasons has declined by approximately one-third since 2010. Medicaid expansions, in particular, have significantly reduced financial burdens and accompanying anxieties experienced by low-income Americans in states that have embraced this opportunity...
December 2016: Journal of Law, Medicine & Ethics: a Journal of the American Society of Law, Medicine & Ethics
https://www.readbyqxmd.com/read/28661245/medicaid-s-role-in-health-reform-and-closing-the-coverage-gap
#7
Diane Rowland, Barbara Lyons
Medicaid coverage matters for millions of low-income Americans, and especially for those with ongoing and serious health challenges. A source of comprehensive and affordable coverage, Medicaid has long been a cornerstone of federal and state efforts to improve access and health outcomes for very poor and medically vulnerable populations. The Affordable Care Act (ACA) leveraged Medicaid's role in serving the poor to broaden the program's reach to millions of low-income uninsured adults, and positioned the program as a fundamental component of the newly established continuum of public and private coverage...
December 2016: Journal of Law, Medicine & Ethics: a Journal of the American Society of Law, Medicine & Ethics
https://www.readbyqxmd.com/read/28660697/intra-ethnic-coverage-disparities-among-latinos-and-the-effects-of-health-reform
#8
Sergio Gonzales, Benjamin D Sommers
OBJECTIVE: To examine the patterns of insurance coverage among nine Latino subgroups and assess heterogeneous effects of the Affordable Care Act (ACA) among these groups. DATA SOURCES: American Community Survey (2010-2014). STUDY DESIGN: We examined pre-ACA disparities in coverage using linear probability models. Then, we used interrupted time series and triple-difference models to evaluate coverage changes associated with the ACA and Medicaid expansion, respectively...
June 28, 2017: Health Services Research
https://www.readbyqxmd.com/read/28658482/association-of-expanded-medicaid-coverage-with-hospital-length-of-stay-after-injury
#9
Jeremy L Holzmacher, Kerry Townsend, Caleb Seavey, Stephanie Gannon, Mary Schroeder, Stephen Gondek, Lois Collins, Richard L Amdur, Babak Sarani
Importance: The expansion of Medicaid eligibility under the Affordable Care Act is a state-level decision that affects how patients with traumatic injury (trauma patients) interact with locoregional health care systems. Washington, DC; Maryland; and Virginia represent 3 unique payer systems with liberal, moderate, and no Medicaid expansion, respectively, under the Affordable Care Act. Characterizing the association of Medicaid expansion with hospitalization after injury is vital in the disposition planning for these patients...
June 28, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28653821/effects-of-aca-medicaid-expansions-on-health-insurance-coverage-and-labor-supply
#10
Robert Kaestner, Bowen Garrett, Jiajia Chen, Anuj Gangopadhyaya, Caitlyn Fleming
We examined the effect of the expansion of Medicaid eligibility under the Affordable Care Act on health insurance coverage and labor supply of low-educated and low-income adults. We found that the Medicaid expansions were associated with large increases in Medicaid coverage, for example, 50 percent among childless adults, and corresponding decreases in the proportion uninsured. There was relatively little change in private insurance coverage, although the expansions tended to decrease such coverage slightly...
2017: Journal of Policy Analysis and Management
https://www.readbyqxmd.com/read/28649732/impact-of-medicaid-disenrollment-in-tennessee-on-breast-cancer-stage-at-diagnosis-and-treatment
#11
Wafa W Tarazi, Cathy J Bradley, Harry D Bear, David W Harless, Lindsay M Sabik
BACKGROUND: States routinely may consider rollbacks of Medicaid expansions to address statewide economic conditions. To the authors' knowledge, little is known regarding the effects of public insurance contractions on health outcomes. The current study examined the effects of the 2005 Medicaid disenrollment in Tennessee on breast cancer stage at the time of diagnosis and delays in treatment among nonelderly women. METHODS: The authors used Tennessee Cancer Registry data from 2002 through 2008 and estimated a difference-in-difference model comparing women diagnosed with breast cancer who lived in low-income zip codes (and therefore were more likely to be subject to disenrollment) with a similar group of women who lived in high-income zip codes before and after the 2005 Medicaid disenrollment...
June 26, 2017: Cancer
https://www.readbyqxmd.com/read/28641909/effect-of-the-affordable-care-act-medicaid-expansion-on-emergency-department-visits-evidence-from-state-level-emergency-department-databases
#12
Sayeh Nikpay, Seth Freedman, Helen Levy, Tom Buchmueller
STUDY OBJECTIVE: We assess whether the expansion of Medicaid under the Patient Protection and Affordable Care Act (ACA) results in changes in emergency department (ED) visits or ED payer mix. We also test whether the size of the change in ED visits depends on the change in the size of the Medicaid population. METHODS: Using all-capture, longitudinal, state data from the Agency for Healthcare Research and Quality's Fast Stats program, we implemented a difference-in-difference analysis, which compared changes in ED visits per capita and the share of ED visits by payer (Medicaid, uninsured, and private insurance) in 14 states that did and 11 states that did not expand Medicaid in 2014...
June 11, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28641821/insurance-coverage-among-women-diagnosed-with-a-gynecologic-malignancy-before-and-after-implementation-of-the-affordable-care-act
#13
Haley A Moss, Laura J Havrilesky, Junzo Chino
OBJECTIVE: The Patient Protection and Affordable Care Act (ACA) included provisions to expand insurance coverage by expanding Medicaid eligibility, providing subsidies of private coverage and enforcing an individual mandate. The objective of this study is to examine the impact of the ACA on insurance rates among women diagnosed with a gynecologic malignancy. METHODS: Using Surveillance, Epidemiology, and End Results 18 registries database, women newly diagnosed with cervical, uterine or ovarian cancer between 2008 and 2014 were identified...
June 19, 2017: Gynecologic Oncology
https://www.readbyqxmd.com/read/28583963/identifying-policy-levers-and-opportunities-for-action-across-states-to-achieve-health-equity
#14
Julia Berenson, Yan Li, Julia Lynch, José A Pagán
In the United States, steps to advance health equity often take place at the state and local levels rather than the national level. Using publicly available data sources, we developed a scorecard for all fifty states and the District of Columbia that measures indicators of the use of five evidence-based policies to address domains related to health equity. The indicators are the cigarette excise tax rate, a state's Medicaid expansion status and the size of its coverage gap, percentage of four-year olds enrolled in state-funded pre-kindergarten, minimum wage level, and the presence of state-funded housing subsidy programs and homelessness prevention and rapid rehousing programs...
June 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28574234/effect-of-the-affordable-care-act-on-health-care-access
#15
Sherry Glied, Stephanie Ma, Anais A Borja
ISSUE: The Affordable Care Act's (ACA) coverage provisions have extended health insurance coverage to millions of Americans. While the effects of the Medicaid expansion and marketplace establishments on coverage have been well studied, the resulting effects of coverage on access to health care remain unclear. GOAL: To examine how the 2014 coverage expansions affected health care access following the first open enrollment period of October 2013 to March 2014. METHODS: Analysis of data from the National Health Interview Survey (NHIS) and the Behavioral Risk Factor Surveillance System (BRFSS)...
May 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28574233/the-impact-of-the-aca-s-medicaid-expansion-on-hospitals-uncompensated-care-burden-and-the-potential-effects-of-repeal
#16
David Dranove, Craig Gartwaite, Christopher Ody
ISSUE: By increasing health insurance coverage, the Affordable Care Act's Medicaid eligibility expansion was also expected to lessen the uncompensated care burden on hospitals. The expansion currently faces an uncertain future. GOAL: To compare the change in hospitals' uncompensated care burden in the 31 states (plus the District of Columbia) that chose to expand Medicaid to the changes in states that did not, and to estimate how these expenses would be affected by repeal or further expansion. METHODS: Analysis of uncompensated care data from Medicare Hospital Cost Reports from 2011 to 2015...
May 2017: Issue Brief of the Commonwealth Fund
https://www.readbyqxmd.com/read/28568245/quality-metrics-and-systems-transformation-are-we-advancing-alcohol-and-drug-screening-in-primary-care
#17
Traci Rieckmann, Stephanie Renfro, Dennis McCarty, Robin Baker, K John McConnell
OBJECTIVE: To examine the influence of Oregon's coordinated care organizations (CCOs) and pay-for-performance incentive model on completion of screening and brief intervention (SBI) and utilization of substance use disorder (SUD) treatment services. DATA SOURCES/STUDY SETTING: Secondary analysis of Medicaid encounter data from 2012 to 2015 and semiannual qualitative interviews with stakeholders in CCOs. STUDY DESIGN: Longitudinal mixed-methods design with simultaneous data collection with equal importance...
May 31, 2017: Health Services Research
https://www.readbyqxmd.com/read/28559508/contextualizing-the-first-round-failure-of-the-ahca-down-but-not-out
#18
REVIEW
Joshua A Hirsch, Andrew B Rosenkrantz, Greg N Nicola, H Benjamin Harvey, Richard Duszak, Ezequiel Silva, Robert M Barr, Richard P Klucznik, Allan L Brook, Laxmaiah Manchikanti
On 8 November 2016 the American electorate voted Donald Trump into the Presidency and a majority of Republicans into both houses of Congress. Since many Republicans ran for elected office on the promise to 'repeal and replace' Obamacare, this election result came with an expectation that campaign rhetoric would result in legislative action on healthcare. The American Health Care Act (AHCA) represented the Republican effort to repeal and replace the Affordable Care Act (ACA). Key elements of the AHCA included modifications of Medicaid expansion, repeal of the individual mandate, replacement of ACA subsidies with tax credits, and a broadening of the opportunity to use healthcare savings accounts...
June 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28558067/impact-of-insurance-coverage-on-utilization-of-pre-exposure-prophylaxis-for-hiv-prevention
#19
Rupa R Patel, Leandro Mena, Amy Nunn, Timothy McBride, Laura C Harrison, Catherine E Oldenburg, Jingxia Liu, Kenneth H Mayer, Philip A Chan
Pre-exposure prophylaxis (PrEP) can reduce U.S. HIV incidence. We assessed insurance coverage and its association with PrEP utilization. We reviewed patient data at three PrEP clinics (Jackson, Mississippi; St. Louis, Missouri; Providence, Rhode Island) from 2014-2015. The outcome, PrEP utilization, was defined as patient PrEP use at three months. Multivariable logistic regression was performed to determine the association between insurance coverage and PrEP utilization. Of 201 patients (Jackson: 34%; St. Louis: 28%; Providence: 28%), 91% were male, 51% were White, median age was 29 years, and 21% were uninsured; 82% of patients reported taking PrEP at three months...
2017: PloS One
https://www.readbyqxmd.com/read/28557515/connected-care-improving-outcomes-for-adults-with-serious-mental-illness
#20
James M Schuster, Suzanne M Kinsky, Jung Y Kim, Jane N Kogan, Allison Hamblin, Cara Nikolajski, John Lovelace
OBJECTIVES: To evaluate the effectiveness of Connected Care-a care coordination effort of physical and behavioral health managed care partners in Pennsylvania-on acute service use among adult Medicaid beneficiaries with serious mental illness (SMI). STUDY DESIGN: We examined changes in service utilization using a difference-in-differences model, comparing study group with a comparison group, and conducted key informant interviews to better understand aspects of program implementation...
October 2016: American Journal of Managed Care
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