The Affordable Care Act (ACA) completed its second open enrollment period in February 2015. Assessing the law's effects has major policy implications.Objective: To estimate national changes in self-reported coverage, access to care, and health during the ACA's first two open enrollment periods, and to assess differences between lowincome adults in states that expanded Medicaid and in states that did not expand Medicaid.Design, Setting, and Participants: Analysis of the 2012-2015 Gallup-Healthways Well-Being Index, a daily national telephone survey. Using multivariable regression to adjust for pre-ACA trends and sociodemographics, we examined changes in outcomes for the nonelderly US adult population aged 18-64 (n= 507,055) since the first open enrollment period began in October 2013. Linear regressions were used to model each outcome as a function of a linear monthly time trend and quarterly indicators. We then compared pre-(January 2012-September 2013) and post-ACA (January 2014-March 2015) changes for adults with incomes below 138% of the poverty level in Medicaid expansion states (n = 48,905 in 28 states and Washington D.C.) versus non-expansion states (n=37,283 in 22 states) using differences-in-differences. Exposure: Beginning of the ACA's first open enrollment period (October 2013).Main Outcomes: Being uninsured, lacking a personal physician, lacking easy access to medicine, inability to afford needed care, self-reported health, and health-related activity limitations.Results: Among the 507,055 adults in this survey, pre-ACA trends were significantly worsening for all outcomes. Compared to the pre-ACA trend, the adjusted uninsured rate decreased 7.9 percentage points (95% CI -9.1, -6.7) by the first quarter of 2015; lacking a personal physician decreased 3.5 percentage points (95% CI -4.8, -2.2); lack of easy access to medicine decreased 2.4 percentage points (95% CI -3.3, -1.5); inability to afford care decreased 5.5 percentage points (95% CI -6.7, -4.2); the proportion reporting "fair" or "poor" health decreased 3.4 percentage points (95% CI -4.6, -2.2); and days with activities limited by health decreased 1.7 percentage points (95% CI -2.4, -0.9). Coverage changes were largest among minorities; for example, the decrease in the uninsured rate was larger among Latino adults (-11.9 percentage points; 95% CI -15.3%, -8.5%) than white adults (-6.1 percentage points; 95% . Medicaid expansion was associated with significant reductions among low-income adults in the uninsured rate (differences-in-differences estimate, -5.2 percentage points; 95% CI -7.9, -2.6), lacking a personal physician, and difficulty accessing medicine. Conclusions:The ACA's first two open enrollment periods were associated with significantly improved trends in self-reported coverage, access to primary care and medications, affordability, and health. Low-income adults in states that expanded Medicaid reported significant gains in insurance coverage and access compared to adults in states that did not expand Medicaid.

Aspirin use was associated with reduced risk of developing HCC and of death due to CLD whereas nonaspirin NSAID use was only associated with reduced risk of death due to CLD.

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The prognosis of endometrial cancer is strongly associated with stage at diagnosis, suggesting that early detection may reduce mortality. Women who are diagnosed with endometrial carcinoma often have a lengthy history of vaginal bleeding, which offers an opportunity for early diagnosis and curative treatment. We performed DNA methylation profiling on population-based endometrial cancers to identify early detection biomarkers and replicated top candidates in two independent studies. We compared DNA methylation values of 1500 probes representing 807 genes in 148 population-based endometrial carcinoma samples and 23 benign endometrial tissues. Markers were replicated in another set of 69 carcinomas and 40 benign tissues profiled on the same platform. Further replication was conducted in The Cancer Genome Atlas and in prospectively collected endometrial brushings from women with and without endometrial carcinomas. We identified 114 CpG sites showing methylation differences with p-values of ≤10−7 between endometrial carcinoma and normal endometrium. Eight genes (ADCYAP1, ASCL2, HS3ST2, HTR1B, MME, NPY, and SOX1) were selected for further replication. Age-adjusted odds ratios for endometrial cancer ranged from 3.44 (95%-CI: 1.33–8.91) for ASCL2 to 18.61 (95%-CI: 5.50–62.97) for HTR1B. An area under the curve (AUC) of 0.93 was achieved for discriminating carcinoma from benign endometrium. Replication in The Cancer Genome Atlas and in endometrial brushings from an independent study confirmed the candidate markers. This study demonstrates that methylation markers may be used to evaluate women with abnormal vaginal bleeding to distinguish women with endometrial carcinoma from the majority of women without malignancy.