Medicaid expansion, health insurance coverage, and cost barriers to care among low-income adults with asthma: the Adult Asthma Call-Back Survey.
Ontology highlight
ABSTRACT: Objective
To examine Medicaid expansion (ME) effects on health insurance coverage (HIC) and cost barriers to medical care among people with asthma.Method
We analyzed 2012-2013 and 2015-2016 data from low-income adults with current asthma aged 18-64 years in the Behavioral Risk Factor Surveillance System Asthma Call-Back Survey (state-level telephone survey). We calculated weighted percentages and 95% confidence intervals from ME and non-ME jurisdictions (according to 2014 ME status). Outcomes were HIC and cost barriers to buying asthma medication (MED), seeing a health care provider for asthma (HCP), or any asthma care (AAC). Using SUDAAN, we performed survey-weighted difference-in-differences analyses, adjusting for demographics. Subgroup analyses were stratified by demographics.Results
Our study population included 6445 participants from 25 states plus Puerto Rico. In 2015-2016 compared to 2012-2013, HIC was more common in ME jurisdictions (P < 0.001) but unchanged in non-ME jurisdictions. Adjusted difference-in-differences analyses showed ME was associated with a statistically significant 13.36 percentage-point increase in HIC (standard error = 0.053). Cost barriers to MED, HCP, and AAC did not change significantly for either group in descriptive and difference-in-differences analyses. In subgroup analyses, we noted variation in outcomes by demographics and 2014 ME status.Conclusions
We found ME significantly affected HIC among low-income adults with asthma, but not cost barriers to asthma-related health care. Strategies to reduce cost barriers to asthma care could further improve health care access among low-income adults with asthma in ME jurisdictions.
SUBMITTER: Hsu J
PROVIDER: S-EPMC8842503 | biostudies-literature | 2021 Nov
REPOSITORIES: biostudies-literature
Publications
Medicaid expansion, health insurance coverage, and cost barriers to care among low-income adults with asthma: the Adult Asthma Call-Back Survey.
Hsu Joy J Qin Xiaoting X Mirabelli Maria C MC Dana Flanders W W
The Journal of asthma : official journal of the Association for the Care of Asthma 20200808 11
<h4>Objective</h4>To examine Medicaid expansion (ME) effects on health insurance coverage (HIC) and cost barriers to medical care among people with asthma.<h4>Method</h4>We analyzed 2012-2013 and 2015-2016 data from low-income adults with current asthma aged 18-64 years in the Behavioral Risk Factor Surveillance System Asthma Call-Back Survey (state-level telephone survey). We calculated weighted percentages and 95% confidence intervals from ME and non-ME jurisdictions (according to 2014 ME stat ...[more]
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| S-EPMC6808332 | biostudies-literature
Project description:ImportanceAlthough nearly 1 in 5 persons in the United States has a physical or mental disability, little is known about the association of the Patient Protection and Affordable Care Act (ACA) with health insurance coverage among persons with a disability.ObjectiveTo determine the association of Medicaid expansion with health insurance coverage among persons with a disability.Design, setting, and participantsCross-sectional analysis of adults eligible for Medicaid expansion (aged 26-64 years with incomes up to 138% of the federal poverty level), using a triple-differences (difference-in-difference-in-difference) approach to compare the pre-ACA with post-ACA trend in health insurance rates by disability status between expansion and nonexpansion states using nationally representative, repeated cross-sectional sample data obtained from the American Community Survey in the United States from January 1, 2010, to December 31, 2016. Time was defined as either pre-ACA (January 1, 2010, to December 31, 2013) or post-ACA (January 1, 2014, to December 31, 2016). Treatment status was defined as whether a state implemented Medicaid expansion after January 1, 2014. States that expanded Medicaid between January 1, 2014, to December 31, 2016, were classified as the treatment group, and states that did not expand Medicaid during the study period were classified as the control group. Data were analyzed from December 12, 2018, to May 21, 2019.Main outcomes and measuresSelf-reported health insurance coverage (uninsured, Medicaid, private) and self-reported disability status (≥1 condition limiting activity, including cognitive, ambulatory, self-care, independent living, and sensory difficulties).ResultsOf 2 549 376 Medicaid-eligible adults, 1 348 620 (52.9%) were female; 1 218 602 (47.8%) were non-Hispanic white, 497 128 (19.5%) were non-Hispanic black, 211 598 (8.3%) were Hispanic, and 206 499 (8.1%) were of other race/ethnicity; and 619 498 (24.3%) reported at least 1 disability. The percentage of persons without health insurance was greatest for persons without a disability who lived in a nonexpansion state before the ACA's Medicaid expansion provision went into effect (236 645 of 426 387 [55.5%]), and the smallest proportion of persons without health insurance was reported for persons with a disability living in an expansion state after the ACA went into effect (19 552 of 176 145 [11.1%]). Triple-differences analysis suggested that Medicaid expansion was associated with a decrease in the uninsured rate for both persons with a disability (7.1% - 16.2% = -9.1%) and without a disability (21.2% - 34.9% = -13.7%) and that Medicaid expansion was associated with a 4.6% decrease in the uninsurance rate for persons without a disability and a 2.6% decrease in persons with a disability (P < .001). Although Medicaid expansion was associated with an increase in Medicaid coverage for both persons with a disability (49.3% pre-ACA to 62.3% post-ACA; change, 13.0%) and persons without a disability (21.6% pre-ACA to 40.3% post-ACA; change, 17.7%), the triple difference-estimated Medicaid coverage was -4.7% for persons with a disability and 0.4% for persons without a disability, a difference of 5.1% (P < .001). Medicaid expansion was associated with a 3% higher private insurance rate for persons with a disability than for persons without a disability.Conclusions and relevanceMedicaid expansion appeared to be associated with lower uninsurance rates and higher Medicaid and private insurance coverage for persons with a disability. This study's findings suggest that the reduction in the uninsured rate and gains in Medicaid coverage were greater for persons without a disability than for persons with a disability.
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| S-EPMC8796906 | biostudies-literature
Project description:ObjectiveThis study examined the effect of Medicaid expansion in Oregon on duration of Medicaid enrollment and outpatient care utilization for low-income individuals during the postpartum period.MethodsWe linked Oregon birth certificates, Medicaid enrollment files, and claims to identify postpartum individuals (N = 73,669) who gave birth between 2011 and 2015. We created one pre-Medicaid expansion (2011-2012) and two post-expansion (2014-2015) cohorts (i.e., previously covered and newly covered by Medicaid). We used ordinary least squares and negative binomial regression models to examine changes in postpartum coverage duration and number of outpatient visits within a year of delivery for the post-expansion cohorts compared to the pre-expansion cohort. We examined monthly and overall changes in outpatient utilization during 0-2 months, 3-6 months, and 7-12 months after delivery.ResultsPostpartum coverage duration increased by 3.14 months and 2.78 months for the post-Medicaid expansion previously enrolled and newly enrolled cohorts (p < 0.001), respectively. Overall outpatient care utilization increased by 0.06, 0.19, and 0.34 visits per person for the previously covered cohort and 0.12, 0.13, and 0.26 visits per person for newly covered cohort during 0-2 months, 3-6 months, and 7-12 months, respectively. Monthly change in utilization increased by 0.006 (0-2 months) and 0.004 (3-6 months) visits per person for post-Medicaid previously enrolled cohort and decreased by 0.003 (0-2 months) and 0.02 (7-12 months) visits per person among newly enrolled cohort.ConclusionMedicaid expansion increased insurance coverage duration and outpatient care utilization during postpartum period in Oregon, potentially contributing to reductions in pregnancy-related mortality and morbidities among birthing individuals.
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Project description:Medicaid expansions through the Affordable Care Act began in January 2014, but we have little information about what is happening in rural areas where provider access and patient resources might be more limited. In 2008, Oregon held a lottery for restricted access to its Medicaid program for uninsured low-income adults not otherwise eligible for public coverage. The Oregon Health Insurance Experiment used this opportunity to conduct the first randomized controlled study of a public insurance expansion. This analysis builds off of previous work by comparing rural and urban survey outcomes and adds qualitative interviews with 86 rural study participants for context. We examine health care access and use, personal finances, and self-reported health. While urban and rural populations have unique demographic profiles, rural populations appear to have benefited from Medicaid as much as urban. Qualitative interviews revealed the distinctive challenges still facing low-income uninsured and newly insured rural populations.
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Project description:Virginia expanded Medicaid under the Affordable Care Act beginning in January 2019, which substantially increased income eligibility up to 138% of the federal poverty level (FPL) for both childless adults and parents. In this study, we examined the effects of Virginia's Medicaid expansion in 2019 on health insurance coverage, access to care, and health status by employing a difference-in-differences and a synthetic control design. The study included data on health insurance from the 2016-2020 American Community Survey (ACS) and data on access to care and health status come from the 2016-2020 Behavioral Risk Factors Surveillance System (BRFSS). The samples from ACS and BRFSS were limited to non-elderly adults with income below 138% of the FPL. Separate models were estimated for individuals below 100% of FPL, and those within 100-138% of FPL. The Virginia Medicaid expansion was associated with a 9-11 percentage-point increase in Medicaid coverage rate and a 7-8 percentage-point increase in the insured rate among individuals below 100% FPL, in the first two years of expansion. There was a larger increase in Medicaid coverage among individuals within 100-138% of FPL which also led to a larger increase in the insured rate in 2020. Both income groups showed no changes in private coverage after the expansion in Virginia. We also found a decline in delaying necessary medical visits due to cost for individuals below 100% FPL in 2019 and for individuals within 100-138% FPL in 2020. There was overall no discernable change in health status outcomes. Virginia's 2019 Medicaid expansion substantially increased insurance coverage among poor adults with suggestive early evidence for improved access. The findings highlight the missed opportunity for other states that have not yet decided to expand their Medicaid programs to improve coverage and access among their low-income individuals.
| S-EPMC9134455 | biostudies-literature
Project description:ObjectiveMultiple studies have detailed the relationship between Medicaid expansion under the Affordable Care Act and various health and financial outcomes. However, fewer studies have examined Medicaid expansion's effects on individuals with psychiatric diagnoses. This study sought to determine the relationship between Medicaid expansion and various health and financial outcomes among low-income adults with depression.MethodsThis quasi-experimental study used a random-digit-dial survey of U.S. citizens ages 19-64 with incomes below 138% of the federal poverty level. Surveys were conducted in three southern states (two expansion states, Arkansas and Kentucky, and one nonexpansion state, Texas) between 2013 and 2016. The study sample consisted of those with a positive screen for depression-score of ≥2 on the two-item Patient Health Questionnaire (N=4,853). Survey-weighted difference-in-differences regressions were conducted with insurance status, health care access and utilization, and affordability of care as outcomes of interest. Subgroup analyses stratified the sample on the basis of the respondent's residence in a health professional shortage area (HPSA) in mental health and severity of depression.ResultsMedicaid expansion was associated with a significant reduction in the proportion of adults with depression who lacked health insurance (-23 percentage points, 95% confidence interval=-32 to -14, p<.001). Medicaid expansion was also associated with significant reductions in delaying care and medications because of cost. These changes were similar regardless of residence in a mental health HPSA and severity of depression.ConclusionsMedicaid expansion was associated with improved access to care and medication among persons with depression, even in areas with relative shortages of mental health professionals.
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